慢性活动性EB病毒感染并冠状动脉瘤4例并文献复习  

Chronic active Epstein - Barr virus infection complicated with coronary aneurysm in 4 pediatric cases and the literature review

作　　者：谢小斐[1] 卢根[2] 黄萍[1] 张丽[1] 汪周平[1] 黄莉[3] 谭丽梅[4] 张明杰[5] 

机构地区：[1]广州医科大学附属广州市妇女儿童医疗中心儿童心脏内科,510120 [2]广州医科大学附属广州市妇女儿童医疗中心呼吸科,510120 [3]广州医科大学附属广州市妇女儿童医疗中心儿童重症医学科,510120 [4]广州医科大学附属广州市妇女儿童医疗中心感染科,510120 [5]广州医科大学附属广州市妇女儿童医疗中心影像科,510120

出　　处：《中华实用儿科临床杂志》2016年第22期1721-1727,共7页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的提高对儿童慢性活动性EB病毒感染（CAEBV）并心血管系统损害的认识。方法对广州医科大学附属广州市妇女儿童医疗中心收治的4例CAEBV并心血管系统损害（冠状动脉瘤形成和其他大动脉受损）患儿的临床资料进行总结和分析，并复习相关文献。结果1．本组患儿除并冠状动脉瘤外，还分别表现了反复发热、肝脾大、淋巴结大、肝损害、胸腔积液，同时并腹主动脉扩形瘤、间质性肺炎、葡萄膜炎、噬血细胞综合征等并发症。2．本组4例患儿的衣壳抗原（CA）-IgG、核抗原（NA）-IgG、EBV高亲和力抗体均为阳性，3例患儿早期抗原（EA）-IgG阳性。血浆EB病毒载量1．46×10^7～3．72×10^10copies/L。3．体液免疫方面：4例患儿血清IgG在诊断时均升高；细胞免疫方面：3例患儿的CD4＋T淋巴细胞数及比例在诊断时均明显升高，而自然杀伤细胞数量下降。结论1．儿童CAEBV可导致冠状动脉瘤及其他大血管扩张／瘤。2．由于不能进行组织活检，CAEBV与川崎病继发的冠状动脉瘤只能依靠实验室检查、临床表现及随访来鉴别。3．临床上诊断CAEBV的患儿应尽早完善心脏彩超、CT血管重建等影像学检查，早期、及时地发现合并心血管损害等严重并发症有助于临床预后的改善。发现有冠状动脉损害患儿要完善EB病毒病原的相关检查，以避免误诊。Objective To enhance the recognition of cardiovascular complications associated with chronic active Epstein - Barr virus infection （CAEBV） in children. Methods In this study, the medical records of 4 pediatric patients with CAEBV complicated with cardiovascular impairment （coronary artery lesion and artery aneurysms ） at Guangzhou Women and Children＇s Medical Center, Guangzhou Medical University were evaluated and the literatures were reviewed. Results （ 1 ） Apart from complicated with coronary aneurysm, these patients exhibited intermittent fever, hepatomegaly, splenomegaly, lymphadenectasis, liver dysfunction and pleural effusion. The main complications in- eluding abdominal aortic dilation,interstitial pneumonia, uveitis and hemophagocytic syndrome were also observed. （2） Epstein - Barr virus - related antibody detected by immunofluorescence assays showed that all patients were Epstein - Barr virus IgG antibodies positive against viral capsid antigen and against nuclear antigen,with anti - early antigens IgG positive in 3 patients. The plasma Epstein - Barr virus DNA level in those patients with CAEBV ranged from 1.46 × 10^7 to 3.72 × 10^10 copies/L at diagnosis. （ 3 ） The inspection of immunological aspects showed that serum IgG levels and CD4 ＋ T cells increased in 4 patients, but the number of natural killer cells decreased in 3 patients with CAEBV at diagnosis. Conclusions （ 1 ） The children with CAEBV could lead to cardiovascular impairment included coronary aneu- rysm and other artery aneurysms. （2） At present, it is difficult to justify whether Epstein - Barr virus contributed to the development of coronary artery lesions or Kawasaki disease complicated by coronary aneurysm because histopathologic examination could not be executed in living body. Differential diagnosis only depends on clinical symptom and follow - up. （3） The study reminds clinicians of the vital importance of early diagnosis and close follow - up of CAEBV - asso- ciated cardiovascular complications

关 键 词：慢性活动性EB病毒感染 心血管损害 冠状动脉瘤 儿童 

分 类 号：R725[医药卫生—儿科]