儿童EBV和CMV不同模式感染相关单核细胞增多症的临床和实验室检查特征分析

目的 探讨儿童感染EB病毒（EBV）或（和）巨细胞病毒（CMV）后所致的传染性单核细胞增多症（IM）的临床特征和实验室指标的差异。方法 回顾性分析2018年1月—2023年1月入本院治疗的109例IM患儿资料,根据感染病原体的不同分为EBV感染组（38例）、CMV感染组（25例）、混合感染组（46例）。分析不同感染组IM患儿的一般特点、临床表现和实验室检查结果。结果 共计收集109例IM患儿,男61例,女48例,男女比例为1.27〖DK〗∶1,平均年龄为（4.66±2.68）岁,2~6岁儿童发病较多,约占73.4%。IM患儿一年四季均有患病,其中冬春季患病人数相对较多,占总人数的58.7%。患儿临床表现多样,其中以发热（86.2%）、淋巴结肿大（78.0%）、咽峡炎（75.2%）、肝脏肿大（48.6%）、咳嗽（47.7%）最常见。其中CMV感染组淋巴结肿大、咽峡炎的发生率显著低于其他两组（P＜0.05)。混合感染组WBC计数、LY%、AL%异常率高于其他两组,LDH、ALT、AST结果异常的发生率在混合感染组更为显著（P＜0.05）。结论 IM儿童CMV和EBV混合感染较为常见,其临床表现更像EBV感染,而实验室检查结果则比单一感染EBV、CMV更为严重,需更加重视     

输血后HBV、EBV、CMV感染的系列研究——Ⅰ.输血传播HBV的定群研究

用固相放射免疫法(spRIA)对150名住院受血患者进行了为期6个月输血后HBV感染的追踪观察.发现用反向间接血凝法(RPHA)检测供血员HB_sAg所致受血者HBV感染为29.33%,如果采用spRIA检测供血员HB_sAg及抗-HB_c(滴度≥1:100),可使受血者HBV感染率(11.71%)显著下降,但仍高于健康对照者(4.67%).作者提出在使用更为敏感的供血员筛检方法的同时也应重视HBV的医院内感染     

CMV与EBV感染引发重型肝炎3例报告

目的：对由于巨细胞病毒（CMV）及埃巴病毒（EBV）感染引发的重型肝炎进行临床探讨，方法：回顾性分析了太原市传染病医院2002年3月至2002年8月收治的3例该病患者。结果讨论；临床上由于单纯CMV，EBV感染引发重型肝炎较少见，故应引起同行重视，以免误诊而延误治疗。     

血液病患者输血相关的巨细胞病毒感染

用间接免疫荧光法和间接酶联免疫吸附实验检测血清巨细胞病毒(CMV)特异性抗体,研究84例血液病患者输血相关的CMV 感染。输血后活动性CMV 感染率为38.10%。感染类型主要为再感染和潜伏感染再活动,原发性感染极少见。输血量、输血次数和供血者CMV 感染状态与受血者CMV 感染密切相关。通过临床观察发现CMV 感染患者骨髓象的     

小儿呼吸道疾病CVB、CMV和EBV感染状态的研究

目的：探讨柯萨奇病毒B组（CVB）、巨细胞病毒（CMV）、EB病毒（EBV）在小儿呼吸道感染性疾病中的感染状态及其检测的临床意义。方法：290例患儿,男158例,女132例,年龄6个月－12岁。以ELISA法检测CVB抗原（CVB－Ag) IgM抗体（CVB－IgM),CMV-IgM,EBV-IgM。结果（1）病毒感染率,上呼吸道感染（上感）、支气管炎、肺炎CVB感染率均明显高于同期住院的非感染组（P＜0．01）;肺炎组CMV阳性率高于上感和非感染组（P＜0．05）。各组CVB感染明显高于CMV和EBV的感染率（P＜0．01）。（2）3种病毒交叉感染率;上感、支气管炎和肺炎存在交叉病毒阳性情况,以CVB合并其他病毒感染多见。肺炎患儿交叉病毒感染率高于上感（P＜0．05）。（3）肺炎病毒感染状态与临床病程的关系。单纯CVB感染性肺炎的病程较全部志物阴性的肺炎患儿长（P＜0．01）,但较合并多种标志物阳性的肺炎短（P＜0．01）。多种病毒阳性的肺炎,其年龄相对较小,发热时间和病程均较单纯CXVB感染的肺炎长,结论：CVB感染在小儿呼吸道感染性疾病中最常见。要注意多种病毒阳性的肺炎。     

