儿童外周血单个核细胞EB病毒DNA和血清抗体的检测结果分析

Analysis of the results of Epstein-Barr virus DNA from peripheral blood mononuclear cell and serum antibodies in children

目的 分析儿童外周血单个核细胞（peripheral blood mononuclear cell,PBMC）epstein-barr病毒（epstein-barr virus,EBV） DNA和血清EBV抗体（VCA-IgG、EBNA-IgG、EBV-IgM和EA-IgG）检测在儿童EBV感染疾病诊断中的价值.方法 回顾性分析2015年4月-2016年12月就诊的1 363名儿童的PBMC EBV-DNA和EBV抗体检测结果.采用ROC曲线评价DNA检测和血清抗体检测对EBV感染的诊断价值.比较EBV-DNA阳性率和载量在原发感染组、复发感染组、隐性感染组和相关临床疾病组间的差异.分析隐性感染患儿发病后,不同的抗体谱模式与病毒载量增长之间的关联.结果 （1） EBV-DNA诊断EBV现症感染效果最佳,ROC曲线下面积为0.729（0.682,0.777）;VCA-IgG检测EBV隐性感染的效果最佳,ROC曲线下面积是0.862（0.839,0.885）.（2）现症感染组的PBMC EB-DNA检测阳性率（75.89％）高于隐性感染组（48.14％）,有统计学差异（x2=30.75,P＜0.001）;现症感染组的PBMC EB-DNA病毒载量高于隐性感染组,差异有统计学意义（Z=5.88,P＜0.001）.临床诊断为EB病毒感染、传染性单核细胞增多症与嗜血细胞增多症的患儿的EBV-DNA载量差异有统计学意义（Z=6.73,P=0.035）.（3）隐性感染患儿发病后,不同抗体谱模式之间,病毒载量增长的差异无统计学意义（Z=10.46,P=0.106）.结论 PBMC EBV-DNA和EBV抗体检测可为儿童EB病毒感染及相关疾病诊断提供实验室参考依据.

Objective To explore the values of Epstein-Barr virus （EBV） DNA testing for peripheral blood mononuclear cell （PBMC） and serum EBV antibody testing （VCA-IgG,EBNA-IgG,EBV-IgM and EA-IgG） in the diagnosis of EBV infection among children.Methods The test results of PBMC EBV-DNA and EBV antibodies in 1 363 children who visited the hospital from April 2015 to December 2016 were collected and analyzed.The ROC curve was drawn to evaluate the diagnostic values of EBV-DNA and EBV antibody testing in EBV infections.The EB viral load values and positive rates in primary infection group,recurrent group and recessive infection group,as well as related diseases group were compared.The relationship between different antibody spectrum models and elevation of viral load after disease onset in patients with recessive infection was also analyzed.Results （1） The area under ROC curve in present EBV infection showed that EBV-DNA was the best [EBV-DNA,0.729 （0.682,0.777）].The VCA-IgG was the best for the diagnosis of EBV recessive infections with the area under ROC curve of 0.862 （0.839,0.885）.（2） The PBMC EBV positive rate was higher in current infection group than that in recessive infection group （75.89% vs 48.14%,x2=30.75,P〈0.001）.The viral load in the current infection group was significantly higher than that in recessive infection group （Z=5.88,P〈0.001）.The EBV-DNA loads among children with clinically diagnosed EBV infection,infectious mononucleosis and hemophagocytic syndrome showed statistically significant difference （Z=6.73,P=0.035）.（3） Among patients with recessive infection,elevations of viral load with different antibody spectrum models after disease onset showed no statistically significant difference （Z=10.46,P=0.106）.Conclusions EBV-DNA detection and antibody spectrum detection are of significant value for the clinical diagnosis of EBV infection.