三种实验室检测方法在儿童传染性单核细胞增多症的诊断应用

Application of 3 laboratory tests in the diagnosis of infectious mononucleosis in children

目的探讨EB病毒-DNA(Epstein-Barr virus-deoxyribonucleic acid,EBV-DNA)载量、EB病毒(Epstein-Barr virus,EBV)抗CA-Ig M(Ig M to Epstein-Barr viral capsid antigens,CA-Ig M)及异型淋巴细胞计数在儿童传染性单核细胞增多症(infectious mononucleosis,IM)中的诊断意义。方法对116例IM患儿EBV-DNA载量、抗CA-Ig M、异型淋巴细胞计数的敏感性和特异性进行比较。结果IM患儿EBV-DNA载量的敏感性为85.34%,特异性为96.00%;抗CA-Ig M的敏感性为84.48%,特异性为94.00%;外周血异淋细胞比例≥10%占39.66%,特异性为100.00%。抗CA-Ig M联合异型淋巴细胞检测的敏感性为88.79%,特异性为94.00%。EBV-DNA载量联合异型淋巴细胞检测的敏感性为88.79%,特异性为96.00%。抗CA-Ig M联合EBV-DNA载量检测的敏感性为93.10%,特异性为90.00%。EBVDNA载量和抗CA-Ig M诊断儿童IM的敏感性明显高于异型淋巴细胞检测(χ2分别为46.05和43.61,P<0.05),三者的特异性较高。结论 EBV-DNA载量、抗CA-Ig M和异型淋巴细胞计数两两联合检测,可提高儿童IM的诊断。

Objective To investigate the diagnostic significance of Epstein-Barr virus-deoxyribonucleic acid（EBV-DNA）, EBV CA-Ig M and atypical lymphocytes in children with infectious mononucleosis（IM）.Methods 116 children with IM and 50 healthy controls were studied, and the sensitivity and specificity of EBV-DNA, EBV CA-Ig M and atypical lymphocytes were calculated, and compared. Results The sensitivity of EBV-DNA, EBV CA-Ig M, and atypical lymphocytes in 116 children with IM were 85.34%, 84.48% and39.66%, respectively. The specificity of EBV-DNA, EBV CA-Ig M and atypical lymphocytes were 96.00%,94.00% and 100.00%, respectively. The sensitivity of pair covering test with combined EBV CA-Ig M and atypical lymphocytes, combined EBV-DNA and atypical lymphocytes, or combined EBV CA-Ig M and EBV-DNA was88.79%, 88.79% or 93.10%, respectively. The specificity of pair covering test with combined EBV CA-Ig M and atypical lymphocytes, combined EBV-DNA and atypical lymphocytes, or combined EBV CA-Ig M and EBVDNA was 94.00%, 96.00% or 90.00%, respectively. The sensitivity of EBV-DNA and EBV CA-Ig M were significantly higher than that of atypical lymphocytes（P〈0.05）. All of the 3 methods had high specificity. Conclusion Pair covering test with combined EBV CA-Ig M and atypical lymphocytes, combined EBV-DNA and atypical lymphocytes, or combined EBV CA-Ig M and EBV-DNA may improve the diagnosis of IM in children.