肾移植受者活动性CMV感染的发生状况

目的明确肾移植患者术前CMV感染的发生率和术后活动性CMV感染的发生规律.方法检测27例健康成人、以及我院2002年3月至2003年6月138例尿毒症患者肾移植前血清抗CMV抗体(抗CMV-IgG、CMV-IgM);观察肾移植后CMV-pp65抗原血症的动态变化.结果27例健康成人血清抗CMV-IgM均为阴性、抗CMV-IgG的阳性率为70.4%、外周血CMV-pp65( )白细胞数为0～4个/5×10 4 WBC;尿毒症患者术前CMV-IgG、CMV-IgM阳性率分别为93.5%、7.1%,肾移植后外周血CMV-pp65( )白细胞数为0～2 280个/5×10 4 WBC(其中＞5者占87.0%)、其高峰期在术后第6～8周.结论肾移植受者术前CMV感染发生率明显高于健康人群,且至少有7.1%存在着活动性CMV感染;肾移植患者术后6个月内,活动性CMV感染发生率高达86.96%;术后第6～8周是活动性CMV感染最严重的时期.     

云南省部分HIV感染者唾液EBV检出率分析

目的探讨HIV感染者唾液EB病毒存在情况及其与免疫抑制的关系.方法采用横断面研究,利用巢氏PCR方法对245例HIV感染者和30例健康对照者唾液EBV DNA的存在情况进行检测,并分析检出率与CD4淋巴细胞计数的关系.结果 HIV感染者和健康对照人群唾液EBV检出率分别为82.0%与30.0%,二者有统计学差异(P<0.05);CD4淋巴细胞计数小于200、200～400和大于400个/μL的患者唾液EBV检出率分别为93.0%、75.8%和45.7%,3组间检出率有显著差异(P<0.05);但是否使用高效抗逆转录病毒治疗对唾液EBV的检出率无明显影响.结论 HIV感染者唾液中EB病毒检出率高,与免疫指标CD4淋巴细胞计数水平有关.     

全血EBV DNA载量检测在儿童EB病毒感染中的应用价值

目的：评价全血EBV DNA载量检测在儿童EB病毒（EBV）感染中的应用价值。方法将231例EBV活动感染儿童（原发感染174例,复发感染57例）、258例非活动EBV感染儿童（EBV既往感染）、45例无EBV感染健康儿童采用自动核酸提取实时荧光定量PCR法检测全血EBV DNA载量,探讨其与EBV感染的关系。结果 EBV活动性感染组全血EBV DNA阳性率81.8%,全血EBV DNA载量为（3.99±0.96）lg Copies/ml。EBV原发感染组与复发感染组的全血EBV DNA阳性率差异无统计学意义（字2＝0.419,P=0.517）,EBV DNA载量差异无统计学意义（t=1.236,P=0.221）。非活动EBV感染儿童组全血EBV DNA阳性率10.9%,全血EBV DNA载量为（2.89±0.20）lg Copies/ml。EBV活动性感染组与非活动性感染组的全血EBV DNA阳性率差异有统计学意义（字2＝251.600,P=0.0001）,全血EBV DNA载量差异有统计学意义（t=3.389,P=0.001）。非EBV感染组全血EBV DNA阳性率0。EBV原发感染组中,全血EBV DNA阳性率（82.7%）高于EBV- CA IgM阳性率（75.8%）,差异有统计学意义（字2＝6.160,P=0.008）,两者结果一致性不佳（Kappa=0.687）。以全血EBV DNA载量检测阳性作为诊断依据,敏感度75.9%,特异度91.2%,诊断符合率84.4%;在全血E-BV DNA载量为3.00lgCopies/ml时,是判断儿童EBV活动性感染的最佳临界点,敏感度70.1%,特异度95.3%,诊断符合率83.4%。结论全血EBV DNA载量是监测EBV活动性感染的独立指标,在儿童EBV感染诊断、疗效观察和愈后评估中的具有重要意义。     

