人微小病毒B19感染与儿童噬血细胞综合征相关性研究

Clinical study of human parvovirus B19infection in children with hemophagocytic syndrome

目的探讨儿童噬血细胞综合征(hemophagocytic syndrome,HPS)的临床特征及其与人微小病毒B19(human parvovirus B19,HPVB19)感染的相关性。方法选择2013-04-01-2014-03-31郑州大学第一附属医院入院且初诊为HPS的65例患儿作为HPS组,选择同期该院体检的65名健康儿童作为对照组,收集两组儿童的相关临床及实验室检查资料。采用酶联免疫吸附检测(enzyme-linked immunosorbent test,ELISA)和荧光定量PCR法对HPS组和对照组儿童进行HPVB19-IgM、IgG和HPVB19-DNA检测,并分析两组患儿的临床和实验室特征。结果 HPS组HPVB19-IgM阳性率为26.15%(17/65),明显高于对照组的9.23%(6/65),χ2=6.392,P=0.011;HPS组HPVB19-IgG阳性率为38.46%(25/65),与对照组29.23%(19/65)比较,差异无统计学意义,χ2=1.237,P=0.266;HPS组HPVB19感染率为21.54%(14/65),与对照组的3.08%(2/65)比较,差异有统计学意义,χ2=10.263,P=0.001。临床特征分析结果显示,HPVB19感染(P=0.003)、血小板计数(PLT)≤100×109 L-1(P<0.001)、血红蛋白(Hb)≤90g/L(P<0.001)、中性粒细胞计数(NE)≤1.5×109 L-1(P<0.001)和纤维蛋白原(FIB)≤1.5g/L(P<0.001)是发生HPS的危险因素,而血清铁蛋白(SF)≤500ng/mL(P<0.001)和甘油三酯(TG)≤2.0mmol/L(P<0.001)是发生HPS的保护因素。Logistic回归分析显示,两组的临床特征差异无独立性。结论儿童HPS发病与临床多种因素有关,HPVB19感染可能是其致病因素之一。

OBJECTIVE To study the epidemiological and clinical features of children with hemophagocytic syndrome （HPS） infected human parvovirus B19 （HPVB19）. METHODS Sixty-five children diagnosed with HPS and 65 healthy children in the First Affiliated Hospital of Zhengzhou University from April 1,2013 to March 31,2014 were collected, and the relevant clinical and laboratory data of tow groups were simultaneously collected. Enzyme Linked Immunosorbent Assay （ELISA） and Flu- orescence quantitative PCR were used to detect HPVB19-IgM, lgG and HPVB19-DNA in two groups, and the clinical features and laboratory characteristics of two groups were analyzed. RESULTS In HPS group, HPVB19-IgM positive rate was 26. 15% （17/65）, and significantly higher than 9.23% （6/65） in the control group （ X2 = 6. 392, P= 0. 011）. HPVB19-IgG positive rate of HPS group was 38. 46%（25/65）,compared with the control group 29. 230/00 （19/65）,the difference was not statistically signifi cant （X2=1. Z37, P = 0. 266）. HPVB19 infection rate of HPS group was 21.54% （14/65）, compared with the control group 3.08% （2/65）,the difference was statistically significant （X2=10. 263, P = 0. 001）. Results of clinical characteristics analysis showed that the infection of HPVB19 （P = 0. 003 ）, platelet count （PLT） 4 100×109 L-1 （ p〈 0. 001 ）, hemoglobin （Hb） 490 g/L （P〈0. 001） ,neutrophil （NE）41.5×109 L-1 （P〈0. 001） ,fibrinogen （FIB）41.5 g/L （P〈0. 001）were the risk fac- tors for the occurrence of HPS. Serum ferritin （SF）4500 ng/mL,triglyceride （TG） 42 mmol/L were protective factors for HPS （all P values〈0. 001）. Logistic regression analysis showed that differences of clinical characteristics were no independence in tow groups. CONCLUSION Children with HPS are associated with clinical factors, HPVB19 infection and the pathogenesis of in chil- dren with HPS may be related.