115例成人急性EB病毒感染相关肝损伤临床特征分析

杨玉英; 王欣慧; 万钢; 孟培培; 周洋; 吴桐; 侯艺鑫; 于浩; 姜婷婷; 江宇泳

doi:10.3969/j.issn.1001-5256.2017.06.025

115例成人急性EB病毒感染相关肝损伤临床特征分析

DOI: 10.3969/j.issn.1001-5256.2017.06.025

1. 首都医科大学附属北京地坛医院中西医结合二科
2. 首都医科大学附属北京地坛医院病案统计科

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中图分类号: R575
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出版历程
- 出版日期: 2017-06-20

Clinical features of liver injury associated with acute Epstein-Barr virus infection in adults: an analysis of 115 cases

摘要

摘要:
目的探讨成人急性EB病毒（EBV）感染者的临床表现、肝功能、外周血淋巴细胞亚群等实验室检查特征,为成人急性EBV感染相关肝损伤的诊治提供依据。方法对北京地坛医院2009年6月-2016年3月因成人急性EBV感染伴发肝功能异常的115例患者临床资料进行回顾性分析,根据有无黄疸分为黄疸组（n=46）和非黄疸组（n=69）,并对黄疸升高的影响因素加以分析。计量资料满足正态分布的组间比较采用t检验;不满足正态分布的组间比较采用Wilcoxon检验;多因素分析采用logistic回归分析。结果 115例患者中出现发热106例（92.2%）,咽峡炎97例（84.3%）,扁桃体肿大73例（63.5%）,浅表淋巴结肿大73例（63.5%）,脾肿大74例（64.4%）。黄疸组和无黄疸组在外周血淋巴细胞的比例（t=-2.51,P=0.014）、ALT（Z=4.93,P<0.001）、AST（Z=5.34,P<0.001）、GGT（Z=5.26,P<0.001）、ALP（Z=5.29,P<0.001）水平差异均有统计学意义。logistic回归分析显示AST（比值比=1.008,95...
- 肝疾病 /
- 疱疹病毒4型,人 /
- 黄疸 /
- 成人
Abstract:
Objective To investigate the clinical manifestations and features of laboratory examinations including liver function and peripheral blood lymphocyte subsets of adult patients with acute Epstein-Barr virus (EBV) infection, and to provide a basis for the diagnosis and treatment of liver injury associated with acute EBV infection in adults. Methods A retrospective analysis was performed for the clinical data of 115 adult patients with acute EBV infection and abnormal liver function who were treated from June 2009 to March 2016, and these patients were divided into two groups according to the presence or absence of jaundice. The influencing factors for jaundice were analyzed. The t-test was used for comparison of normally distributed continuous data between groups, the Wilcoxon test was used for comparison of non-normally distributed continuous data between groups, and the logistic regression analysis was used for univariate analysis. Results Of all patients, 106 (92. 2%) had pyrexia, 97 (84. 3%) had angina, 73 (63. 5%) had swelling of the tonsil, 73 (63. 5%) had superficial lymph node enlargement, and 74 (64. 4%) had splenomegaly. There were significant differences between the jaundice group and the non-jaundice group in terms of the percentage of peripheral blood lymphocytes (t =-2. 51, P = 0. 014) and the levels of alanine aminotransferase (ALT) (Z = 4. 93, P < 0. 001) , aspartate aminotransferase (AST) (Z = 5. 34, P < 0. 001) , gamma-glutamyl transpeptidase (Z =5. 26, P < 0. 001) , and alkaline phosphatase (ALP) (Z = 5. 29, P < 0. 001) . The logistic regression analysis showed that AST (OR =1. 008, 95% CI: 1. 003-1. 012, P < 0. 001) and ALP (OR = 1. 008, 95% CI: 1. 003-1. 013, P = 0. 001) were independent risk factors for the increase in total bilirubin (TBil) . Conclusion Liver injury associated with acute EBV infection mainly manifests as increases in ALT and AST, and common clinical manifestations include pyrexia, angina, swelling of the tonsil, cervical lymph node enlargement, and splenomegaly. AST and ALP are independent risk factors for the increase in TBil and provide a basis for clinical diagnosis.
- liver diseases /
- herpesvirus 4, human /
- jaundice /
- adult

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参考文献(16)

[1]HE ZX, ZHAO X.Research advances in primary infection of EB virus[J].J China Pediatr Blood Cancer, 2013, 18 (6) :241-244. (in Chinese) 何志旭, 赵星.EB病毒原发性感染研究进展[J].中国小儿血液与肿瘤杂志, 2013, 18 (6) :241-244.

[2]HJALGIRM H, SMEDBY KE, ROSTGAARD K, et al.Infectious mononucleosis, childhood social environment, and risk of Hodgkin lymphoma[J].Cancer Res, 2007, 67 (5) :2382-2388.

