成人EBV感染临床特点及发生噬血细胞综合征的预测因素

doi:10.19871/j.cnki.xfcrbzz.2022.02.008

摘要/Abstract

摘要： 目的分析成人爱泼斯坦-巴尔病毒（EBV）感染患者的临床特点,探讨该类患者发生噬血细胞综合征（HLH）的预测因素。方法收集并分析2016年9月至2021年9月深圳市人民医院收治的成人EBV感染患者的临床资料,根据是否发生HLH分为两组,其中传染性单核细胞增多症（传单）56例（IM组）,传单合并HLH 12例（HLH组）。采用单因素分析及Logistic回归分析筛选出成人EBV感染发生HLH的独立预测因素。结果 68例符合诊断标准的患者纳入研究,其中男性33例,平均（25.1±7.16）岁,女性35例,平均（21.83±9.25）岁。临床表现典型三联症（发热、咽痛、颈淋巴结肿大）的患者37例（54.4%）,血WBC增多26例（38.2%）,淋巴细胞占比（LY%）≥50%有52例（76.5%）,异型LY%≥10%有20例（统计46例,43.5%）,肝损伤61例（89.7%）,脾大43例（63.2%）,肝脏肿大9例（13.2%）,EBV脱氧核糖核酸（EBV DNA）定量中位数5.59×10³copies/ml。两组性别、年龄比较,发热、咽痛症状占比,淋巴结肿大、脾大、皮疹体征占比,血WBC升高及在正常范围占比,血红蛋白（HGB）下降占比,异型LY%≥50%占比、LDH≥1000U/L占比和ALT升高分别大于5倍和10倍正常值占比比较差异均无统计学意义（P>0.05）。PLT降低占比,LY%≥50%占比,血清铁蛋白（SF）升高占比（分别进行了>500、800、1000、1500μg/L分析）,ALT/AST≤1占比和EBV DNA≥1.0×10⁵copies/ml占比比较差异均有统计学意义（P<0.05）。logistic回归分析显示患者年龄、血WBC<4×10⁹/L、PLT<100×10⁹/L、LY%≥50%、ALT/AST≤1、EBV DNA≥1.0×10⁵copies/ml是成人EBV感染发生HLH的独立预测因素（OR=1.111,P=0.009;OR=0.033,P=0.027;OR=0.967,P<0.001;OR=0.890, P<0.001;OR=0.006,P=0.001;OR=1.000,P=0.019）。结论成人EBV感染患者临床症状不典型;患者年龄、 WBC<4×10⁹/L、PLT<100×10⁹/L、LY%≥50%、ALT/AST≤1、EBV DNA≥1.0×10⁵copies/ml是成人EBV感染发生HLH的独立预测因素。

关键词: 爱泼斯坦-巴尔病毒, 传染性单核细胞增多症, 成人, 噬血细胞综合征, 预测因素

Abstract: Objective To analyze the clinical features in adult patients admitted to our hospital with infection of Epstein-Barr virus (EBV) and explore the predictive factor of hemophagocytic Lymphohistiocytosis(HLH). Method The cli-nical data of adult patients with infection of EBV treated in the Shenzhen People's Hospital from September 2016 to September 2019 were collected and analyzed. The patients were divided into two groups, including 56 cases of infectious mononucleosis（IM）,12 cases of combined with HLH. Univariate analysis and logistic regression analysis were conducted to identify independent predictive factors for HLH in adults with infection of EBV. Result A total of 68 patients were analyzed, including 33 males [mean age (25.1±7.16) years] and 35 females [mean age (21.83±9.25) years]. Thirty-seven patients(30.6%) had typical triads (fever, sore throat, cervical lymphadenopathy).Increased WBC count was found in 26 cases (38.2%), lymphocyte ratio(LY%)≥50% in 52 cases (76.5%), abnormal lymphocyte ratio≥10% in 20 cases (46 cases accounted for analysis, 43.5%), liver injury in 61 cases (89.7%),spleen enlargement in 43 cases(63.2%), liver enlargement in 9 cases (13.2%). The median value of EBV-deoxyribonucleic acid(EBV DNA) was 5.59×10³copies/ml. There was no statistically significant difference in sex, age, the proportion of fever and sore throat symptoms, the proportion of lymphadenectasis、splenomegaly or rash, the proportion of leukocytosis, the proportion of WBC in the normal range, the proportion of a decrease in hemoglobin(HGB), the proportion of abnormal lymphocyte ratio≥10%, the proportion of LDH≥1000U/L and the proportion of alanine ALT≥5 and 10 times the normal value between the two groups (P>0.05). There have statistically significant differences in the PLT decreased, the proportion of the (LY%≥50%, the proportion of serum ferritin increased(respectively greater than 500, 800, 1000, 1500μg/L accounted for analysis), the proportion of ALT/AST≤1, the proportion of EBV DNA≥1.0×10⁵copies/ml between the two groups(P<0.05). Logistic regression analysis showed that patient age, WBC<4×10⁹/L, PLT<10×10⁹/L, LY%≥50%, ALT/AST≤1 and EBV DNA≥1.0×10⁵copies/ml were independent predictive factor for HLH in adults with infection of EBV(OR=1.111, P=0.009; OR=0.033, P=0.027; OR=0.967,P<0.001;OR=0.890,P<0.001; OR=0.006,P=0.001; OR=1.000,P=0.019）. Conclusion Adult persons with infection of EBV had atypical symptoms. Patient age, WBC<4×10⁹/L, PLT<10×10⁹/L, LY%≥50%, ALT/AST≤1 and EBV DNA≥1.0×10⁵copies/ml were independent predictive factor for HLH in adults with infection of EBV.

Key words: Epstein-Barr Virus, Infectious mononucleosis, Adults, Hemophagocytic lymphohistiocytosis, Predictive factors

杨智, 吴伟刚, 欧鹏程, 李斌, 杨桂林. 成人EBV感染临床特点及发生噬血细胞综合征的预测因素[J]. 新发传染病电子杂志, 2022, 7(2): 35-40.

Yang Zhi, Wu Weigang, Ou Pengcheng, Li Bin, Yang Guilin. Clinical features in adult patients with infection of Epstein-Barr virus and predictive factors for hemophagocytic lymphohistiocytosis[J]. Electronic Journal of Emerging Infectious Diseases, 2022, 7(2): 35-40.

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