EB病毒相关噬血细胞性淋巴组织细胞增生症患儿的EB病毒感染特征

Characteristics of Epstein-Barr Virus Infection in Children with Epstein-Barr Virus-Associated Hemo-phagocytic Lymphohistiocytosis

目的了解儿童EB病毒(EBV)相关噬血细胞性淋巴组织细胞增生症(EBV-HLH)患儿的EBV血清学抗体及病毒复制水平等特征。方法对67例EBV-HLH患儿和60例原发性EBV感染所致的传染性单核细胞增多症(EBV-IM)患儿的临床资料进行分析,EBV特异性抗体和血清EBV DNA载量分别采用间接免疫荧光法和荧光定量PCR测定。结果 EBV-HLH患儿EBV特异性抗体结果:EBV-CA-IgM、EBV-CA-IgG、EBV-EA-IgG和EBV-NA-IgG的阳性率分别为28.8%、100.0%、51.5%和78.8%,EBV-VCA-IgG高亲和力为78.9%,低亲和力为12.1%;血清学抗体结果显示,71.2%的患儿为EBV再激活感染,其余为急性原发EBV感染;45.5%的EBV-HLH患儿可在血清中检测到EBV DNA,其拷贝数中位数为1.976×103copies.L-1。EBV-IM患儿的EBV-CA-IgM、EBV-CA-IgG、EBV-EA-IgG和EBV-NA-IgG阳性率分别为100.0%、100.0%、58.3%和26.7%,EBV-VCA-IgG高亲和力为18.3%,低亲和力为81.7%,EBV DNA阳性率为10.0%,DNA拷贝数均值为8.495 copies.L-1。IM患儿均为EBV原发感染状态。结论EBV-HLH可发生在EBV原发感染或既往EBV感染再激活时期,但多数患儿由既往EBV感染再激活所致。EBV-HLH患儿血清中EBV复制水平显著高于EBV-IM患儿。

HUANG Zhi - zhuo ,XIE Zheng - de, YAN Jing , GA0 Li - wei , LIU Chun -yan, SHEN Kun - ling （Pediatric Research Institute of Virology Laboratory, Beijing Children＇s Hospital Affiliated to Capital Medical University, Beijing 100045, China） Abstract： Objective To evaluate the characteristics of Epstein - Barr virus （ EBV ） serological profiles and DNA replication levels in children with EBV associated hemophagocytic lymphohistiocytosis （ EBV - HLH ）. Methods The clinical data of 67 children with EBV - HLH and 60 children with primary EBV - associated infectious mononucleosis （ EBV - IM） were analyzed. EBV specific antibodies and serum EBV DNA were measured by means of indirect immunofluorescence assay and polymerase chain reaction, respectively. Results The EBV specific antibodies of children with EBV - HLH were indicated. The positive rates of EBV - CA - IgM, EBV - CA - IgG, EBV - EA - IgG and EBV - N A - IgG were 28.8%, 100.0% ,51.5% and 78.8% , respectively. The rate of high - avidity antibodies against EBV - VCA was 78.9% and the rate of low - avidity antibodies was 12.1%. Results of serologic antibodies showed that 71.2% of the children were EBV reactivate infection, while the rest of them were primary EBV infection;The serum EBV DNA could be detected from 45.5% children with EBV - HLH,and the median of DNA copies were 1. 976 ~ 103 copies ~ L i. The positive rates of EBV - CA - IgM, EBV - CA - IgG, EBV - EA - IgG and EBV - NA - IgG of the EBV - IM children were 100.0% , 100.0% , 58.3% and 26.7% ,respectively. The rate of high - avid- ity antibodies against EBV - VCA was 18.3% and the rate of low - avidity antibodies was 81.7%. The positive rate of EBV DNA was 10.0% ,the mean DNA copies were 8. 495 copies . L-1. All IM children were caused by EBV primary infection. Conclusions EBV - HLH may occur in different stages of EBV infection, and most children with EBV - HLH are the reactivation of past EBV infection. The serum EBV copy level in EBV - HLH children is significantly higher than that of EBV - IM children.