慢性活动性EB病毒感染患者111例的临床特征分析  

Clinical characteristics of 111 patients with chronic active Epstein-Barr virus infection

作　　者：李嘉雯 张弛[1] 吴朝[1] 代丽华[1] 赵鸿[1] Li Jiawen;Zhang Chi;Wu Zhao;Dai Lihua;Zhao Hong(Department of Infectious 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》2021年第9期548-555,共8页Chinese Journal of Infectious Diseases

摘　　要：目的分析慢性活动性EB病毒感染(chronic active Epstein-Barr virus infection,CAEBV)的临床特征,以降低疾病的漏诊、误诊率。方法检索首篇文献发表时间(1987年5月)至2020年8月29日PubMed、Embase、Cochrane Library、中国知网、万方数据知识服务平台和维普网数据库收录的CAEBV相关文献,回顾性分析CAEBV患者的临床特点、实验室检查、转归和死亡原因等。统计学分析采用曼-惠特尼U检验、χ^(2)检验或Fisher确切概率法。结果纳入文献46篇,共111例患者,年龄为22.0(10.0,39.0)岁。年龄≥18岁组64例(57.7%),年龄<18岁组47例(42.3%)。发热、脾大、肝大、淋巴结肿大为常见临床表现,发生率分别为95.5%(106/111)、84.7%(94/111)、57.7%(64/111)、56.8%(63/111)。年龄≥18岁组患者的皮疹和肝大的发生率分别为3.1%(2/64)和45.3%(29/64),均低于年龄<18岁患者的27.7%(13/47)和74.5%(35/47),其肝脏生物化学指标异常的发生率则高于年龄<18岁患者[45.3%(29/64)比23.4%(11/47)],差异均有统计学意义(χ^(2)=13.957、9.436、5.643,均P<0.05)。70例随访结局可知的患者中,死亡38例(54.3%),存活32例(45.7%),死亡原因包括消化道出血、重症感染、呼吸衰竭、肝衰竭等,死亡组和存活组的脾大发生率分别为92.1%(35/38)和68.8%(22/32),差异有统计学意义(χ^(2)=6.266,P<0.05)。年龄<18岁组患者的21例死亡和17例存活病例中合并噬血细胞性淋巴组织细胞增生症(hemophagocytic lymphohistiocytosis,HLH)者分别为15例(71.4%)和2例,差异有统计学意义(χ^(2)=13.527,P<0.01)。90例可获得HLH相关资料的患者中,合并HLH组38例,无HLH组52例,男性所占比例分别为36.8%(14/38)和65.4%(34/52),性别分布差异有统计学意义(χ^(2)=7.187,P=0.007)。111例患者在病程中治疗方案多样,但缺乏详细资料。结论CAEBV临床表现多变,可有致死性并发症,缺乏有效治疗,且预后不佳,需要积极开展相关研究,探索有效治疗方案,降低病死率。Objective To analyze the clinical features of chronic active Epstein-Barr virus infection(CAEBV)in order to reduce the rates of underdiagnosis and misdiagnosis of this disease.Methods The CAEBV related literatures of PubMed,Embase,Cochrane Library,China National Knowledge Infrastructure,WanFang Database and Chongqing VIP since the first literature published(May 1987)until August 29,2020 were searched.The clinical characteristics,laboratory examinations,outcome and causes of death of CAEBV patients were retrospectively analyzed.Statistical analysis was performed by Mann-Whitney U test,chi-square test or Fisher′s exact probability test.Results A total of 111 patients aged 22.0(10.0,39.0)years were included from 46 articles.There were 64 cases(57.7%)in the age≥18 years group and 47 cases(42.3%)in the age<18 years group.Fever,splenomegaly,hepatomegaly,and lymph node enlargement were common clinical manifestations,with incidences of 95.5%(106/111),84.7%(94/111),57.7%(64/111)and 56.8%(63/111),respectively.The incidences of rash and hepatomegaly in the age≥18 years group were 3.1%(2/64)and 45.3%(29/64),respectively,which were both lower than those in patients aged<18 years group(27.7%(13/47)and 74.5%(35/47),respectively),while the incidence of abnormal liver biochemical indexes was higher(45.3%(29/64)vs 23.4%(11/47)).The differences were all statistically significant(χ^(2)=13.957,9.436 and 5.643,respectively,all P<0.05).Of the 70 patients with follow-up outcomes,38(54.3%)died and 32(45.7%)survived.The causes of death included gastrointestinal bleeding,severe infection,respiratory failure,liver failure,etc.The incidences of splenomegaly in the death and survival groups were 92.1%(35/38)and 68.8%(22/32),respectively.The difference was statistically significant(χ^(2)=6.266,P<0.05).Of 21 death and 17 survival cases in the age<18 years group,15(71.4%)and two cases were combined hemophagocytic lymphohistiocytosis(HLH),respectively,with statistical significance(χ^(2)=13.527,P<0.01).Of the 90 patients whose HLH-related

关 键 词：爱泼斯坦巴尔病毒感染 慢性活动性EB病毒感染 噬血细胞性淋巴组织细胞增生症 

分 类 号：R512.7[医药卫生—内科学]