贫困山区孕期CMV感染与IL—6的关系

目的 研究贫困山区孕期巨细胞病毒（Cytomegalovirus,CMV)感染状况，探讨孕期CMV感染与白细胞介素6（Inter leukin-6,IL-6)的关系。方法 用ELISA和PCR方法检测贫困山区305例正常孕妇外周血特异性CMV IgM抗体及CMV DNA，对其中48例孕期CMV感染者及68例孕期未感染CMV者进行随访，检测产后两周内乳汁及新生儿尿液CMV DNA；并采用双抗体夹心ELISA法检测孕妇及乳母外周血中IL－6水平。结果 孕妇CMV活动性感染率19．02％，孕期CMV活动性感染及乳汁排泄CMV者其外周血IL－6水平显著高于未感染者（P＜0．05）。结论 贫困山区孕期CMV感染率较国内外报道的高；IL－6在孕期活动性CMV感染中可能起着重要作用。     

CMV—IgM动态检测预测造血干细胞移植术后CMV感染研究

目的探讨白血病患者异基因造血干细胞移植（Allo-HSCT）术后巨细胞病毒（CMV）IgM抗体滴度的动态变化与CMV感染进展的关系。方法采用单克隆抗体免疫荧光测定法和微粒子酶免分析法对86例接受Allo-HSCT的白血病患者,在术后50d内每周检测1次,50-270d每2周检测1次CMV-Ag和CMV-IgM,同时观察有无CMV病症状出现,并分析CMV—Ag阳性细胞数和CMV—IgM滴度变化与CMV感染进展的关系。结果86倒患者在移植后270d内共有57例患者发生过活动性感染。这57例患者CMV—Ag首次检出阳性时,其中只有5例患者CMV-IgM出现阳性,而且CMV-IgM首次出现阳性的平均检出时间为121．6d,明显迟于CMV-Ag的平均46．7d（P〈0．05）;在CMV活动性感染的中后期,由于受到抗病毒治疗的干预,CMV-Ag的平均阳性细胞数并不和CMV—IgM滴度呈相同的趋势性改变。两者之间不存在相关性（γ=0．146,P〉0．05）;8例患者从无症状感染进展到CMV病时,CMV—IgM滴度呈进行性升高,其中4例患者感染得到控制后,滴度逐渐下降。当CMV-IgM滴度在10以下,CMV病尚能控制,若滴度均超过10以上,大部分患者会发生死亡。结论CMV—IgM动态定量检测对预测Allo-HSCT后中后期CMV活动性感染进展及其预后有一定的临床指导意义。     

Epstein-Barr virus antibodies and risk of multiple sclerosis: a prospective study.

CONTEXT: Epidemiological studies suggest an association between infection with Epstein-Barr virus (EBV) and risk of multiple sclerosis (MS). OBJECTIVE: To determine whether elevation in serum antibody titers to EBV viral capsid antigen (VCA), nuclear antigens (EBNA, EBNA-1, and EBNA-2), and diffuse and restricted early antigen (EA-D and EA-R) as well as to cytomegalovirus (CMV) precede the occurrence of MS. DESIGN, SETTING, AND SUBJECTS: Prospective, nested case-control study. Of 62 439 women participating in the Nurses' Health Study (aged 30-55 years in 1976) and Nurses' Health Study II (aged 25-42 years in 1989) who gave blood samples in 1989-1990 and 1996-1999, respectively, and were followed up through 1999, 144 women with definite or probable MS and 288 healthy age-matched controls were included in the analysis. MAIN OUTCOME MEASURE: Serum antibody titers to the specific EBV and CMV antigens, compared between cases and controls. RESULTS: We documented 18 cases of MS with blood collected before disease onset. Compared with their matched controls, these women had higher serum geometric mean titers (GMTs) of antibodies to EBV but not CMV. Elevations were significant for antibodies to EBNA-1 (GMT, 515 vs 203; P =.03), EBNA-2 (GMT, 91 vs 40; P =.01), and EA-D (15.9 vs 5.9; P =.04). The strongest association was found for antibodies to EBNA-2; a 4-fold difference in titers was associated with a relative risk (RR) of MS of 3.9 (95% confidence interval [CI], 1.1-13.7). The corresponding RRs were 1.6 (95% CI, 0.7-3.7) for VCA, 2.5 (95% CI, 1.0-6.3) for EBNA, 1.8 (95% CI, 1.0-3.1) for EA-D, and 1.0 (95% CI, 0.6-1.7) for CMV. Significant but generally weaker elevations in anti-EBV antibodies were also found in analyses of 126 cases of MS with blood collected after disease onset and their matched controls. CONCLUSIONS: Our results support a role of EBV in the etiology of MS.     

