儿童传染性单核细胞增多症临床特点及淋巴细胞亚群变化的意义  

The clinical characteristics of IM and the significance of lymphocyle subsets in children with IM

作　　者：钱冰涛 汤殿维 刘海涛 毕淑英 刘芳 王萌[1] 宋庆[1] QIAN Bingtao;TANG Dianwei;LIU Haitao(Department of Pediatrics,Aerospace Center Hospital,Beijing 100049,China)

机构地区：[1]航天中心医院儿科,北京市100049

出　　处：《河北医药》2022年第6期838-842,共5页Hebei Medical Journal

摘　　要：目的总结传染性单核细胞增多症(IM)患儿临床发病特点,比较EBV-IM患儿感染EBV后其细胞免疫功能尤其是淋巴细胞亚群的变化特点及其临床意义,为EBV-IM患儿的个体化治疗提供一定依据。方法选取2015年1月至2019年12月北京航天中心医院儿科住院并确诊为EBV感染IM临床资料进行回顾性分析。共94例传染性单核细胞增多症患儿为研究对象,对其发病年龄、临床表现、实验室检查、治疗前及治疗后淋巴细胞亚群进行回顾性总结。根据EBV-DNA的拷贝数将全血EBV-DNA分为阳性组和阴性组,采用“Pandas”进行相关性分析。使用配对t检验比较EBV-DNA阳性组和阴性组淋巴亚群的变化是否有差异。使用配对t检验比较25例治疗前后淋巴亚群的变化是否有差异。结果94例患儿中发热、颈部淋巴结肿大、咽扁桃体炎典型三联征症状,共74例,占78.2%。病初外周血异型淋巴细胞>10%64例(68.0%),异型淋巴细胞<10%30例(32.0%)。根据入院时EBV-DNA的拷贝数10^(3)将全血EBV-DNA分为(拷贝数>10^(3))阳性组36例和(拷贝数<10^(3))阴性组58例,EBV-DNA分为阳性组36例和阴性组58例,EBV-DNA阳性组CD3、CD8、CD4绝对值显著高于阴性组,差异有统计学意义(P<0.05);但2组NK绝对值细胞差异无统计学意义(P>0.05)。其中25例治疗1周后CD8、NK细胞绝对值显著低于入院时,细胞差异有统计学意义(P<0.05);但2组CD3、B细胞绝对值细胞差异无统计学意义(P>0.05)。结论EBV感染IM患儿体内存在淋巴细胞亚群失衡和细胞免疫功能紊乱,可能与EBV细胞内复制活动性有关。EBV感染引起的传染性单核细胞增多症儿童CD8+T细胞明显增多,在免疫防御中有关键作用。EBV病毒感染患儿检测外周血淋巴细胞亚群有助于IM的诊断和鉴别诊断。治疗期间患儿对淋巴细胞亚群复查,有助于判断其免疫功能恢复情况。Objective To investigate the clinical characteristics of infectious mononucleosis(IM)and the expression levels of Epstein-Barr virus(EBV)antibodies and EBV-DNA as well as the changes of cellular immune function subsets in children with EBV-IM,so as to provide basis for the prevention and treatment of EBV infection.Methods The clinical data of 94 children patients with EBV-IM who were treated in our hospital from January 2013 to December 2020 were retrospectively analyzed.According to the copy numbers of EBV-DNA,the 94 patients were divided into(EBV-DNA)positive group and negative group.The changes of EBV antibodies,EBV-DNA,immunoglobulin levels,lymphocyte subpopulation were observed and compared between the two groups.Results Of the 94 patients,there were 74 cases of triad(fever,neck lymphadenectasis and pharyngitis),accounting for 78.2%,and there were 64 cases(68.0%)with peripheral blood abnormal lymphocyte>10%,and 30 cases(32.0%)with peripheral blood abnormal lymphocyte<10%.Moreover the levels of CD3,CD8,CD4 cells in positive group were significantly higher than those in negative group(P<0.05),however,there were no significant differences in the levels of NK cells between the two groups(P>0.05).After 1-weel treatment,the levels of CD8,NK cells in 25 patients were significantly decreased,but,there were no significant differences in the levels of CD3 and B cells between the two groups(P>0.05).Conclusion There exist imbalance of lymphocyle subsets and disturbance of cellular immunity in children patients with EBV-IM,which may be correlated with the copy activity of EBV cells,and the levels of CD8+cells are significantly increased in the patients.Detecting peripheral-blood lymphocyte subsets is helpful for the diagnosis and differential diagnosis of EBV-IM,which is conductive to evaluating the recovery of immune function of patients.

关 键 词：EB病毒 传染性单核细胞增多症 淋巴细胞亚群 免疫功能 儿童 

分 类 号：R512.7[医药卫生—内科学]