EB病毒感染43例临床分析

EB病毒原发感染中,多数为传染性单核细胞增生症（IM）,该病毒与非洲儿重Burkitts淋巴瘤、鼻咽癌的发病有密切关系,与恶性组织细胞增多症似有密切关系,为了提高儿童EB病毒感染的诊断及预后,现将43例EB病毒感染患     

儿童EB病毒相关性传染性单核细胞增多症

EB病毒相关性传染性单核细胞增多症(EBV-IM)是EB病毒原发感染后引起的急性单核-巨噬细胞系统增生性疾病.目前此病的发病率有所升高,且重症病例增多,因此特异性细胞免疫的作用机制及新的治疗方法、疫苗的研制日益成为研究热点.     

儿童EB病毒感染的免疫功能状况

目的研究EB病毒(EBV)感染儿童免疫功能状况及其与临床和预后的关系。方法用流式细胞仪(FCM)分别对30例传染性单核细胞增多症(IM)患儿急性期、恢复期外周血淋巴细胞CD3 、CD4 、CD8 、CD19 、CD23 抗原进行检测,并与20例同龄健康对照组儿童比较。结果IM患儿急性期CD4 、CD8 、CD19 、CD23 淋巴细胞百分率分别为(14.88±3.14)%,(65.49±5.33)%,(5.70±2.89)%,(2.41±1.83)%,恢复期为(36.75±3.88)%,(41.64±5.11)%,(15.98±2.80)%,(5.02±2.76)%。急性期CD8 明显高于恢复期和对照组,而CD4 、CD19 、CD23 淋巴细胞明显低于恢复期和对照组。恢复期3例CD23 细胞比值较高。结论EBV感染儿童外周血淋巴细胞亚群明显异常,CD23 细胞的持续增高与CD4 T细胞的长期低下有可能成为评价IM预后的指标。     

儿童EB病毒脑炎24例临床分析

目的　分析儿童EB病毒脑炎的临床特征 ,探讨其早期诊断方法及治疗手段。方法　应用酶联免疫吸附试验(ELISA)检测脑脊液及血清中EBV外壳抗原抗体 (VCA IgM ) ,对 2 4例脑脊液EBVCA IgM阳性患儿的临床特征进行分析。结果　 2 3例为急性发病 ,1例为慢性起病。发热 2 4例 (10 0 % ) ;头痛、呕吐 10例 (42 % ) ;惊厥 10例(42 % ) ;意识障碍 16例 (6 7% ) ,其中昏迷 6例 ;惊厥 10例 ,伴精神症状 2例 ;脊髓炎 2例 ,颅神经损害 3例 ;呼吸衰竭 1例 ,合并传染性单核细胞增多症 1例。脑CT/MRI检查 :15例检查者 13例异常 ;脑脊液EBVCA IgM均阳性 ,血清VCA IgM 15例阳性。经 6个月至 1年随访 ,完全康复 2 1例 ,3例遗留后遗症 :1例左下肢活动障碍 ,2例轻度的智力低下并有癫疒间 发作。结论　EBV脑炎临床表现多样 ,多为急性起病 ,少数呈慢性活动性损害。伴有传染性单核细胞增多症表现者很少见。脑脊液EBVCA IgM阳性为主要确诊依据。大多数患儿预后良好 ,少数病情严重 ,可遗留后遗症。     

