传染性单核细胞增多症并发肝损害的相关因素分析

Correlation factors of liver injury in infectious mononucleosis

目的探讨传染性单核细胞增多症（IM）并发肝损害的相关因素，为IM并发肝损害发生的防治提供参考。方法共纳入175例IM儿童患者，按照其是否发生肝损害分为两组，其中85例并发肝损害为病例组，90例未并发肝损害为对照组，应用非条件Logistic回归进行单因素及多因素分析。结果单因素分析结果表明：两组间年龄≥6岁、男性、病程、病情（累及器官≥2个）、发热时间、最高体温、白细胞（WBC）、C反应蛋白（CRP）、CD4＋、CD8＋,CD4＋／CD8＋、EB病毒．衣壳抗原EBV-CA-IgM抗体阳性及红细胞沉降率增快比较差异有统计学意义（P〈0．05），其中年龄≥6岁、男性、病程、病情（累及器官1〉2个）、发热时间、最高体温、WBC、CRP、CD8＋、抗EBV-CA-IgM抗体阳性及红细胞沉降率增快与IM并发肝损害呈正相关，而CD4＋、CD4＋／CD8＋与IM并发肝损害呈负相关。进一步行多因素分析结果表明：病情（累及器官≥2个）、CDs＋高为IM并发肝损害的独立危险因素，而CD4＋高、CD4＋／CD8＋高为IM并发肝损害的保护因素（P〈0．05）。结论病情（累及器官≥2个）、CDs＋高为IM并发肝损害的独立危险因素，而CD4＋高、CD4＋／CD8＋高为IM并发肝损害的保护因素，因此在临床工作中，积极抗病毒治疗的同时，可以使用免疫调节剂等对上述因素进行必要的干预。

Objective To investigate the correlation factors of liver injury in infectious mononucleosis （IM）. Methods One hundred and seventy-five IM patients were divided into two gToups：IM with liver injury （patient group, 85 cases） and IM without liver injury （control group, 90 cases）. Single factor and multiple factor analysis were completed by unconditional Logistic regression. Results Single factor analysis results showed that there were significance differences between the two groups in age （ ≥ 6 years old）, male, course of disease, severe disease （involving ≥ 2 organs ）, heating time, the peak temperature, white blood cell （WBC） and C reactive protein （CRP）, CD4＋, CD8＋, CD4＋/CD8＋, Epstein-Barr virus （EBV）-capsid antigen （CA）-IgM antibody positive and increased erythrocyte sedimentation rate （ESR） （P 〈 0.05 ）. Age （ ≥ 6 years old）,male,course of disease,severe disease （involving ≥2 organs）,heating time,the peak temperature, WBC,CRP,CD8＋,EBV-CA-IgM antibody positive and increased ESR showed positive correlation with IM combined with liver injury,and CD4＋,CD4VCD8＋ showed negatively correlated with IM combined with liver injury. Multiple factor analysis results showed that severe disease （involving ≥2 organs）, CDs＋ high levels were independent risk factors for IM combined with liver injury, and CDZ high levels and CD4＋/CD8＋ high were protection factors for IM combined with liver injury （P 〈 0.05 ）. Conclusions Severe disease （involving ≥2 organs）,CDs＋ high levels are independent risk factors for IM combined with liver injury,and CD4＋ high levels and CD4＋/CD8＋ high are protection factors for IM combined with liver injury. Therefore,immune modulators should be used to intervene the above factors when patients are treated with antiviral drugs.