儿童慢性活动性EB病毒感染的临床分析

Clinical analysis of chronic active epstein-barr virus infection in children

目的研究儿童慢性活动性EB病毒感染（CAEBV）的临床特征，为CAEBV的诊治提供依据。方法回顾性分析2008年1月至2016年1月在我院收治的10例CAEBV患儿的临床资料、实验室血清学、病理学检查和治疗及随访结果。结果儿童CAEBV主要临床表现为持续或间断发热、肝脾肿大和淋巴结肿大，其他还伴有乏力、咳嗽、呕血、腹泻、皮疹、视网膜炎、黄疸、咽痛、肌肉关节痛等。多有肝功能和血液学异常等。所有患者均有抗EB病毒衣壳抗原IgG（VCA-IgG）抗体和早期抗原EA-IgG抗体阳性，抗EB病毒衣壳抗原IgM（VCA-IgM）抗体均为阴性。实时定量聚合酶链反应检测外周血EBV-DNA病毒载量中位数为7.15×105 copies/ml。随访10例CAEBV患儿中，死亡6例，死亡原因分别为颅内出血1例、呼吸衰竭2例、消化道出血1例、肝衰竭1例，多重感染1例；3例好转，1例病情仍有反复。结论CAEBV临床表现多样，预后差，病死率高，临床上存在不明原因的发热、肝脾或淋巴结肿大的病例应及时行病毒学及组织病理学检查以尽早确诊。

Objective To study the clinical characteristics of chronic active Epstein-Barr virus（EBV） infection （CAEBV） in children and to provide a basis for the diagnosis and treatment of CAEBV.Methods Clinical data, laboratory serology, pathological examination, treatment and follow-up results of 10 cases with CAEBV infection who were treated in Xijing Hospital of the Fourth Military Medical University from January 2008 to January 2016 were analyzed retrospectively.Results CAEBV major manifestations were continuous or intermittent fever, hepatomegaly, splenomegaly and lymphadenopathy, and others, including general fatigue, cough, hematemesis, diarrhea, skin rash, jaundice, sore throat, muscle joint pain, and so on.And with liver dysfunction, hematologic abnormality, and so on.All patients in anti-EB virus capsid antigen IgG（EBVCA-IgG ） antibodies and EBEA-IgG antibodies had positive, while all patients in EBVCA-IgM antibodies had negative.The median load of EBV-DNA detected by real- time polymerase chain reaction（PCR ） in the peripheral blood was 7.15×105 copies/ml.Six of 10 cases CAEBV patients presented a poor clinical course, 1 case died from intracranial hemorrhage, 2 cases from respiratory failure, 1 case from gastrointestinal bleeding, 1 case from liver failure, 1 case from severe multiple pathogens infection, rest 3 cases showed an improvement and 1 cases had a recurrence.Conclusion CAEBV infection has varieties of clinical features, with poor prognosis and high mortality.If the patients had unexplained fever, hepatomegaly, splenomegaly and lymphadenectasis, we should be timely detect virology and histopathological to diagnosis as early as possible.