儿童噬血细胞综合征与人微小病毒B19感染的相关性及临床特征分析

Clinical features of childhood hemophagocytic syndrome and its association with human parvovirus B19 infection

目的探讨儿童噬血细胞综合征(HPS)与人微小病毒B19(HPVB19)感染可能存在的相关性,并对其临床特征进行分析。方法采用酶联免疫吸附试验(ELISA)和荧光定量PCR法对65例HPS患儿(HPS组)及65例健康体检儿童(对照组)进行HPVB19 Ig M、Ig G及HPVB19 DNA检测,并根据HPVB19DNA检测结果将HPS患儿分为HPVB19感染组(n=14)和非感染组(n=51),比较两组患儿临床资料。结果 HPS组HPVB19-Ig M阳性率(26%,17/65)显著高于对照组(9%,6/65)(P=0.011);而HPVB19-Ig G阳性率(38%,25/65)与对照组(29%,19/65)比较差异无统计学意义(P=0.266)。HPS组HPVB19感染率(22%,14/65)明显高于对照组(3%,2/65)(P=0.001)。与HPVB19非感染组HPS患儿比较,感染组患儿入院时血小板计数与血红蛋白水平显著降低,肝功能损伤更严重,发病时间更早,病程迁延时间更长(均P<0.05)。结论 HPVB19感染与HPS发病可能具有相关性。HPVB19感染的HPS患儿起病更急,临床表现更为严重,病程迁延时间更长。

Objective To investigate the association of childhood hemophagocytic syndrome （HPS） with human parvovirus B19 （HPVB19） infection, and to analyze the clinical features of this disease. Methods ELISA and quantitative real-time PCR were used to detect HPVB19-IgM, HPVB19-IgG and HPVB19-DNA in 65 children with HPS （HPS group） and 65 healthy children （control group）. The HPS group was divided into HPVB19-infected （n=14） and non-infected （n=51） groups according to the detection results of HPVB19-DNA. The clinical data of two groups were compared. Results The positive rate of HPVB19-IgM in the HPS group （26%, 17/65） was signiifcantly higher than that in the control group （9%, 6/65） （P=0.011）, and there was no signiifcant difference in the positive rate of HPVB19-IgG between the HPS （38%, 25/65） and control groups （29%, 19/65） （P=0.266）. The infection rate of HPVB19 in the HPS group （22%, 14/65） was signiifcantly higher than that in the control group （3%, 2/65） （P=0.001）. Compared with the non-infected group, the HPVB19-infected group had signiifcantly lower platelet count and hemoglobin level on admission, signiifcantly more severe liver function damage, a signiifcantly earlier onset time, and a signiifcantly longer course of disease （P〈0.05）. Conclusions The pathogenesis of HPS may be associated with HPVBl9 infection. HPVBl9-infected children with HPS have more acute onset, more severe clinical manifestations, and a longer disease duration.