儿童EB病毒原发性感染血浆病毒DNA拷贝数特征  

Characteristics of plasma Epstein-Barr virus DNA in children with primary infection

作　　者：张雨涵 李飞 周圆圆 施鹏[2] 曹凌峰[3] 王建设 沈军 Zhang Yuhan;Li Fei;Zhou Yuanyuan;Shi Peng;Cao Lingfeng;Wang Jianshe;Shen Jun(Department of Infectious Disease,Children′s Hospital of Fudan University,National Children′s Medical Center,Shanghai 201102,China;Clinical Research Unit,Children′s Hospital of Fudan University,National Children′s Medical Center,Shanghai 201102,China;Department of Virology,Children′s Hospital of Fudan University,National Children′s Medical Center,Shanghai 201102,China)

机构地区：[1]国家儿童医学中心、复旦大学附属儿科医院感染传染科,上海201102 [2]国家儿童医学中心、复旦大学附属儿科医院临床研究中心管理办公室,上海201102 [3]国家儿童医学中心、复旦大学附属儿科医院病毒室,上海201102

出　　处：《中华儿科杂志》2023年第3期245-249,共5页Chinese Journal of Pediatrics

基　　金：上海市2021年度“科技创新行动计划”医学创新研究专项(21Y11901300);复旦大学附属儿科医院重点发展项目(EK2022ZX05)。

摘　　要：目的探讨儿童EB病毒(EBV)原发性感染血浆病毒DNA拷贝数特征及其变化规律。方法回顾性病例总结。选择2017年9月1日至2018年9月30日于复旦大学附属儿科医院诊断为EBV原发性感染的571例患儿为研究对象,收集患儿病毒实验室指标及临床信息等资料。根据血浆EBV DNA结果分为阳性组和阴性组,根据EBV DNA载量将阳性组分为高载量组和低载量组。组间差异采用χ^(2)检验、Wilcoxon秩和检验进行比较。结果571例EBV原发性感染患儿中男334例、女237例,初诊年龄3.8(2.2,5.7)岁。阳性组255例(44.7%)、阴性组316例(55.3%)。阳性组发热、肝和(或)脾肿大、转氨酶升高的患儿比例均高于阴性组[235例(92.2%)比255例(80.7%)、169例(66.3%)比85例(26.9%)、144例(56.5%)比120例(38.0%),χ^(2)=15.22、96.80、18.27,均P<0.001];阳性组中有70例进行了随访,随访时间46(27,10^(6))d,其中68例(97.1%)患儿在28 d内转阴,另2例(2.9%)患儿随访修正诊断为慢性活动性EBV感染。血浆病毒低载量组218例、高载量组37例。高载量组转氨酶升高患儿占比高于低载量组[75.7%(28/37)比56.0%(116/207),χ^(2)=5.00,P=0.025]。外周血白细胞中EBV DNA的阳性率及拷贝数均高于血浆中EBV DNA[84.2%(266/316)比44.7%(255/571)、7.0×107(1.3×107,3.0×108)比3.1×10^(6)(1.6×10^(6),6.1×10^(6))拷贝/L,χ^(2)=76.26、Z=15.23,均P<0.001]。结论免疫功能正常EBV原发性感染患儿中,血浆病毒DNA阳性患儿易有发热、肝和(或)脾肿大、转氨酶升高的临床表现。阳性血浆EBV DNA一般在初诊后28 d内转阴,多数血浆病毒高载量患儿有转氨酶升高特征。Objective To explore the characteristics of plasma Epstein-Barr virus(EBV)DNA in primary infection in pediatric cases.Methods The laboratory and clinical data of 571 children diagnosed with EBV primary infection in Children′s Hospital of Fudan University during September 1st,2017 to September 30th,2018 were retrospectively analyzed.According to the results of plasma EBV DNA,they were divided into positive group and negative group.According to the EBV DNA,they were devided into high plasma virol load group and low plasma virol load group.The Chi-square test,Wilcoxon rank sum test were used to compare the differences between groups.Results Among the 571 children with EBV primary infection,334 were males and 237 were females.The age of first diagnosis was 3.8(2.2,5.7)years.There were 255 cases in positive group and 316 cases in negative group.The percentage of cases with fever,hepatomegaly and(or)splenomegaly,elevated transaminase in the positive group were higher than those in the negative group(235 cases(92.2%)vs.255 cases(80.7%),χ^(2)=15.22,P<0.001;169 cases(66.3%)vs.85 cases(26.9%),χ^(2)=96.80,P<0.001;and 144 cases(56.5%)vs.120 cases(38.0%),χ^(2)=18.27,P<0.001;respectively).In the positive group,70 cases were followed up for 46(27,10^(6))days,68 cases(97.1%)turned negative within 28 days,with the exception of 2 cases(2.9%)developed chronic active EBV infection by follow-up revision.There were 218 cases in high plasma viral DNA copies group and 37 cases in low copies group.More cases presented with elevated transaminases in the high plasma viral DNA copies group than those in the low group(75.7%(28/37)vs.56.0%(116/207),χ^(2)=5.00,P=0.025).Both the positive rate of EBV DNA in peripheral blood leukocytes(84.2%(266/316)vs.44.7%(255/571),χ^(2)=76.26,P<0.001)and the copies of EBV DNA(7.0×107(1.3×107,3.0×108)vs.3.1×10^(6)(1.6×10^(6),6.1×10^(6))copies/L,Z=15.23,P<0.001)were higher than that of plasma.Conclusions In immunocompetent pediatric cases diagnosed as EBV primary infection,cases with positive plasma

关 键 词：爱泼斯坦巴尔病毒感染 病毒血症 儿童 

分 类 号：R725.1[医药卫生—儿科]