EB病毒抗-VCA IgM阳性患者病毒标志物及肝功能检查结果分析

Analysis on the virus markers and liver function of patients with EBV-IgM positive

目的探讨EB病毒感染对患者肝功能损坏及预后的影响。方法收集2013年1月至2013年12月因不明原因肝炎就诊患者的EB病毒抗-VCA Ig M及肝功能检查结果,结合2000年9月中华医学会传染病与寄生虫病学分会制定的《病毒性肝炎防治方案》中诊断标准进行回顾性分析。结果对门诊及住院的957例不明原因肝功能损害患者进行EB病毒抗-VCA Ig M及其他病毒标志物的筛查,其中EB病毒抗-VCA Ig M阳性者111例,占总检测例数的11.6%,EBV合并HBV阳性者77例,占阳性例数69.4%;EBV合并HCV阳性者2例,占阳性例数1.8%;EBV合并HEV感染者4例,占阳性例数3.6%;肝功能检查情况:单纯EBV感染(排除甲型、乙型、丙型、丁型和戊型肝炎病毒及MCV病毒感染),ALT、AST轻度或中度上升,TBil正常或稍高值,TP、ALB及PT%均在正常值范围;EB病毒合并其他病毒感染者肝功能损害则比较明显,较多患者出现中度及重度肝损坏,这些患者往往预后较差,并出现重复入院治疗。在对111例EBV阳性住院治疗患者第1、2、3、和4周肝功能及PT%检查结果进行分析,发现单纯EB病毒感染者大部分在治疗第2周肝功能基本恢复正常,EB病毒合并其他病毒感染者则恢复较慢,很多患者至治疗第4周肝功能仍不能恢复正常,病程迁延3个月,甚至半年以上,PT%<60%,并出现血清TP和ALB水平异常,A/G<1.0。结论单纯EBV感染对肝脏损坏程度较轻,治疗后预后较好,尤其是婴幼儿EB病毒感染性肝炎,早期诊断、治疗是关键;EBV合并其他病毒感染(如HBV、HCV和HEV等)引起的肝脏损坏较重,病情较凶险,预后差,故临床发现EBV感染,特别是病毒重叠感染时应引起足够重视。

Objective To explore the impacts of the Epstein-Barr virus（EBV） infection on liver function and the prognosis. Methods The anti-EBV-IgM antibody was detected in patients with abnormal liver function from January 2013 to December 2013. Results There were 111（11.6%） cases with anti-EBV-IgM positive among all the 957 patients with abnormal liver function. During the 111 anti-EBV-IgM positive patients, there were 77（69.4%） cases with HBs Ag positive, 2（1.8%） cases with HCV infection, 4（3.6%） cases with HEV infection. There were mild or moderate elevated ALT and AST in the patients with simple EBV infection, in which with normal or slightly higher TBil, normal TP, ALB and PT%. But in patients suffering from EBV co-infection with other viruses, the liver damage were usually moderate and severe. The liver function recovered after two weeks treatment in the most patients with simple EBV infection. However, the liver funtion could not be normal until 3 months even 6 months after disease attack in those patients suffering from EBV co-infection with other viruses, which with PT% 〈60%, abnormal TP and ALB. Conclusions Liver damage caused by EBV co-infection with other viruses（such as HBV, HCV and HEV, etc.） are more sever than simple EBV infection, whitch should be paied more attention to.