摘要
目的探讨儿童传染性单核细胞增多症(IM)临床表现及外周血Th1/Th2型细胞标志物与EB病毒(EBV)-DNA载量的关系。方法选择2019年12月—2021年5月在苏州市第九人民医院和苏州市吴江区儿童医院就诊的IM患儿,共纳入研究63例,根据患儿的EBV-DNA载量(中位水平),分为高载量组(31例)和低载量组(32例),比较两组患儿的临床特征、T淋巴细胞亚群水平(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))、Th1/Th2型细胞标志物(IFN-γ、IL-4)水平及肝功能,并分析EBV-DNA载量与T淋巴细胞亚群水平及Th1/Th2型细胞标志物的相关性。记录患儿住院时间及转归情况。结果高载量与低载量组患儿的发热、咽峡炎、颈部淋巴结肿大、皮疹发生例数比较差异无统计学意义(P>0.05),高载量组患儿的肝脾肿大、眼睑水肿发生率高于低载量组(P<0.05);高载量组患儿的CD3^(+)、CD8^(+)、AST、ALT、IL-4水平均高于低载量组,CD4^(+)、CD4^(+)/CD8^(+)、IFN-γ水平低于低载量组(P<0.05);CD3^(+)、CD8^(+)、IL-4水平与EBV-DNA载量呈正相关(P<0.05),CD4^(+)、CD4^(+)/CD8^(+)、IFN-γ水平与EBV-DNA载量呈负相关(P<0.05);高载量组患儿的住院时间较低载量组长(P<0.05);复诊时发现,高载量组患儿的EBV-DNA载量阳性例数、颈部淋巴结肿大例数均高于低载量组,差异有统计学意义(P<0.05),两组肝脾肿大例数比较,差异无统计学意义(P>0.05)。结论IM患儿多出现发热、咽峡炎和颈部淋巴结肿大等临床症状,EBV-DNA高载量患儿临床症状更严重,免疫功能更紊乱;EBV-DNA载量及Th1/Th2型细胞标志物的检测对IM病情诊断及对病情严重程度了解具有重要意义。
Objective To examine the clinical manifestations of infectious mononucleosis(IM)in children and the relationship between peripheral blood Th1/Th2 markers and EBV-DNA load.Methods A total of 79 children with IM treated in Wujiang District Children's Hospital,Suzhou,were enrolled between December 2019 and May 2021.The EBV-positive children were assigned to high viral-load group(n=31)or low viral-load group(n=32)according to the median level of EBV-DNA load.The clinical characteristics,levels of T lymphocyte subsets(CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+))and Th1/Th2 markers(IFN-γ,IL-4),and liver function tests were compared between the two groups.The correlation between EBV-DNA load and T lymphocyte subsets,Th1/Th2 markers was analyzed.The length of hospital stay and outcomes of patients were recorded.Results The prevalence of fever,angina,cervical lymphadenopathy,or rash did not show significant difference between high viral-load group and low viral-load group(all P>0.05).The prevalence of hepatosplenomegaly and eyelid edema in high viral-load group was significantly higher than that in low viral-load group(P<0.05).High viral-load group showed significantly higher levels of CD3^(+),CD8^(+),AST,ALT and IL-4,but significantly lower levels of CD4^(+),CD4^(+)/CD8^(+)and IFN-γthan low viral-load group(all P<0.05).CD3^(+),CD8^(+)and IL-4 levels were positively correlated with EBV-DNA load(all P<0.05),while CD4^(+),CD4^(+)/CD8^(+)and IFN-γlevels were negatively correlated with EBV-DNA load(all P<0.05).The length of hospital stay in high viral-load group was longer than that in low viral-load group(P<0.05).At follow-up visit,the prevalence of positive EBV-DNA load and cervical lymphadenopathy in high viral-load group was significantly higher than that in low viral-load group(P<0.05),but the prevalence of hepatosplenomegaly did not show significant difference between the two groups(P>0.05).Conclusions The clinical symptoms such as fever,angina,cervical lymphadenopathy are prevalent in children with IM.High EBVDNA load w
作者
沈燕
陆建春
冯妍
沈晨涛
蒋雯
SHEN Yan;LU Jianchun;FENG Yan;SHEN Chentao;JIANG Wen(Department of Pediatrics,Suzhou Ninth People's Hospital,Suzhou Jiangsu 215200,China)
出处
《中国感染与化疗杂志》
CAS
CSCD
北大核心
2023年第3期318-322,共5页
Chinese Journal of Infection and Chemotherapy
基金
苏州市吴江区“科教兴卫”(WWK202035)。
