成人EB病毒和巨细胞病毒混合感染相关性单核细胞增多症的临床分析  

Clinical features of mononucleosis because of Epstein-Barr virus and cytomegalovirus co-infection in adult patients

作　　者：李璐[1] 林菲[1] 贾莹[1] 梁京津[1] 胥婕[1] 

机构地区：[1]北京大学第三医院感染疾病科,100191

出　　处：《中华医学杂志》2017年第39期3068-3071,共4页National Medical Journal of China

基　　金：北京市科技计划基金资助（D151100002115002）

摘　　要：目的探讨免疫功能正常成人EB病毒（EBV）和巨细胞病毒（CMV）混合感染相关性单核细胞增多症的临床特征。方法将2013年5月至2016年5月在北京大学第三医院住院的103例单核细胞增多症患者根据病原不同分为3组：EBV和CMV混合感染组33例，EBV单一感染组53例，CMV单一感染组17例。采用回顾性病例对照的研究方法，使用方差分析、t检验及秩和检验等统计学方法，比较3组患者的临床特点及预后。结果混合感染组咽痛（33．3％）、咽部充血（54．5％）、扁桃体肿大（18．2％）及伪膜形成（3．0％）、淋巴结肿大发生率（18．2％）低于EBV感染组（84．9％、98．1％、66．0％、56．6％、96．2％）（Х^2=19．202—25．492，均P〈0．05），与CMV感染组（29．4％、23．5％、8．3％、0．0％、47．1％）差别不大（Х^2=0．078～4．381，均P〉0．05）。混合感染组碱性磷酸酶、吖谷氨酰转肽酶、乳酸脱氢酶、外周血白细胞、异型淋巴细胞比例均低于EBV感染组（t／U=3．471～104．629，均P〈0．05），与CMV感染组相当（t／U=0．447—24．330，均P〉0．05），谷丙转氨酶和总胆红素与EBV感染组和CMV感染组相当（U=1．695，6．371，均P〉0．05），混合感染组发热持续时间[（18±9）d]介于EBV感染组[（15±7）d]与CMV感染组[（21±7）d]之间。结论EBV和CMV混合感染不少见，其临床表现更像CMV感染，肝损伤及发热持续时间无加重表现。Objective To identify the clinical features of mononucleosis caused by co-infection of Epstein-Barr virus （EBV） and cytomegalovirus （CMV） in adult patients. Methods A total of 103 inpatients with mononucleosis in Peking University Third Hospital from May 2013 to May 2016 were collected as the study subjects. The patients were divided into three groups according to the responsible pathogens：33 patients infected with EBV and CMV, 53 infected with EBV alone and 17 infected with CMV alone. Furthermore, a case-control study was employed to retrospectively compare the clinical characteristics and prognosis with X2 , t or rank tests. Results The incidences of sore throat, pharynx congestion, tonsil enlargement, tonsil membrane, lymphadenectasis in co-infected patients were statistically lower than those in EBV-infected patients （ Х^2 = 19. 202 - 25. 492, all P 〈 0. 05 ）, and were equivalent to those in CMV-infected patients （ X2 = 0. 078 - 4. 381, all P 〉 0. 05 ）. The levels of alkaline phosphatase, glutamyl transferase, lactic dehydrogenase, white blood cell count and atypical lymphocyte in co-infected patients were statistically lower than those in EBV-infeeted patients（ t/U = 3. 471 - 104. 629, all P 〈 0. 05 ）, and were similar to those in CMV-infected patients（ t/U = 0. 447 - 24. 330, all P 〉 0. 05 ）. The levels of alanine aminotransferase and total bilirubin in co-infected patients were equivalent to those in the other two groups（ U = 1. 695,6. 371, both P 〉0. 05）. The duration of fever in co-infected patients [ （18 ± 9） d] was between EBV alone [ （15± 7） d ] and CMV alone [ （21 ± 7） d] infected patients. Conclusions Co-infection of EBV and CMV is not uncommon. The clinic manifestation of co-infection is more like CMV infection. Liver injury and duration of fever shows no aggravation.

关 键 词：单核细胞增多症 成人 EB病毒 巨细胞病毒 混合感染 

分 类 号：R511[医药卫生—内科学]