[3]TAO Q, YOUNG LS, WOODMAN CB, et al.Epstein-Barr virus (EBV) and its associated human cancer-genetics, epigenetics, pathobiology and novel therapeutics[J].Front Biosci, 2006, 11:2672-2713.

[4]CRUM NF.Epstein Barr virus hepatitis:ease series and review[J].South Med J, 2006, 99 (5) :544-547.

[5]ZHOU Z, LAI N, WANG MT, et al.Etiology and clinical characters of hepatitis caused by non-hepatotropic virus[J].Chin J Hepatol, 2004, 12 (3) :129-130. (in Chinese) 周智, 赖宁, 王明桃, 等.68例非嗜肝病毒所致肝炎患者病因学分析及其临床特点[J].中华肝脏病杂志, 2004, 12 (3) :129-130.

[6]Infection Study Group&National Cooperative Group on EB Virus Infection in Children, Chinese Society of Pediatrics, Chinese Medical Association.Recommendations on principles for the diagnosis and treatment of non-tumor EB virus infection-related diseases in children[J].Chin J Pediatr, 2016, 54 (8) :563-568. (in Chinese) 中华医学会儿科学分会感染学组, 全国儿童EB病毒感染协作组.儿童主要非肿瘤性EB病毒感染相关疾病的诊断和治疗原则建议[J].中华儿科杂志, 2016, 54 (8) :563-568.

[7]CUNHA BA, MICKAIL N, LAGUERRE M.Babesiosis mimicking Epstein Barr Virus (EBV) infectious mononucleosis:another cause of false positive monospot tests[J].J Infetct, 2012, 64 (5) :531-532.

[8]ZHENG JM, ZHANG YX.Clinical analysis of infectious mononucleosis in 70 adult patients[J].Infect Dis Info, 2014, 27 (1) :52-54. (in Chinese) 郑建铭, 张永信.成人传染性单核细胞增多症70例临床分析[J].传染病信息, 2014, 27 (1) :52-54.

[9]CHEN JG, LI HY, LI JF, et al.Clinica I features and treatment of68 cases with EB virus infection in adult[J].Shandong Med J, 2010, 50 (45) :18-20. (in Chinese) 陈进国, 李海燕, 李居富, 等.成人EB病毒感染的临床特点及治疗[J].山东医药, 2010, 50 (45) :18-20.

[10]LIU Y, HANG SQ, LI XH, et al.An investigation of EBV infection in hepatitis patients and their clinical features[J].Chin J Exp Clin Virol, 2005, 19 (2) :109. (in Chinese) 刘雅, 张树琴, 李杏红, 等.肝炎患者EBV感染调查及临床特点分析[J].中华实验和临床病毒学杂志, 2005, 19 (2) :109.

[11]XIE ZD.Relationship between Epstein—Barr virus infection and hepatic lesions in children[J].J Clin Hepatol, 2012, 28 (12) :893-895. (in Chinese) 谢正德.EB病毒感染与儿童肝损害.临床肝胆病杂志, 2012, 28 (12) :893-895.

[12]ZHANG DL, WANG SX, ZHANG ZG, et al.Correlation factors of liver injury in infectious mononucleosis[J].Chin J Postgrad Med, 2012, 35 (31) :32-34. (in Chinese) 张东兰, 王淑香, 张志刚, 等.传染性单核细胞增多症并发肝损害的相关因素分析[J].中国医师进修杂志, 2012, 35 (31) :32-34.

[13]ZHANG XD, HE CN.Research advances in molecular immunology of EB virus[J].Int J Virol, 2007, 14 (2) :27-30. (in Chinese) 张学东, 何春年.EB病毒分子免疫学研究进展[J].国际病毒学杂志, 2007, 14 (2) :27-30.

[14]QIANG CQ, JING GH, XU XC, et al.Analysis on the clinical characteristics and prognosis of 104 patients with liver function damage caused by Epstein-Barr virus infection[J/CD].Chin J Exp Clin Infect Dis:Electronic Edition, 2014, 8 (3) :410-413. (in Chinese) 强春倩, 荆国红, 徐学彩, 等.104例EB病毒感染肝功能损害患者的临床特点及预后分析[J/CD].中华实验和临床感染病杂志:电子版, 2014, 8 (3) :410-413.

[15]KOGTERIDIS DP, KOULENTAKI M, VALACHIS A, et al.Epstein Barr virus hepatitis[J].Eur J Intern Med, 2011, 22 (1) :73-76.

[16]VINE LJ, SHEPHERD K, HUNTER JG, et al.Characteristics of Epstein-Barr virus hepatitis among patients with jaundice or acute hepatitis[J].Aliment Pharmacol Ther, 2012, 36 (1) :16-21.

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