儿童EB病毒感染传染性单核细胞增多症T细胞亚群的动态变化

目的研究儿童传染性单核细胞增多症(IM)不同时期外周血T细胞亚群CD3+、CD4+、CD8+细胞的改变及其变化规律。方法在病程不同时期采集30例IM患儿的外周血,肝素抗凝,采用流式细胞术方法分别检测了30例IM患儿急性期、病程1月、病程3月、病程6月及正常对照组外周血淋巴细胞CD3+、CD4+、CD8+细胞表达率。结果1IM急性期CD4+(14.84±5.03%)及CD4/CD8(0.25±0.13%)明显降低,CD3+(82.55±5.49%)、CD8+(66.17±8.10%)明显增高,与其余各组比较均存在显著性差异(P<0.001);2随时间推移及感染的控制CD4+及CD4/CD8细胞逐渐升高,但病程1月(CD4+:27.89±6.04%,CD4/CD8:0.66±0.16%)与病程3月(CD4+:29.49±4.49%,CD4/CD8:0.76±0.20%)比较无显著性差异(P>0.05),与病程6月(CD4+:32.81±6.79%,CD4/CD8:0.93±0.31%)及对照组(CD4+:65.04±6.50%,CD4/CD8:1.18±0.35%)比较,均存在显著性差异(P<0.001);3病程1月CD3+(76.25±8.33%),CD8+(46.35±9.43%)与病程3月CD3+(71.20±5.32%),CD8+(37.76±8.28%)、病程6月CD3+(67.98±8.01%),CD8+(33.96±7.37%)及对照组CD3+(65.04±6.50%),CD8+(30.72±16.51%)比较均存在显著性差异(P<0.001);4实验各组病程3月与病程6月CD3+、CD4+、CD8+及CD4+/CD8+比较均无显著性差异(P>0.05),但3月组与对照组比较均存在显著性差异(P<0.01);5实验各组病程病程6月CD3+、CD4+、CD8+及CD4+/CD8+与对照组比较均无显著性差异(P>0.05)。结论IM急性期CD3+、CD8+明显增高,CD4+及CD4/CD8明显降低,随着时间推移及感染控制,CD3+、CD8+逐渐降低,CD4+及CD4/CD8逐渐增高,6月CD3、CD4、CD8的表达及CD4+/CD8+达正常水平。     

先天性EB病毒感染诊断与治疗:附3例报告

EB病毒(EBV)是由Epstein、Barr于1964年从Burkitt淋巴瘤细胞系中分离到的DNA病毒，主要与传染性单核细胞增多症、鼻咽癌等有关，在成人和儿童研究较多。而有关先天性EBV感染，国外报道不多，国内未见报道。我院新生儿科自2001年9月～2002年9月收治3例，经治疗取得一定效果，现报告如下。     

儿童传染性单核细胞增多症临床特点与发病年龄的关系:附312例分析

目的 探讨儿童传染性单核细胞增多症(IM)的临床特点与发病年龄的关系.方法 312例IM儿童分成0 ～ 3岁、～ 6岁、～ 15岁3组,进行回顾性分析.结果 IM儿童中6岁以下占74.4%,春季和秋季高发.0 ～ 3岁组发热天数平均(7.08 ± 3.31)d,～ 6岁组平均(7.91 ± 3.78)d,～ 15岁组平均(12.38 ± 4.14)d,～ 15岁组与其他组差异有统计学意义(P ＜ 0.01).各年龄组咽峡炎(100%)、淋巴结肿大(82.69%)、肝肿大(66.7%)、脾肿大(62.5%)、鼻塞(42.3%)组之间差异无统计学意义(P ＞ 0.05);眼睑浮肿(36.2%)～ 15岁组明显低于其他组(P ＜ 0.05),皮疹(23.1%)在0 ～ 3岁组多见(P ＜ 0.05).外周血白细胞年幼儿升高明显,异型淋巴细胞年幼儿偏低,血清ALT、AST在年长儿偏高,血清LDH在各年龄组均呈高值,血清嗜异凝集试验年长儿阳性率高.结论儿童IM某些临床特点与发病年龄有关,应予以重视,以提高确诊率.     

儿童传染性单核细胞增多症临床特点与发病年龄的关系(附142例分析)

目的　探讨儿童传染性单核细胞增多症(infectiousmononucleosis ,IM )临床特点与发病年龄的关系。方法　将1 4 2例儿童IM分成0～3岁,>3～6岁,>6～1 5岁3个组,进行回顾性分析。结果　儿童IM 6岁以下儿童占66.9% ,临床表现以发热、咽峡炎、淋巴结肿大、肝脾大为主。年长儿发热时间长,眼睑浮肿和皮疹在年幼儿多见。外周血白细胞年幼儿升高明显,异型淋巴细胞年幼儿偏低,血清ALT、AST值在年长儿偏高,血清LDH值在各年龄组均呈高值。血清嗜异性凝集试验年长儿阳性率高。结论　儿童IM某些临床特点与发病年龄有关,应予以重视,以提高确诊率。     

