EBV DNA检测在小儿EBV感染相关疾病诊断中的意义

EBV DNA detection in the diagnosis of Epstein-Barr virus infection realated diseases in children

目的探讨EB病毒（EBV）DNA检测在小儿EBV感染相关疾病诊断中的应用价值。方法。回顾性队列研究。收集2012年6月至2013年8月在山东省立医院就诊的临床诊断为EBV感染的222例患儿血液标本，实时荧光定量PCR（FQ—PCR）检测外周血淋巴细胞EBVDNA、同时使用ELlSA方法检测患者血清中EBV4项抗体，2组结果进行比对。同时也对AST、ALT、血尿素氮（BUN）、肌酐（CREA）、肌酸激酶（CK）及肌酸激酶同工酶（CKMB）等生化结果按照EBVDNA拷贝数的高低分组，并采用SPSS21．0统计软件对各生化指标进行非参数检验及相关性统计学分析。结果EBV．CAIgM阳性检出率为51．35％（114／222），EBVDNA阳性检出率为72．97％（162／222），x2=24．01，P〈0．001，差异具有统计学意义。处于不同感染阶段的患儿EBVDNA拷贝数（既往无感染：6．30×10^3-1．20×10^4拷贝数／ml：早期感染期：5．56×10^3-3．92×10^4拷贝数／ml；急性感染期：6．58×10^3～1．73×10^6拷贝数／ml；慢性感染期或感染后复发：8．92×10^3-2．34×10^4拷贝数／ml；感染晚期或恢复期：5．20×10^3～1．12×10^7拷贝数／ml；既往感染：5．46×10^3-1．33×10^4拷贝数／m1）之间有显著性差异（x2=11．79，P〈0．05）。按患儿EBVDNA拷贝数的高低分为I（〉1×10^6拷贝数／m1）、II（1×10^5-1×10^6拷贝数／m1）、Ⅲ（1×10^4～1×10^5拷贝数／m1）、IV（5×10^3～1×10^4拷贝数／m1）、V（〈5×10^3拷贝数／m1）组，不同组之间ALT（x2=10．14，P〈0．05）、BUN（x2=18．17，P〈0．05）、CK（x2=13．09，P〈0．05）、CKMB（x2=17．93，P〈0．01）的差异具有统计学意义，且EBVDNA拷贝数对数值与AST（r=0．357，P=0．001）、ALT（r=0．376，P=0．001）、BUN（r=0．329，P=0．000）、CK（r=0．235，P=0．035）之间有一定的正相关性。结论EBVDNA检测可用于小儿EBV感染相关疾病的早期诊断及病情的评估，肝、肾功能及心肌酶谱的检测对判断EBV感染严重程度有一定的参考价值。

Objective To investigate the clinical significance of Epstein-Barr virus EBV DNA in children with Epstein-Barr virus infection realated diseases. Methods A retrospective cohort study was performed. Totally 222 blood samples were collected from children who were diagnosed as EBV infection in Shandong Provincial Hospital from June 2012 to August 2013. Fluorescent quantitative PCR （FQ-PCR）was used to analyze the EBV DNA in peripheral blood lymphocytes. ELISA was used to analyze the four EBV serology antibodies in the serum. Two groups of tested results were compared. Heart, hepatic impairment and renal function were analyzed through detecting AST, ALT, BUN, CREA, CK, CKMB. The results were grouped by EBV DNA copy number, and then non-parametric test together with correlation analysis was performed using SPSS21.0 analytics software. Results The positive rate of EBV-CA IgM and EBV DNA was 51.35% （114/222） and 72. 97% （162/222） respectively, X2 = 24. 01, P 〈 0. 001. The EBV DNA copy number was significant difference （ x2 = 11.79, P 〈 O. 05 ） in children at different stages of infection （no previous infection：6. 30×10^3 - 1.20 ×10^4 copies/ml; early infection：5.56 ×10^3 - 3.92×10^6 copies/ ml;aeute infection：6, 58 ×10^3 - 1.73 ×10^6 copies/ml;chronic infection or recurrent infection：8.92 ×10^3 - 2. 34×10^4 eopies/ml;late infection or recovery：5.20 ×10^3 - 1. 12×10^7 copies/ml;past infection：5.46 ×10^3 - 1.33×10^4 copies/ml）. Each biochemical targets were divided into five groups by EBV DNA copy number （ I 〉1 ×10^6 copies/ml, III ×10^5 -1 ×10^6 copies/ml, 111 1×10^4 -1 ×10^5 copies/ml, 1V 5 ×10^3 - 1 ×10^4 copies/ml, V 〈 5 ×10^3 copies/ml）, and ALT （ X1= 10. 14, P 〈 0.05 ）, BUN （ X2 = 18.17, P 〈 O. 05）, CK （ X： = 13.09, P 〈 O. 05 ）, CKMB （ X： = 17.93, P 〈 0. O1 ） had a statistically significant difference between each group. Well, the log value of EBV DNA copy number had a positive correlation relationship with AST（ r = O. 357, P = O. 001 ）, ALT （ r = 0. 376, P = O. 001 ）, BUN （ r = O. 329, P = 0. 000 ）, CK（ r = O. 235,P = O. 035）. Condusions Detection of EBV DNA can be used for the early diagnosis and assessment of process of the EBV infection related disease in children. The detection of liver, kidney function and myocardial enzymes can be used for evaluating the severity of EBV infection.