术前巨细胞病毒感染对肾移植的影响

目的探讨术前巨细胞病毒(cytomegalovirus infection,CMV)感染对肾移植术后急性排斥反应(acute rejection,AR)的影响及术前预防性抗病毒治疗的意义.方法回顾性分析了116例肾移植受体的术前CMV感染和预防性抗病毒治疗情况,根据术前有无CMV感染分为感染组和非感染组,将CMV感染组肾移植受体根据有无预防性抗病毒治疗分为治疗组和非治疗组.同时检测35例正常健康者CMV结果.采用检测CMV-PP65抗原诊断CMV感染.结果术前CMV感染率肾移植受体为63.8%(74/116)高于正常健康者14.3%(5/35).术后发生CMV感染或CMV病非治疗组为5例(15.6%)高于治疗组1例(2.4%).发生急性排斥反应的术前CMV感染组为14例(18.9%)高于非感染组2例(4.8%).术后发生AR治疗组为4例(9.5%)低于非治疗组10例(31.3%).结论肾移植受体术前CMV感染发生率高于正常健康人群.预防性抗病毒治疗可以降低术后CMV感染或CMV病的发生率.术前CMV感染的肾移植受体术后AR发生率高于非感染者.对术前CMV感染患者采取预防性抗病毒治疗可以降低术后AR的发生率.     

肾移植受者并发巨细胞病毒感染的临床实验研究

目的 :探讨肾移植受者并发巨细胞病毒 (Cytomegalovirus ,CMV)感染后实验指标的变化及各指标的相关性 ,为诊断CMV感染及预防CMV病发作提供依据。方法 :运用Real TimePCR及流式细胞分析法等技术对肾移植受者的标本进行检测。结果 :(1)肾移植术后 14周内 ,尿液、血浆及白细胞中CMV DNA阳性检出率分别为 73 5 %、79 4 %及85 3% ;肾移植术后 18周内 ,尿液、血浆及白细胞中CMV DNA阳性检出率分别为 82 1%、85 7%及 85 7% ;(2 )肾移植术后 8周内 ,血浆及白细胞中CMV DNA的载量随术后时间的延长而增加 ;尿液中CMV DNA的载量在术后 12周内随时间的延长而波动性增加 ;(3)尿液、血浆及白细胞内CMV DNA检出率的峰值分别出现在肾移植术后第 12周、第 8周内及第 8周时 ;(4 )肾移植术后第 8周时 ,尿液中CMV DNA载量与CD3 T淋巴细胞 (P =0 0 0 2 0 )、CD4 T淋巴细胞 (P=0 0 0 19)、CD5 6 T淋巴细胞 (P =0 0 2 35 )及血清肌酐 (P =0 0 2 5 3)的相关性具有统计学意义 ,而与CD8 T淋巴细胞、丙氨酸转移酶、谷草转氨酶、血清尿素氮等的相关性无统计学意义 (P >0 0 5 ) ;血浆及白细胞中CMV DNA载量均只与丙氨酸转移酶的相关性有统计学意义 (P <0 0 0 1) ;结论 :(1)Real TimePCR是监测肾移植受者CMV感染进程的     