儿童EB病毒传染性单核细胞增多症临床特征及诊断标准

传染性单核细胞增多症(IM)是儿童原发性EB病毒感染的典型表现。国外的诊断标准不适合我国儿童EB病毒IM的诊断。本文介绍儿童EB病毒IM的临床特征、适合我国儿童EB病毒IM的诊断标准及处理原则。     

EB病毒相关噬血细胞性淋巴组织细胞增生症患儿的EB病毒感染特征

目的 了解儿童EB病毒(EBV)相关噬血细胞性淋巴组织细胞增生症(EBV-HLH)患儿的EBV血清学抗体及病毒复制水平等特征.方法 对67例EBV-HLH患儿和60例原发性EBV感染所致的传染性单核细胞增多症(EBV-IM)患儿的临床资料进行分析,EBV特异性抗体和血清EBV DNA载量分别采用间接免疫荧光法和荧光定量PCR测定.结果 EBV-HLH患儿EBV特异性抗体结果:EBV-CA-IgM、EBV-CA-IgG、EBV-EA-IgG和EBV-NA-IgG的阳性率分别为28.8％、100.0％、51.5％和78.8％,EBV-VCA-IgG高亲和力为78.9％,低亲和力为12.1％;血清学抗体结果显示,71.2％的患儿为EBV再激活感染,其余为急性原发EBV感染;45.5％的EBV-HLH患儿可在血清中检测到EBV DNA,其拷贝数中位数为1.976×103 copies·L-1.EBV-IM患儿的EBV-CA-IgM、EBV-CA-IgG、EBV-EA-IgG和EBV-NA-IgG阳性率分别为100.0％、100.0％、58.3％和26.7％,EBV-VCA-IgG高亲和力为18.3％,低亲和力为81.7％,EBV DNA阳性率为10.0％,DNA拷贝数均值为8.495 copies·1-1.IM患儿均为EBV原发感染状态.结论 EBV-HLH可发生在EBV原发感染或既往EBV感染再激活时期,但多数患儿由既往EBV感染再激活所致.EBV-HLH患儿血清中EBV复制水平显著高于EBV-IM患儿.     

Infectious mononucleosis as a disease of early childhood in Japan caused by primary Epstein-Barr virus infection

The present study investigated 54 pediatric patients with acute Epstein-Barr virus (EBV)-induced infectious mononucleosis (IM) in Japan. Most of the acute cases clustered within the first 5 years of life, and the peak incidence was observed at around 4 years of age. These patients were arbitrarily separated into three age groups (less than 3 years, 3–5 years, and 6–14 years). Fever, pharyngitis, lymphadenopathy and hepatomegaly were detected in more than 80% of all cases. Tonsillitis and splenomegaly were present in about 60% of cases. Skin manifestations and eyelids edema were less often detected in the older age group than in the younger age groups. In addition to an increase of total white blood cell and lymphocyte counts in the peripheral blood, a significant increase in the percentage of CD3⁺ CD8⁺ HLA-DR⁺ T cells was always observed. Epstein-Barr virus seropositivity increased soon after birth and reached approximately 70% around 3 years of age. Close to 100% of the adult controls were EBV seropositive. The results suggest that EBV-induced acute IM is a disease of early childhood in Japan.     

儿童EB病毒感染首发症状及相关疾病谱分析

目的 详细了解儿童EBV感染的首发症状及疾病诊断情况,以提高临床诊断水平,并探讨EBV感染临床多样性的机制。方法 对本院经酶联免疫吸附法(ELISA)测定EBV-VCA-IgM阳性的190例EBV感染患儿的首发症状、疾病诊断及预后进行前瞻回顾性分析。结果 EBV感染患儿起病症状不一,首发症状中以发热多见(66．8％),其他依次为咳嗽(14．2％)、皮疹(7．9％)、淋巴结肿大(5．3％)、眼睑浮肿(3．2％)、咽痛(1．6％)、惊厥(1．6％)、肉眼血尿(0．5％)等。可累及全身各个系统,引起疾病多样,但以呼吸道感染最多见(4|D．5％),其次为传染性单核细胞增多症(17．9％)、川崎病(6．3％)、特发性血小板减少性紫癜(11‘P)(5．8％)、病毒性心肌炎(2．6％)、病毒性脑炎(2．6％)、噬血细胞综合征(1．6％)、类风湿性关节炎(1．0％)、急性淋巴结炎(1．0％)、面神经炎(1．0％)、Evans综合征(0．5％)、系统性红斑狼疮(SLE)(0．5％),亚急性坏死性淋巴结炎(0．5％)等。EBV感染预后不一,1例病人因患噬血细胞综合征而死亡。结论 儿童EBV感染症状多样,累及系统多,临床医生应该综合分析,及早作相应的检查才能作出正确诊断及减少误诊率,并进行合理治疗。     

