慢性活动性EB病毒感染15例临床分析

目的分析慢性活动性EB病毒感染病例的临床特征,以指导临床诊治。方法 回顾性分析15例慢性活动性EB病毒感染患者的临床资料、实验室检查、治疗及随访结果。结果慢性活动性EB病毒感染常见临床表现为发热、肝脾肿大、淋巴结肿大,其他还有咳嗽、咯痰、皮疹、乏力、黄疸、鼻塞、流涕、咽痛、胸闷等症状。实验室检查异常最多见的是转氨酶升高,部分伴有胆红素升高,血液系统主要为全系或二系血细胞减少及淋巴细胞比例升高,包括贫血、白细胞降低、血小板减少,血清乳酸脱氢酶、铁蛋白升高多见,且危重者明显升高;所有患者均有抗EB病毒衣壳抗原IgG(EBVCA-IgG)抗体的升高,而其IgM抗体均为阴性,14例患者检测了早期抗原EBEA-IgG抗体和核抗原EBNA-IgG抗体,EBEA-IgG抗体阳性12例,而EBNA-IgG抗体阳性10例;实时定量聚合酶链反应检测外周血EBVDNA均为阳性,病毒载量(中位数)为4.3×10⁶copies/ml。15例患者中失访1例;死亡8例,死亡原因分别为噬血细胞综合征3例、间质性肺炎3例、肝衰竭1例、心功能衰竭1例;余6例仍随访中。结论慢性活动性EB病毒感染临床表现多样,预后差,病死率高,临床上遇到发热原因不明、肝脾或淋巴结肿大的病例应及时行EBV—DNA和EB相关抗体检测以尽早确诊。

Clinical characteristics of 15 cases with chronic active Epstein-Barr virus infection

Objective To investigate the clinical characteristics of chronic active Epstein-Barr virus（CAEBV） infection cases.Methods Retrospective analyzed the clinical data,laboratory tests,treatment and follow-up results of IS patients with chronic active EB virus infection.Results Chronic active EB virus common clinical manifestations were fever,hepatosplenomegaly,lymphadenopathy,others including cough,expectoration,rash,fatigue,jaundice,nasal congestion,runny nose,sore throat,chest tightness and other symptoms,the most common laboratory abnormalities are elevated aminotransferases,some accompanied by elevated bilirubin,blood system mainly finding are the whole series or two lines cytopenia decreased and increased the proportion of lymphocytes,including anemia,leukopenia,thrombocytopenia,increased serum lactate dehydrogenase and ferritin more common,and were significantly elevated in critically ill patients.All patients had anti-EB virus capsid antigen IgG（EBVCA-IgG） antibodies increased,while the IgM antibodies were negative,14 patients in the early detection of antigen EBEA-IgG antibodies and nuclear antigen EBNA-IgG antibodies,EBEA-IgG antibody positive in 12 cases,while EBNA-IgG antibody positive in 10 cases.Real-time quantitative polymerase chain reaction detection of EBV-DNA in peripheral blood were positive,viral load（median） of 4.3×10^6 copies/ml.In 15 patients,one case were lost of follow up;eight cases were dead,including three cases of hemophagocytic syndrome,interstitial pneumonia in three cases,one case of liver failure,heart failure in one case;rest 6 cases are still under follow-up.Conclusion Diagnosis of CAEBV infection is difficult due to the variety of clinical features.It is important to test EB virus antibody and DNA for diagnosis as early as possible because of its severe complications,poor prognosis and high mortality.