慢性肝病合并EB病毒感染的临床特征  

Clinical features of chronic liver disease complicated with Epstein⁃Barr virus infection

作　　者：刘伟强 曾警燕 王甜[1] 江维[1] 罗红春[1] LIU Weiqiang;ZENG Jingyan;WANG Tian;JIANG Wei;LUO Hongchun(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：《热带医学杂志》2024年第2期240-245,共6页Journal of Tropical Medicine

基　　金：重庆市自然科学基金资助项目(cstc2021jcyj-msxmX0202);重庆市科卫联合医学科研项目(2020MSXM099)。

摘　　要：目的分析慢性肝病患者合并EB病毒(EBV)感染的临床特征,初步探讨EBV对慢性肝病患者疾病进展可能的机制。方法收集2019年1月-2023年6月重庆医科大学附属第一医院感染科肝病区住院的慢性肝病患者221例,按纳入排除标准分为EBV阳性(EBV+)组和EBV阴性(EBV-)组,分析两组慢性肝病患者的临床特征差异;并通过GeneCards网站进行生信分析筛选出EBV+组和EBV-组外周血中淋巴细胞的差异表达基因,选取4个显著差异表达的基因作为目标基因,分别为TNF、TGF-β1、STAT3、NPM1;采用qRT-PCR技术分别在EBV+组和EBV-组慢性肝病患者外周血淋巴细胞中进一步验证目标基因的差异表达情况。结果EBV+慢性肝病患者92例(41.6%),其中慢性乙型肝炎20例(21.7%);乙肝肝硬化42例(45.7%),非乙肝肝硬化30例(32.6%)。EBV+组和EBV-组患者的平均年龄及其≥60岁者、红细胞计数、血红蛋白、白蛋白、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、胆碱酯酶、甲胎蛋白、尿素、Na^(+)、D-二聚体、纤维蛋白降解产物(FDP)比较,差异均有统计学意义(t/χ^(2)/Z=3.416、4.203、-2.567、-2.214、-2.876、-2.632、-2.586、-3.534、-2.221、-3.529、-3.453、-3.632、-4.346,P均<0.05)。而在EBV+组的72例肝硬化患者中,乙肝肝硬化组与非乙肝肝硬化组外周血单核细胞绝对值、单核细胞百分比、丙氨酸氨基转移酶、γ-谷氨酰转肽酶、甲胎蛋白、凝血酶原活动度、纤维蛋白原、MELD模型分级比较,差异均有统计学意义(Z/χ^(2)=-2.103、-2.004、-2.011、-3.248、-2.930、-1.985、-2.063、4.101,P均<0.05)。同时收集入组的EBV+患者11例,EBV-患者13例的外周血,根据GeneCards网站行生信分析筛选出的4个目标差异基因,经实验验证,两组患者外周血淋巴细胞中TNF基因表达比较差异有统计学意义(Z=-2.206,P<0.05)。结论慢性肝病患者合并较高的EBV感染率,年龄是其感染的危险因素;EBV感染主要加重对肝脏Objective To analyze the clinical characteristics of Epstein⁃Barr virus(EBV)infection in patients with chronic liver disease,and explore the possible mechanism of the effect of EBV infection on the disease progression in patients with chronic liver disease.Methods A total of 221 patients with chronic liver disease who were hospitalized in the Infectious Diseases Department of the First Affiliated Hospital of Chongqing Medical University,from January 2019 to June 2023 were divided into EBV positive(EBV+)group and EBV negative(EBV-)group according to the inclusion and exclusion criteria,and the clinical characteristics of patients with chronic liver disease in the two groups were analyzed.The differential expression genes of lymphocytes in peripheral blood of EBV+group and EBV-group were screened through biogenic analysis on the GeneCards website,and four significantly differentially expressed genes were selected as target genes,namely TNF,TGF⁃β1,STAT3 and NPM1.qRT⁃PCR was used to further verify the differential expression of target genes in peripheral blood lymphocytes of patients with chronic liver disease in EBV+group and EBV-group.Results There were 92 patients(41.6%)with EBV+chronic liver disease,including 20 patients(21.7%)with chronic hepatitis B,42 cases(45.7%)of hepatitis B cirrhosis and 30 cases(32.6%)of non⁃hepatitis B cirrhosis.There were statistically significant differences in age and distribution(≥60 years old),red blood cell count,hemoglobin,albumin,alanine aminotransferase,aspartate aminotransferase,cholinesterase,alpha⁃fetoprotein,urea,Na^(+),D⁃dimer and fibrinogen degradation product(FDP)between the two groups(t/χ^(2)/Z=3.416,4.203,-2.567,-2.214,-2.876,-2.632,-2.586,-3.534,-2.221,-3.529,-3.453,-3.632,-4.346;all P<0.05).Among 72 patients with liver cirrhosis in EBV+group,the absolute value of peripheral blood monocytes,percentage of monocytes,alanine aminotransferase,γ⁃glutamyl transpeptide,alpha⁃fetoprotein,prothrombin activity,fibrinogen and MELD model were compared between

关 键 词：慢性肝病 EB病毒 差异表达基因 肝功能 

分 类 号：R512.6[医药卫生—内科学]