儿童非肿瘤性EB病毒感染相关疾病的血清学和免疫学特征分析

目的 了解非肿瘤性EB病毒(Epstein-Barr virus,EBV)感染患儿不同临床类型的EBV抗体、EBV-DNA水平及免疫功能的变化特点,为EBV感染防治提供依据.方法 回顾性分析第四军医大学西京医院住院的资料完整的103例EBV感染患儿的临床资料,按临床疾病类型分为3组:传染性单核细胞增多症(infectious mononualeosis,IM)组68例;慢性活动性EBV感染(chronic active Epstein-Barr virus infection,CAEBV)组13例;EBV相关噬血细胞性淋巴组织细胞增多症(Epstein-Barr virus-related hemophagocytic lymphohistiocytosis,EBV-HLH)组22例.检测并比较各组的EBV抗体、EBV-DNA、免疫球蛋白水平、淋巴细胞亚群及补体系列的变化.选择同期正常儿童26例为对照组,检测其免疫球蛋白水平、淋巴细胞亚群及补体系列,并与其余3组比较.结果 (1)CAEBV组、EBV-HLH组的C3、C4水平明显低于其余2组(P均<0.05);EBV-HLH组、CAEBV组、IM 组及对照组的IgA、IgG、IgE水平均逐渐升高,EBV-HLH组、CAEBV组均低于对照组,差异均有统计学意义(P均<0.05),IM组略低于对照组,但差异无统计学意义(P>0.05).(2)IM组CD8+T细胞较其余3组显著升高,差异均有统计学意义(P均<0.05);EBV-HLH组的总T细胞、CD4+、CD8+、CD4+/ CD8+、NK及B细胞比其余3组均显著下降(P均<0.05).(3)IM组及CAEBV组各项EBV抗体阳性率均高于EBV-HLH(P均<0.05);EBV-HLH组的EBV-DNA水平均高于IM组及CAEBV组,差异均有统计学意义(P均<0.05).结论 血清中的EBV-DNA水平与疾病种类及严重程度呈正相关;EBV感染导致的IM、CAEBV 及EBV-HLH 3种疾病发病机制均与免疫功能紊乱有关;动态监测EBV载量和细胞免疫功能可反映疾病状态和进展的风险.

Characteristics study of serology and immunology of non-malignant diseases associated with Epstein-Barr virus infection in children

Objective To study the characteristics of immune function,Epstein-Barr virus(EBV) antibodies and EBV-DNA in children with different clinical types of EBV infection,which provide basis for prevention and treatment of EBV infection.Methods Clinical data of 103 patients suffering from EBV infection were retrospectively analyzed in Xijing Hospital of the Fourth Military Medical University.A total of 103 children were divided into infectious mononualeosis(IM) group(n=68),chronic active Epstein-Barr virus infection(CAEBV) group(n=13) and Epstein-Barr virus-related hemophagocytic lymphohistiocytosis(EBV-HLH) group(n=22).The changes of EBV antibodies,EBV-DNA,immunoglobulin levels,lymphocyte subpopulation and complement series were detected and compared among the three groups.A total of 26 healthy children at the same stage were enrolled as a control group,immunoglobulin levels,lymphocyte subpopulation and complement series were detected in control group,then compared with the rest of the three groups.Results The levels of C3 and C4 in CAEBV group and EBV-HLH group were significantly decreased than those in the control group(P<0.05).The levels of IgA,IgG and IgE in EBV-HLH group,CAEBV group,IM group and control group gradually increased(P<0.05,respectively).The levels of IgA,IgG and IgE in EBV-HLH group and CAEBV group significantly decreased than those in control group(P<0.05,respectively).The levels of IgA,IgG and IgE in IM group decreased than those in control group,while there were no statistically significant differences(P>0.05).CD8+T cells in IM group significantly increased than those in the rest of the three groups(P<0.05,respectively).T cells,CD8+T cells,CD4+ T cells,CD4+/CD8+ ratios,NK cells,B cells of EBV-HLH group significantly decreased than those in the rest of the three groups(P<0.05).The positive rates of EBV antibodies in CAEBV group and IM group were significantly higher than those in EBV-HLH group(P<0.05).EBV-DNA in EBV-HLH group were significantly higher than those of CAEBV group and IM group(P<0.05).Conclusion EBV-DNA levels in the serum are positively correlated with disease types and severity,the pathogenesis of IM,CAEBV and EBV-HLH induced by EBV infection are associated with immune dysfunction.Dynamic monitoring of EBV load and cell immune function can reflect disease status and progress risk.