血清CD19^(+)、白细胞介素-4与EB病毒DNA载量交互作用对小儿传染性单核细胞增多症发病的影响  

Effect of interactions among serum CD19^(+),interleukin-4 and Epstein-Barr virus DNA load on occurrence of pediatric infectious mononucleosis

作　　者：戴炜 戚畅[2] 熊瑞华 龙元 DAI Wei;QI Chang;XIONG Ruihua;LONG Yuan(Emergency Department(West Campus),Wuhan Children's Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology,Wuhan,Hubei,430000;Nephrology Department,Wuhan Children's Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology,Wuhan,Hubei,430000)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院急诊科(西院区),湖北武汉430000 [2]华中科技大学同济医学院附属武汉儿童医院肾脏内科,湖北武汉430000

出　　处：《实用临床医药杂志》2025年第5期20-25,共6页Journal of Clinical Medicine in Practice

基　　金：湖北省科技计划项目[2022MS(LH)289]。

摘　　要：目的探讨血清CD19^(+)、白细胞介素-4(IL-4)与EB病毒(EBV)DNA载量交互作用对小儿传染性单核细胞增多症(IM)发病的影响。方法选取100例IM患儿作为研究组,另选取同期200例健康体检儿童作为对照组,比较2组儿童的基线资料、EBV-DNA载量、CD19^(+)及IL-4表达水平。采用多因素Logistic回归模型分析IM发病的影响因素,基于相加模型分析EBV-DNA载量与CD19^(+)、IL-4的交互作用,并绘制受试者工作特征(ROC)曲线分析EBV-DNA载量、CD19^(+)、IL-4单一及联合检测对IM的诊断效能。结果2组儿童EBV-DNA载量、CD19^(+)、IL-4、中性粒细胞与淋巴细胞比值(NLR)、单核细胞与淋巴细胞比值(MLR)、红细胞分布宽度(RDW)、异型淋巴细胞比率及VCA-IgM阳性率比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,EBV-DNA载量、CD19^(+)、IL-4、RDW、异型淋巴细胞比率、VCA-IgM阳性均为IM发病的独立影响因素(P<0.05)。相加交互作用分析表明,EBV-DNA载量与IL-4同时暴露时,交互效应超额相对危险度(RERI)为63.888,交互作用归因比(API)为77.312,交互效应指数(S)为4.532;EBV-DNA载量与CD19^(+)同时暴露时,RERI为2.655,API为16.773,S为1.210。ROC曲线分析结果显示,EBV-DNA载量、CD19^(+)、IL-4三者联合诊断IM的曲线下面积为0.945,诊断效能优于单一指标诊断及两两联合诊断。结论血清CD19^(+)、IL-4与EBV-DNA载量在IM发病中存在相加交互作用,且同时暴露可增加IM发病风险,联合检测有助于提高IM诊断效能,为临床诊治提供参考依据。Objective To explore the impact of interactions among serum CD19^(+),interleukin-4(IL-4),and Epstein-Barr virus(EBV)DNA load on the occurrence of pediatric infectious mononucleosis(IM).Methods A total of 100 IM pediatric patients were enrolled as study group,and 200 healthy pediatric controls were recruited during the same period.Baseline characteristics,EBV-DNA load,CD19^(+)levels,and IL-4 expression were compared between the two groups.A multivariate Logistic regression model was used to analyze the influencing factors of IM.The interactions between EBV-DNA load and CD19^(+),IL-4 were analyzed based on an additive model.Receiver operating characteristic(ROC)curves were plotted to assess the diagnostic performance of EBV-DNA load,CD19^(+),IL-4 alone and their combination for IM.Results Significant differences were observed between the two groups in terms of EBV-DNA load,CD19^(+)levels,IL-4 expression,neutrophil-to-lymphocyte ratio(NLR),monocyte-to-lymphocyte ratio(MLR),red cell distribution width(RDW),atypical lymphocyte ratio,and VCA-IgM positivity(P<0.05).Multivariate Logistic regression analysis revealed that EBV-DNA load,CD19^(+),IL-4,RDW,atypical lymphocyte ratio,and VCA-IgM positivity were independent influencing factors for IM occurrence(P<0.05).Additive interaction analysis showed that when EBV-DNA load and IL-4 were simultaneously exposed,the relative excess risk due to interaction(RERI)was 63.888,the attributable proportion due to interaction(API)was 77.312,and the synergy index(S)was 4.532;when EBV-DNA load and CD19^(+)were simultaneously exposed,RERI was 2.655,API was 16.773,and S was 1.210.ROC curve analysis indicated that the area under the curve(AUC)for the combined diagnosis of IM using EBV-DNA load,CD19^(+),and IL-4 was 0.945,which was superior to that of single indicator and dual combination.Conclusion Serum CD19^(+),IL-4,and EBV-DNA load exhibit additive interactions in the occurrence of IM,and simultaneous exposure increases the risk of IM.Combined detection of these biomarkers enhances the d

关 键 词：传染性单核细胞增多症 儿童 白细胞介素-4 EB病毒 DNA载量 CD19+ 病毒载量 交互作用 

分 类 号：R725.1[医药卫生—儿科] R446[医药卫生—临床医学] R319