输血后丙型肝炎感染及影响因素的研究

采用回顾性定群研究方法，对济南市１１９例输血后丙型肝炎感染情况进行了调查。结果表明，１１９例受血者中，抗－ＨＣＶ阳性３１例，阳性率为２６．１％，其中１４例为临床丙型肝炎患者，罹患率为１１．７％。输入经筛检血液的受血者中，ＨＣＶ感染率和丙肝罹患率分别为１４．６％和４．２％，输入未经筛检血液者分别为３３．８％和１６．９％，差异有显著性（Ｐ＜０．０５，ＲＲ＝２．３０ＲＲ＝４．０２）。对输血量，输血次数及住院天数双向筛选法多元线性逐步回归分析表明，输血量是影响受血者感染ＨＣＶ的主要因素。     

Rapid Internal Control Reference Recombinase-Aided Amplification Assays for EBV and CMV Detection

Epstein-Barr virus (EBV) and cytomegalovirus (CMV), two of the most prevalent human herpesviruses, cause a wide spectrum of diseases and symptoms and are associated with serious health problem. In this study, we developed an internal control reference recombinase-aided amplification?(ICR-RAA)?assay?for?the?rapid?detection of EBV and CMV within 30 min. The assay had a sensitivity of 5 and 1 copies/test for EBV and CMV, respectively, with no cross reaction with other pathogens. In comparison with those of the commercial quantitative polymerase chain reaction (qPCR), the sensitivity of the EBV and CMV ICR-RAAs using extracted DNA was 93.33％? and 84.84％, respectively; the specificity was 98.75％? and 100.00％, respectively;?and the Kappa values were 0.930 and 0.892 (P? < 0.05), respectively. In comparison?with?those?of?qPCR,?the?sensitivity?of?the EBV and CMV ICR-RAAs using the DNA by thermal lysis was 72.22％? and 80.00％, respectively; the specificity was 100.00％;?and the Kappa values were 0.764?and?0.878?(P?相似文献   

肾移植受者外周血白细胞CMV抗原阳性细胞数及意义

【目的】探讨肾移植受者外周血白细胞巨细胞病毒(CMV)PP-65抗原阳性细胞数的变化及意义。【方法】用免疫细胞化学法检测外周血白细胞CMV-PP65抗原,术后头3个月每周1次。【结果】273例肾移植受者中124例术后检出CMV-PP65抗原阳性,初次检出CMV-PP65抗原的平均时间为(24.1±11.3)d,每5万白细胞中CMV抗原阳性细胞数均值为7.1±5.8,其中5例CMV抗原阳性细胞数超过10/5万白细胞。无症状性和症状性CMV感染受者初次检出CMV抗原阳性细胞数分别为(6.7±5.6)/5万白细胞、(10.1±9.3)/5万白细胞(P>0.05);峰值水平为(8.1±4.2)/5万白细胞、(26.3±5.7)/5万白细胞(P<0.05);分别有17例(15%)、12例(100%)患者其峰值超过10/5万白细胞(P<0.05)。抗病毒治疗中90例(72.6%)患者CMV抗原阳性细胞数进一步升高。【结论】肾移植受者在CMV感染早期病毒复制能力强,CMV抗原阳性细胞数峰值有助于预测症状性CMV感染。     