Systemic type Epstein-Barr virus-related lymphoproliferative diseases in children and young adults: challenges for pediatric hemato-oncologists and infectious disease specialists

Involvement of Epstein-Barr virus (EBV) has long been known in the development of various tumor-forming proliferating diseases, such as nasopharyngeal carcinoma in adults. However, in children and young adults more attention should be focused on systemic, severe type EBV-related diseases, such as fatal infectious mononucleosis, hemophagocytic syndrome, or chronic active EBV infection (CAEBV). These disorders show the typical clinical features of hemophagocytic lymphohistiocytosis (HLH). Although viral infectious diseases are mostly taken care of by infectious disease specialists, pediatric hemato-oncologists need to intervene in the treatment of this kind of disease because of their clonal and neoplastic disease characteristics and of their hematologically problematic, rapid, and life-threatening clinical courses.     

Kawasaki disease with a concomitant primary Epstein-Barr virus infection

A two year old boy exhibited not only clinical manifestations which suggested a recurrence of Kawasaki disease (KD) but also evidence of a primary infection by Epstein-Barr virus (EBV) including tonsillitis, splenomegaly and atypical lymphocytosis in the peripheral blood. An inverted CD4/CD8 ratio in lymphocyte subsets suggested the presence of infectious mononucleosis (IM). Epstein-Barr virus titers (viral capsid antigen-immunoglobulin G 1:20; Epstein-Barr virus-associated nuclear antigen < 1:10) showed an acute EBV infection and the presence of EBV genome in the blood was determined by the polymerase chain reaction technique. In Japan, the peak incidence of KD and IM is in children under 4 years of age. From the investigation of EBV titers, it has been reported that some patients with KD develop an associated, unusual primary EBV infection. Kawasaki disease concurrent with a primary EBV infection as in this case, suggests the possibility of an etiologic agent related to the KD rather than to the EBV infection itself.     

可溶性白细胞介素-2受体检测在儿童EB病毒感染相关疾病中的应用价值

目的探讨可溶性白细胞介素(白介素)-2受体检测在儿童EB病毒(EBV)感染相关疾病鉴别诊断中的应用价值。方法将72例患儿分为IM组、IM转化EBV相关的噬血细胞淋巴组织细胞增生症(EBV-HLH)组和EBV-HLH组;采用酶联免疫吸附试验(ELISA)分别检测患儿血清可溶性白介素-2受体和EBV抗体四项(EBV壳抗原VCA-IgM、VCA-IgG和EBV早期抗原EA-IgG、EBV核抗原-1 EBNA-1-IgG),荧光实时定量PCR检测患儿血浆EBV-DNA的表达,流式细胞术分析淋巴细胞亚群(CD3,CD4,CD8,CD19,CD56)。结果 72例患儿急性期可溶性白介素-2受体水平均超过2 400 U/ml;IM转化组在急性期可溶性白介素-2受体水平仅轻度增高(4 320 U/ml),与IM组(3 310 U/ml)无明显差异,治疗后却明显增高(8 970 U/ml),并接近EBV-HLH组水平(11 230U/ml);EBV抗体四项显示IM转化组和EBV-HLH组在治疗后VCA-IgG和EA-IgG仍然持续高滴度,同时EBV核抗原-1-IgG仍持续阴性;三组急性期都有EBV-DNA拷贝数从低拷贝至高拷贝的病例,治疗后IM转化组和EBV-HLH组仍可检测到EBV-DNA(3×103~4×105copies/ml);IM转化组和EBV-HLH组CD8+细胞在治疗后仍持续较高水平[(61.32±4.63)%,(68.36±4.32)%],并同时出现NK细胞(CD56+)比例下降[(9.23±3.28)%,(10.52.±3.34)%]。结论结合EBV抗体、EBV-DNA和淋巴细胞亚群检测,可溶性白介素-2受体检查有可能成为追踪观察EBV感染相关疾病的指标之一。     

