EB病毒抗体滴度及EB病毒DNA载量与传染性单核细胞增多症患者临床特征的回顾性分析  

EBV capsid antigen-immunoglobulin M antibody titer and serum EBV DNA load are associated with severity of patients with infectious mononucleosis: a retrospective analysis of clinical features of 250 cases

作　　者：李妞妞 徐京杭[1] 施逸怡 霍娜[1] 王贵强[1] 徐小元[1] 于岩岩[1] Li Niuniu;Xu Jinghang;Shi Yiyi;Huo Na;Wang Guiqiang;Xu Xiaoyuan;Yu Yanyan(Department of Infectious Diseases, Center for Liver Diseases, Peking University First Hospital, Beijing,100034 China)

机构地区：[1]北京大学第一医院感染科,100034

出　　处：《中华传染病杂志》2018年第10期616-621,共6页Chinese Journal of Infectious Diseases

摘　　要：目的分析青少年和成人传染性单核细胞增多症(infectiousmononucleosis,IM)患者EBV衣壳抗原M抗体(EBVcapsidantigen-immunoglobulinMantibody,EBV-VCA-IgM)滴度及血清EBVDNA载量与临床症状及实验室检查之间的关系。方法回顾性分析250例青少年和成人IM患者的临床资料,按EBV-VCA-IgM>160IU/mL和EBV-VCA-IgM≤160IU/mL分为两组,另按血清EBVDNA≥3.38lg拷贝/mL和血清EBVDNA<3.38lg拷贝/mL分为两组,分别比较不同VCA-IgM滴度及不同病毒载量患者临床特点的差异。计量资料组间比较采用t检验,非正态计量资料采用Mann-WhitneyU检验。结果与VCA-IgM滴度≤160IU/mL组相比,>160IU/mL组患者的咽痛[(83.0%,122/147)比(67.2%,43/64),χ2=6.534,P=0.011]、咽部分泌物[(59.9%,88/147)比(40.6%,26/64),χ2=6.645,P=0.010]、扁桃体肿大[(78.9%,116/147)比(59.4%,38/64),χ2=8.631,P=0.003]更常见,ALT水平更高[290.5(168.0,460.5)U/L比221.0(113.0,440.5)U/L,Z=-2.251,P=0.024]。与血清EBVDNA载量<3.38lg拷贝/mL组相比,≥3.38lg拷贝/mL组患者体温高峰值[(39.2±0.7)°C比(38.7±0.7)°C,t=-3.150,P=0.002]、最高白细胞计数[16.2(12.2,20.4)×109/L比13.4(11.1,17.3)×109/L,Z=-2.098,P=0.036]、淋巴细胞百分比最大值[(72.0±7.8)%比(68.2±7.0)%,t=-2.238,P=0.028]、淋巴细胞EBVDNA载量[(5.5±0.9)lg拷贝/mL比(4.8±1.0)lg拷贝/mL,t=-2.602,P=0.012]较高。多元逐步回归分析显示,血清EBVDNA载量的独立影响因素为体温高峰值(回归系数为0.368,P=0.003)及淋巴细胞EBVDNA载量(回归系数为0.389,P=0.002)。结论青少年和成人传染性单核细胞增多症患者中,EBV-VCA-IgM滴度及血清EBVDNA载量与临床症状严重程度呈正相关。Objective To explore the possible associations between EBV capsid antigen-immunoglobulin M antibody (EBV-VCA-IgM), serum EBV DNA load and clinical severity, laboratory results in adolescent and adult patients with infectious mononucleosis (IM). Methods Clinical data of 250 adolescent and adult IM patients were retrospectively analyzed. Patients were divided into two groups by EBV-VCA-IgM titer (>160 U/mL or≤160 U/ mL) and serum EBV DNA level (>3.38 lg copies/mL or <3.38 lg copies/mL), respectively. Clinical data were compared between the two groups, respectively. The t test was used for intergroup comparison and the Mann-Whitney U test was used for non-normally distributed data. Results Compared with those with lower VCA-IgM antibody titer (≤160 U/ mL), sore throat (83.0% [122/147] vs 67.2%[43/64], χ2=6.534, P=0.011), pharynx secretion (59.9% [88/147] vs 40.6% [26/64], χ2=6.645, P=0.010), and swollen tonsils (78.9% [116/147] vs 59.4% [38/64], χ2=8.631, P=0.003) were more common in those with higher VCA-IgM antibody titer (>160 U/mL). ALT level was higher as well in those with higher VCA-IgM antibody titer (290.5[168.0, 460.5] U/L vs 221.0[113.0, 440.5] U/L, Z=-2.251, P=0.024). The peak body temperature ([39.2±0.7] °C vs [38.7±0.7] °C, t=-3.150, P=0.002), maximum WBC counts (16.2 [12.2, 20.4]×109/L vs 13.4[11.1, 17.3] ×109/L, Z=-2.098, P=0.036), maximum percentage of lymphocyte ([72.0±7.8]% vs [68.2±7.0]%, t=-2.238, P=0.028), and lymphocyte EBV DNA load ([5.5±0.9] lg copies/mL vs [4.8±1.0] lg copies/mL, t=-2.602, P=0.012) in those with higher serum EBV DNA load >3.38 lg copies/mL were higher than those with serum EBV DNA load <3.38 lg copies/mL. Regression analysis showed that serum EBV DNA load was associated with the peak body temperature (regression coefficient 0.368, P=0.003) and lymphocyte EBV DNA load (regression coefficient 0.389, P=0.002). Conclusions In adolescents and adults, EBV-VCA-IgM antibody titer and serum EBV DNA load are associated with severity of patients with infectious mononu

关 键 词：传染性单核细胞细胞增多症 病毒学 成年人 青少年 严重度 

分 类 号：R512.7[医药卫生—内科学]