造血干细胞移植受者免疫抑制治疗 与巨细胞病毒感染的关系

目的：探讨异基因造血干细胞移植(HSCT)术后免疫抑制治疗个体外周血中巨细胞病毒(CMV)脱氧核糖核酸( DNA)与免疫抑制剂环孢素A(CsA)血药浓度变化的关系,并评价其潜在的临床应用价值。方法：选择行异基因HSCT的32例患者进行回顾性分析。移植前采用更昔洛韦预防CMV感染。移植后应用核酸扩增(PCR)荧光检测法定期进行CMV DNA监测。根据CMV DNA检测结果将患者分为CMV DNA阴性组和CMV DNA阳性组。用酶放大免疫技术（EMIT）定期监测CsA血药浓度,分析CMV DNA与CsA血药浓度的关系。结果：异基因造血干细胞患者CMV感染率为53.13%(17/32);DNA阳性组的CsA血药浓度明显高于CMV DNA阴性组（P＜0.05）;通过ROC曲线得出异基因干细胞移植患者使用CsA药物第7,14,21天时曲线下面积与0.5比较,差异具有统计学意义（P＜0.05）,分别对应的血药浓度为203.15, 215.55和302.65 ng/mL。结论：免疫抑制药物浓度可影响CMV DNA的动态变化,CsA血药浓度偏高可能是导致造血干细胞移植受者移植后对CMV易感的原因之一,适时监测CsA血药浓度对指导临床用药有一定的辅助价值。     

Hemorrhagic cystitis following hematopoietic stem cell transplantation: incidence, risk factors and association with CMV reactivation and graft-versus-host disease

Background The definite pathogenesis of hemorrhagic cystitis (HC) after allogenic hematopoietic stem cell transplantation (allo-HSCT) has not been well elucidated. The role of cytomegalovirus (CMV) reactivation and graft-versus-host disease (GVHD) in the development of HC remains obscure. This study determined the incidence and risk factors for HC after allo-HSCT and analyzed its association with CMV reactivation and GVHD.Methods We retrospectively studied 250 patients at high risk for CMV disease who underwent allo-HSCT all based on busulfan/cyclophosphamide (BU/CY) myloablative regimens. The incidence, etiology, risk factors and clinical management of HC were investigated. Results HC developed within 180 days of transplant in 72 patients, with an overall incidence of 28.8% and an incidence of 12.6% in patients with HLA-matched related donors (MRD), 34.38% in those with HLA-matched unrelated donors (MUD), 49.45% in those with mismatched related donors (MMRD). CMV-viremia significantly increased the incidence of later onset HC (LOHC); however, only 9 out of 15 patients with CMV viruria actually developed LOHC. Multiple regression analysis identified grade II–IV acute GVHD (RR=2.75; 95% CI 1.63–4.66; P&lt;0.01) and grafts from MUD or MMRD (RR=2.60; 95% CI 1.52–5.20; P&lt;0.01) as independent risk factors for HC. Event sequence analysis indicated a majority of HC episodes began around GVHD initiation.Conclusions CMV-viremia is a high risk factor for LOHC. Our data also showed a correlation between acute GVHD and HC, which suggested that alloimmunity may be involved in the pathogenesis of HC.     

Rapid loss of both CD4+ and CD8+ T lymphocyte subsets during the acute phase of severe acute respiratory syndrome

Objective To study the alteration of peripheral lymphocyte subsets in severe acute respiratory syndrome (SARS) patients and to help improve the early diagnosis of the disease. Methods Anti-coagulating blood samples from 98 SARS patients in the acute phase, 56 normal healthy blood donors, and from patients infected by HIV, CMV and EBV were collected. The T lymphocyte subsets were counted by flow cytometry using fluorescence-labeled specific monoclonal antibodies. Results A significant decrease was observed in all SARS patients in their peripheral CD4+ and CD8+ T lymphocyte absolute counts ［256(104)×10(6)/L and 256 （117）×10(6)/L, respectively］, which were also lower than those of the patients infected with HIV, CMV and EBV. All patients infected with HIV, CMV and EBV had significantly higher CD8+ T lymphocyte counts in comparison with normal controls. Conclusions Decrease of both CD4+ and CD8+ T lymphocytes of patients is related to onset of SARS. T lymphocyte subset analysis would help improve the early diagnosis of the disease.     

CYTOMEGALOVIRUS AND EPSTEIN-BARR VIRUS INFECTION IN RENAL TRANSPLANT RECIPIENTS

23 renal transplant recipients were fot.rnd to be sensitive to CMV and EBV infection. The infection began early after transplantation, with increase of the titer of antibody to CMV. The peak infection with CMV occurred in 8-12 weeks in most cases, while EBV infection occurred mainly in the 3rd month.