EBV DNA定量检测对儿童传染性单核细胞增多症早期诊断的临床意义

Clinical significance of quantitative detection of Epstein-Barr virus DNA in children with fever for the early diagnosis of infectious mononucleosis

目的探讨实时荧光定量PCR技术(Real-time quantitative PCR,RT-qPCR)检测发热患儿EB病毒(EpsteinBarr virus,EBV)DNA载量对儿童传染性单核细胞增多症(IM)早期诊断的临床意义。方法选择湖南省人民医院儿科2011年5月-2013年5月以发热为主诉的患儿827例为研究对象,采用实时荧光定量PCR技术,对其外周血EBV DNA载量进行检测,同时检测外周血异型淋巴细胞及血清嗜异凝集反应,结合IM首发主要临床表现进行综合分析。结果①827例发热患儿中,外周血细胞EBV DNA阳性176例,阳性率21.3%;②与651例EBV DNA阴性发热患儿比较,EBV DNA阳性发热患儿异淋巴细胞检出率(>10%)及血清嗜异凝集反应阳性率明显高于EBVDNA阴性发热患儿,差异有统计学意义(x^2=113.57、106.10,P<0.01);③与EBVDNA阴性发热患儿比较,EBVDNA阳性发热患儿首发主要临床表现如咽峡炎、淋巴结肿大以及肝脾肿大的阳性率明显高于EBV DNA阴性患儿,且差异均有统计学意义(P<0.01);④176例EBVDNA阳性发热患儿中最终确诊为IM的96例,显著高于EBV DNA阴性组(x^2=390.17,P<0.01)。结论应用实时荧光定量PCR检测EBV DNA载量有助于儿童传染性单核细胞增多症的早期诊断,有助于较早明确发热原因,提高疾病治疗的针对性,对临床诊断治疗有一定指导意义。

Objective To explore the clinical value of real-time quantitative PCR （RT-qPCR） in detecting the Epstein-Barr virus （EBV） DNA load of children with fever for early diagnosis of infectious mononucleosis （IM）.Methods RT-qPCR was used to detect EBV DNA load in peripheral blood of 827 children with fever,who were hospitalized in the People＇s Hospital of Hunan Province from May 2011 to May 2013.Atypical lymphocyte in peripheral blood and serum heterophile agglutination reaction were simultaneously examined,and a comprehensive analysis was conducted through combining with the first major clinical manifestations of EBV infection.Results ① Among 827 children with fever,176 were positive for EBV DNA in peripheral blood,with the positive rate of 21.3％.② The detection rate of atypical lymphocytes and the positive rate of serum heterophile agglutination reaction were significantly higher in EBV DNA-positive children with fever than those in 651 EBV DNA-negative children with fever,and the differences were statistically significant （x2 =113.57,x2 =106.10,P ＜ 0.01）.③ The positive rates of first main clinical manifestations,including angina,swollen lymph nodes and hepatosplenomegaly abnormality in EBV DNA-positive children with fever were significantly higher than those in 651 EBV DNA-negative children with fever,with statistically significant differences （P＜0.01）.@Among 176 EBV DNA-positive children with fever,96 were diagnosed as IM at last and the diagnosis rate was significantly higher than that of EBV DNA-negative children with fever （x2 =390.17,P ＜ 0.01） Conclusions EBV DNA RT-qPCR test contributes to the early diagnosis of EBV infection in children with fever and can enhance the pertinence and validity of the therapy.It has certain guiding significance for clinical diagnosis and treatment.