44例成人EB病毒性肝炎临床诊疗规律及中医病机初探

[目的] 探讨成人EB病毒性肝炎是具有独特临床表现与诊疗规律的肝炎类型，目前临床诊疗规律及中医研究均较少。[方法] 本研究以2011年1月—2013年1月间北京地坛医院收治的成人EB病毒性肝炎为对象进行回顾性研究。[结果] 总计筛查患者149名，符合纳入标准者44名，平均年龄24.5岁，男女比例23：21，发病时间规律不明显。发热、咽痛、扁桃体肿大、乏力、淋巴结肿大等是最为常见的临床表现。抗EB-IgM是诊断EB病毒感染的最常用病原检查，敏感性高于传统嗜异凝集实验。EB病毒性肝炎的肝损害特征与常见病毒性肝炎相似，均为肝实质炎症损害，但乳酸脱氢酶（LDH）的升高更为突出，同时多伴有轻度胆汁淤积；异形淋巴细胞、淋巴细胞及CD8⁺T细胞升高是主要的血细胞变化特征。肝脾增大，尤其是脾脏增大较为常见（31/44）。支持治疗及保肝治疗是基础治疗，部分患者需要接受抗病毒治疗。多数患者预后良好，部分患者可以出现病毒感染的慢性化及重型化。本组患者痊愈5例，好转37例，未愈1例，恶化1例。该组患者平均病程24 d，平均住院时间15 d。[结论] EBV是值得重视的肝损害病原。本组成人EB病毒性肝炎缺乏季节特征。除肝功能异常外，发热、淋巴结（或扁桃体、脾脏）肿大、淋巴及单核细胞异常升高是常见表现。其中，异形淋巴细胞升高与乳酸脱氢酶（LDH）升高具有特殊提示价值。EB病毒感染的抗病毒治疗适应症、疗程及中远期疗效仍欠明确，重症倾向患者使用抗病毒治疗可能有助于改善预后。EB病毒性肝炎中存在慢性化病例，其长期预后仍不明确。EB病毒性肝炎具有典型的中医温病传变特征，可参照卫气营血传变理论结合现代药理研究开展治疗。中医药在改善消化道症状，加快肝功能的恢复并稳定退热方面显示出一定疗效。EB病毒性肝炎的诊疗规律仍欠清晰，需要未来进一步的研究。

A preliminary explore on clinical regularity and pathogenesis of TCM based on 44 adult EB viral hepatitis patients

[Objective] Epstein-Barr viral (EBV) hepatitis is a type of hepatitis with unique clinical features and developing process.[Methods] This study was a retrospective survey of adult EBV hepatitis patients admitted in Beijing ditan hospital from January 2011 to January 2013.[Results] Total of 149 patients were screened and 44 patients were enrolled. The average age is 24.5 years old, the ratio of male to female is 23:21, and the onset time is not regular. Fever, sore throat, tonsil enlargement, fatigue, and swollen lymph nodes are the most common clinical manifestations. EB-IgM is the most commonly used test for the diagnosis of EBV infection and is more sensitive than traditional heterophilic agglutination experiments. The liver damage characteristics of EB virus hepatitis are similar to those of common viral hepatitis, all of which are inflammation of liver parenchyma, but the increase of LDH is more prominent, and more often accompanied by mild cholestasis. The increasing of atypical lymphocytes, lymphocytes, and CD8+ T cells are major features of blood cell changes. Hepatomegaly and splenomegaly are common, especially splenomegaly (31/44). Supporting and liver-protecting treatment are basic therapy, while some patients need antiviral therapy. Most patients had a good outcome. Five patients were cured, thirty seven patients were improved, one patients was unhealed, and one patients was worsened. Some patients may experience chronic and severe viral infections. The average duration of this group of patients was 24 days and the average length of hospital stay was 15 days. The antiviral treatment group had a heavier condition and a longer hospital stay.[Discussion] EBV is a pathogen of liver damage worthy of more attention. Current EB viral hepatitis lacks seasonal distribution characteristics. Fever, lymphadenopathy (or tonsil enlargement, splenomegaly), abnormal elevation of lymphocytes and monocytes are common clinical manifestations of EBV. The increasing of atypical lymphocyte and lactate dehydrogenase (LDH) have special diagnostic value. Though the antiviral therapy for EBV infection is still controversial, the patients with severe condition should receive the nucleoside antiviral drugs. Though the hepatitis process in most patients with normal immunity is self-limited, there are chronic and severe cases. For the EBV hepatitis has typical TCM epidemiological characteristics, it can be treated on the TCM theories and modern pharmacological research. TCM therapy showed certain effect in alleviating gastrointestinal symptoms, accelerating the recovery of liver function and fever. The disease pattern of EBV hepatitis in adults is still unclear and further research is needed in the future.