慢性活动性EB病毒感染肠道受累误诊为炎症性肠病10例临床特征分析  

Clinical characteristics of 10 patients of chronic active Epstein-Barr virus infection with intestinal involvement misdiagnosed as inflammatory bowel disease

作　　者：李煜 宋德利 陈蕾蕾 宋正阳 李文晴 王晶石[1] Li Yu;Song Deli;Chen Leilei;Song Zhengyang;Li Wenqing;Wang Jingshi(Department of Hematology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院血液内科,北京100050

出　　处：《中华传染病杂志》2024年第6期356-362,共7页Chinese Journal of Infectious Diseases

摘　　要：目的分析慢性活动性EB病毒感染(CAEBV)肠道受累且曾被误诊为炎症性肠病(IBD)患者的临床特征。方法回顾性分析2019年2月至2022年11月于首都医科大学附属北京友谊医院血液内科就诊的10例CAEBV肠道受累且被误诊为IBD患者的临床特征、实验室检查结果、消化内镜检查结果、组织学结果、治疗和预后。采用原位杂交法检测EB病毒编码的小RNA(EBER)。结果10例CAEBV肠道受累患者中,男8例,女2例,7例曾被误诊为溃疡性结肠炎,3例曾被误诊为克罗恩病,中位起病年龄为36岁,范围为26~52岁,起病至确诊CAEBV的中位时间为18.5个月,范围为2.0~96.0个月。患者的主要临床特征包括发热>38.5℃(10例),腹泻(7例),腹痛(7例),腹部淋巴结肿大(6例),便血(7例);6例以消化系统症状为首发表现,合并肠外器官受累7例,3例患者并发消化道出血所致失血性休克。实验室检查结果为血红蛋白降低7例,红细胞沉降率加快6例,自然杀伤细胞活性减低5例,铁蛋白升高3例;外周血单个核细胞(PBMC)中检出EB病毒DNA者9例,中位病毒载量为23000拷贝/mL;抗EB病毒衣壳抗体IgG、抗EB病毒核抗原1 IgG抗体阳性者7例。患者内镜下多表现为受累肠壁黏膜充血、水肿,可伴糜烂,多发、散在、大小不一的浅溃疡;全结肠受累患者6例,直肠3例,食管、胃窦、十二指肠和小肠各1例;7例患者确诊后行肠镜检查,4例病变进展。10例患者肠道组织病理均表现为活动性慢性炎症,4例隐窝改变,1例肉芽肿样改变;8例患者肠道组织经EBER染色阳性,7例EBER阳性细胞≥50个/高倍视野。7例患者确诊前使用5-氨基水杨酸治疗,5例患者复查肠镜发现病变较前无好转或进展,2例患者因不可控制的消化道大出血而死亡。结论CAEBV肠道受累患者的临床特征、内镜、病理表现缺乏特异性,对于初诊伴有发热且存在肠外器官受累证据的IBD患者,建议同时行PBMC及血浆中EB病毒DNA、�Objective To analyze the clinical characteristics of patients of chronic active Epstein-Barr virus infection(CAEBV)with intestinal involvement misdiagnosed as inflammatory bowel disease(IBD).Methods A retrospective analysis was conducted on the clinical characteristics,laboratory results,digestive endoscopic findings,histological results,treatment and prognosis of 10 patients with CAEBV intestinal involvement who were misdiagnosed as IBD and treated at the Department of Hematology,Beijing Friendship Hospital,Capital Medical University from February 2019 to November 2022.Epstein-Barr virus-encoded small RNA(EBER)was detected by in situ hybridization.Results Among the 10 patients with CAEBV,eight were males and two were females.Seven patients had been misdiagnosed as ulcerative colitis and three misdiagnosed as Crohn′s disease.The median age of onset was 36 years(ranged from 26 to 52 years),and the median time from onset to CAEBV diagnosis was 18.5 months(ranged from 2.0 to 96.0 months).The main clinical characteristics of these patients included fever>38.5℃ in 10 cases,diarrhea in seven cases,abdominal pain in seven cases,abdominal lymph node enlargement in six cases and hematochezia in seven cases.Six patients primarily presented with gastrointestinal symptoms,and seven patients had involvement of extraintestinal organs,three patients developed hemorrhagic shock due to gastrointestinal bleeding.The laboratory findings included anemia in seven cases,elevated erythrocyte sedimentation rate in six cases,decreased natural killer cell activity in five cases,and elevated ferritin in three cases.Epstein-Barr virus(EBV)DNA were detected in the peripheral blood mononuclear cells(PBMCs)of nine patients,with a median viral load of 23000 copies/mL.Seven patients were tested positive for anti-EBV viral capsid antigen IgG and nuclear antigen 1 IgG.The main endoscopy findings were hyperemia,edema of the affected intestinal wall mucosa,which could be accompanied by erosion,multiple scattered shallow ulcers with varying sizes

关 键 词：肠 炎性肠疾病 慢性活动性EB病毒感染 临床特征 

分 类 号：R512.99[医药卫生—内科学]