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??Abstract??Objective??To understand the prevalence of Epstein-Barr virus in hospitalized children. Methods??All results of anti-VCA-IgM and anti-VCA-IgG to Epstein-Barr virus detected by ELISA in Chongqing Children’s Hospital from January to December in 2009 were collected. The data was counted using statistical analysis of Chi-Square Test by gender?? age group and season. Results??The total infection rate of Epstein-Barr virus for hoapitalized children under 18 years old was 35.27% in 2009 and the recent infection rate was 12.66%.The accumulation infection rate gradually increased with ages?? and nearly half of children had been infected by Epstein-Barr virus in pre-school age group. The period from 3 to 5 years old was the peak age of infection. The accumulation rate among 0??3 months?? 3??6 months?? 6??12 months?? 1??2 years?? 3??5 years?? 6??12 years and 13??18 years old was 27.70%?? 10.48%?? 14.13%?? 27.69%?? 44.61%?? 51.99% and 57.34%?? respectively. And the recent infection rate was 1.15%?? 1.25%?? 2.52%?? 12.55%?? 22.21%?? 18.55% and 20.3%?? respectively. The recent infection rates in March?? September and October were higher than those of others in 2009?? and the difference was statistically significant ??P < 0.05??. Except the 1??2 years group ??P < 0.05???? there was no difference in other age groups about the cumulative and the recent infection rate by gender ??P > 0.05??. Conclusion??1. The infection rate of Epstein-Barr virus for childen is lower than that reported before in China. Nearly half of children have been infected by Epstein-Barr virus in pre-school age group?? the peak period of infection being 3??5 years old.2. There is no gender difference of cumulative and recent infection rate in Chongqing in 2009?? the infection rate in March and September-October were higher than those of others.     

Epstein-Barr Virus Infection and Serological Profile in Greenland Eskimo Children

ABSTRACT. The Epstein-Barr virus (EBV)-specific antibody profile of 101 Greenland Eskimo children was determined. The proportion of children with serological evidence of recent or past primary EBV infections rose from 22 % at 6 months of age to 79 % at 24 months of age. All but 2 of 49 children more than 4 years of age proved seropositive. The geometric mean titre (GMT) of antibodies to the viral capsid antigen (VCA) was highest during the first 3 years of life and declined sharply to a lower, nearly constant level in older children. The GMT of antibodies to the nuclear antigen (EBNA), rose slowly during the first 4 years of life to its persistent level. None of the children had a history of illnesses comparable to infectious mononucleosis. The results have shown that in this population with an enhanced risk of nasopharyngeal carcinoma, primary EBV infection occurs at a very early age.     

乌鲁木齐地区住院呼吸道感染患儿EB病毒感染的调查

目的探讨乌鲁木齐地区住院呼吸道感染患儿EB病毒(Epstein-Barr virus,EBV)感染率和临床特征。方法采用酶联免疫吸附试验法(ELISA),对2010年1月至12月收治住院的呼吸道感染患儿887例,进行血清EBV IgM抗体测定,调查EBV感染率;同时进行血清支原体、衣原体、腺病毒及合胞病毒IgM抗体检测;并对EBV感染的季节,感染患儿的性别、年龄、民族及临床表现进行分析。结果 2010年乌鲁木齐地区住院呼吸道感染患儿中,EBV感染率为33.48%(297/887);EBV IgM抗体全年都有检出,冬春季为高峰期;EBV感染以≤7岁患儿为主;EBV感染在性别及民族间差异均无统计学意义(P均>0.05)。EBV合并支原体感染为14.48%(43/297),合并腺病毒感染为10.77%(32/297),合并合胞病毒感染为9.43%(28/297),合并衣原体感染为2.69%(8/297)。患儿感染EBV后多以发热为主。结论 EBV感染是乌鲁木齐地区住院呼吸道感染患儿的重要致病病原之一,及时针对EBV感染作相应的实验室检查,明确病原诊断,及时治疗,可以缩短病程,提高治愈率。