河北省儿童医院住院患儿EB病毒感染流行病学特征

目的了解河北省儿童医院住院患儿EB病毒(EBV)感染的流行病学特征,为儿童EBV感染的诊断和预防提供科学依据。方法收集2017年1—12月河北省儿童医院0~14岁EBV感染住院患儿的全血样本,采用酶联免疫吸附试验(ELISA)检测其EBV衣壳抗原(VCA)IgG及IgM抗体,抗早期抗原(EA)IgG抗体和抗核抗原1(NA1)IgG抗体,以检测结果为研究样本的抗体谱。根据4种EBV抗体的检测结果分为现症感染(抗VCA-IgM抗体阳性,抗NA1-IgG抗体阴性、抗VCA-IgG抗体、抗EA-IgG抗体阳性或阴性)、亚急性感染(抗VCA-IgG抗体阳性,抗VCA-IgM抗体、抗NA1-IgG抗体、抗EA-IgG抗体阳性或阴性)、既往感染(抗NA1-IgG抗体阳性,抗VCA-IgG抗体阳性或阴性,其他抗体均为阴性)和未感染(4种抗体均阴性)。按照患儿年龄、检出月份和性别分析各组的阳性率。结果共纳入符合要求的样本4 451例,其中3 257例(73.17%)抗体谱提示EBV感染,包括现症感染380例(8.54%)、亚急性感染616例(13.84%)、既往感染2 261例(50.80%)。不同年龄组原发阳性检出率差异有统计学意义(P<0.05),其中学龄前(>3岁)组的阳性检出率最高(P<0.05);不同检出月份组阳性检出率差异有统计学意义(P<0.05),7月份阳性检出率高于其他月份(P<0.05);男性患儿与女性患儿EBV感染率差异无统计学意义(P>0.05)。380例现症感染患儿的疾病谱以血液系统疾病[传染性单核细胞增多症、急性粒细胞缺乏症、血小板减少性紫癜、EBV相关嗜血细胞综合征]为主,其中传染性单核细胞增多症为临床常见疾病;其次是呼吸系统疾病(急性支气管炎、疱疹性咽峡炎、急性扁桃体炎);其他疾病谱包括神经系统疾病及血流感染、肾病综合征、川崎病。结论河北省儿童医院住院患儿EBV阳性检出率有年龄和检出月份差异,现症感染以血液系统疾病患儿为主,医院应根据流学病学特征制定相应预防措施。

Epidemiological characteristics of EB virus infection in inpatients from Hebei Children's Hospital

Objective To understand the epidemiological characteristics of Epstein-Barr virus(EBV)infection in inpatients from Hebei Children's Hospital,and to provide a reference for the diagnosis and prevention of EBV infection in children.Methods The whole blood samples of children with EBV infection in Hebei Children's Hospital from January to December in 2017 were collected,and anti-viral capsid antigen(VCA)IgG and IgM antibodies,anti-early antigen(EA)antibody and anti-nuclear antigen-1(NA1)IgG antibody were determined by enzyme-linked immunosorbent assay(ELISA).The antibody spectrum was analyzed.According to the determination results of 4 kinds of EBV antibodies,the primary infection group(anti-VCA-IgM positive,anti-NA1-IgG negative,anti-VCA-IgG positive or negative,anti-EA-IgG positive or negative),sub-acute infection group (anti-VCA-IgG positive,anti-VCA-IgM positive or negative,anti-NA1-IgG positive or negative,anti-EA-IgGpositive or negative),previous infection group (anti-NA1-IgG positive,anti-VCA-IgG positive or negative,the rest negative) and uninfected group(all antibodies negative). The positive rate of each group was analyzedaccording to age,season and sex. Results The antibody spectrums of 3 257 (73.17%) of 4 451 samples met theset requirements,indicating EBV infection,of which 380 cases were primary infection(8.54%),616 cases ofsub-acute infection(13.84%) and 2 261 cases of previous infection(50.80%). There was statistical significance inthe primary positive rate among different age groups(P<0.05). The positive rate of pre-school age group(>3 yearsold) was the highest(P<0.05). The positive rates of different months had statistical significance(P<0.05),and the positive rate of EBV in July was higher than those in the other months(P<0.05). There was no statisticalsignificance in the EBV infection rate between females and males(P>0.05). The disease spectrum of 380 casesof primary infection was mainly hematological diseases (infectious mononucleosis,acute agranulocytosis,thrombocytopenic purpura,EBV-associated hemophilia syndrome),of which infectious mononucleosis was acommon clinical disease;followed by respiratory diseases (acute bronchitis,herpes angina,acute tonsillitis);the other diseases included neurological diseases and bloodstream infection,nephrotic syndrome and Kawasakidisease. Conclusions The positive rate of EBV in children in Hebei Children's Hospital varies with ages andmonths. Among the cases of primary infection,the main disease is hematological disease. The hospital should makecorresponding preventive measures according to the epidemiological characteristics.