成人EB病毒相关噬血细胞综合征的危险因素  

Risk factors for adults with Epstein-Barr virus associated hemophagocytic lymphohistiocytosis

作　　者：肖梦瑶 辛小娟[1] Xiao Mengyao;Xin Xiaojuan(Department of Infectious Diseases,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院感染科,重庆400016

出　　处：《中华实验和临床感染病杂志（电子版）》2022年第2期73-81,共9页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：重庆市科卫联合医学科研项目(No.2019ZDXM004)。

摘　　要：目的分析成人EB病毒(EBV)感染导致的传染性单核细胞增多症(IM)和EBV相关噬血综合征(EBV-HLH)患者临床特征,探讨IM发展为EBV-HLH的危险因素。方法收集重庆医科大学附属第一医院2016年1月至2020年12月收治的217例EBV感染者,按照是否发生噬血分为IM组和EBV-HLH组,回顾性收集和分析两组患者的一般资料、临床表现、实验室检查、治疗及预后特点,采用二元Logistic回归分析IM进展为EBV-HLH的危险因素。结果EBV-HLH组患者中位发病年龄显著大于IM组[25(21,56)岁vs.21(18,25)岁,Z=-2.658、P=0.008],IM组患者较EBV-HLH组更易出现扁桃体炎[83.1%(167/201)vs.25.0%(4/16),χ^(2)=26.556、P<0.001];而EBV-HLH组患者较IM组热峰更高[40.3(39.8,40.9)℃vs.38.9(38.4,39.3)℃,Z=-5.723、P<0.001]、热程更长[30(18,44)d vs.7(4,12)d,Z=-5.469、P<0.001],且更常见肝肿大、腹泻、黄疸、肺炎、出血(χ^(2)=18.341、13.444、27.344、68.405、32.967,P均<0.001)、心力衰竭(Fisher’s确切概率法:P=0.005)等表现,差异均有统计学意义。与IM组相比,EBV-HLH组患者血常规指标中白细胞[2.2(1.4,3.0)×10^(9)/L vs.11.2(7.7,14.4)×10^(9)/L,Z=-5.883、P<0.001]、血红蛋白[(87.8±17.1)g/L vs.(134.4±16.5)g/L,t=-10.806、P<0.001]、血小板[45.5(27.0,74.5)×10^(9)/L vs.165.0(133.0,205.5)×10^(9)/L,Z=-6.316、P<0.001]均显著降低;肝功能指标总胆红素[58.2(13.9,108.3)μmol/L vs.12.3(9.1,16.7)μmol/L,Z=-4.119、P<0.001]、乳酸脱氢酶[3000.0(953.8,6665.8)U/L vs.1459.5(991.0,2023.6),Z=-3.206、P=0.001]显著升高,白蛋白[(26.9±4.6)g/L vs.(40.1±4.6)g/L,t=-11.054、P<0.001]显著下降;凝血功能提示D-二聚体[4.8(0.8,10.4)mg/L vs.1.0(0.7,1.7)mg/L,Z=-3.063、P=0.002]显著升高,纤维蛋白原[0.9(0.7,2.9)g/L vs.2.7(2.2,3.1)g/L,Z=-3.395、P=0.001]显著下降,差异均有统计学意义。EBV-HLH组患者较IM组患者C-反应蛋白[51.7(31.6,90.0)mg/L vs.17.2(7.1,23.0)mg/L,Z=-3.206、P<0.001]、铁蛋白[7835.0(2101.5,23481.5)ng/mL vs.563.3(213.9,1215.5)ng/ml,ZObjective To analyze the clinical characteristics of infectious mononucleosis(IM)and Epstein-Barr virus associated hemophagocytic syndrome(EBV-HLH),and to investigate the risk factors for IM progressing to EBV-HLH.Methods Data of 217 patients with EBV infection who were treated in the First Affiliated Hospital of Chongqing Medical University from January 2016 to December 2020 were collected,and then divided into IM group and EBV-HLH group according to whether complicated with hemophagocytic syndrome or not.The general data,clinical manifestations,laboratory examination,treatment and prognosis of the two groups were collected and analyzed,retrospectively.The clinical risk factors of IM progressing to EBV-HLH were analyzed by multivariate Logistic regression.Results The median age of patients in EBV-HLH group was elder than IM group[25(21,56)years old vs.21(18,25)years old;Z=-2.658,P=0.008].Compared with patients in IM group,patients in EBV-HLH group had higher peaks[40.3(39.8,40.9)℃vs.38.9(38.4,39.3)℃;Z=-5.723,P<0.001]and longer duration of fever[30(18,44)d vs.7(4,12)d;Z=-5.469,P<0.001].The incidences of hepatomegaly,diarrhea,jaundice,pneumonia,bleeding(χ^(2)=18.341,χ^(2)=13.444,χ^(2)=27.344,χ^(2)=68.405,χ^(2)=32.967;all P<0.001)and heart failure(Fisher’s exact test:P=0.005)in EBV-HLH group were significantly higher than those of IM group,while the incidence of tonsillitis of patients in EBV-HLH group was significantly lower than that of IM group[83.1%(167/201)vs.25.0%(4/16);χ^(2)=26.556,P<0.001].Compared with patients in IM group,the leukocytes[2.2(1.4,3.0)×10^(9)/L vs.11.2(7.7,14.4)×10^(9)/L;Z=-5.883,P<0.001],hemoglobin[(87.8±17.1)g/L vs.(134.4±16.5)g/L;t=-10.806,P<0.001],platelet[45.5(27.0,74.5)×10^(9)/L vs.165.0(133.0,205.5)×10^(9)/L;Z=-6.316,P<0.001]of patients in EBV-HLH group were significantly higher.The liver function showed that total bilirubin[58.2(13.9,108.3)μmol/L vs.12.3(9.1,16.7)μmol/L;Z=-4.119,P<0.001],lactate dehydrogenase[3000.0(953.8,6665.8)U/L vs.1459.5(991.0,2023.6)U/L;Z=-3

关 键 词：EB病毒 传染性单核细胞增多症 EB病毒相关噬血细胞综合征 

分 类 号：R511[医药卫生—内科学]