EB病毒感染患儿凝血和免疫功能相关指标分析及临床意义

Coagulation and immunological indexes in children with Epstein-Barr virus infection and its clinical significance

目的分析EB病毒(EBV)感染患儿的凝血功能和免疫功能相关指标的变化及其临床意义。方法选取青海红十字医院于2017年2月至2018年2月收治的82例EBV感染患儿为病例组,同时选取于本院体检的健康儿童82例为健康对照组。采集血液样本,分别检测和比较病例组和对照组患儿凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、纤维蛋白原(FIB)、D-D二聚体(D-D)等凝血指标和IgG、IgM、IgA、CD4^+T细胞等免疫指标水平。结果EBV感染患儿TT、PT、APTT分别为(19.31±2.72)s、(15.93±1.96)s和(40.43±5.68)s,均显著长于对照组[(16.65±2.10)s、(13.46±1.72)s、(37.15±5.14)s,t=7.010、8.577、3.877,P均=0.001];FIB水平亦显著低于对照组[(1.17±0.19)g/Lvs.(1.53±0.21)g/L,t=11.511、P=0.001)],D-D二聚体水平显著高于对照组[(0.76±0.11)mg/Lvs.(0.16±0.06)mg/L,t=43.362、P<0.001];PLT水平较对照组显著下降[(105.32±13.54)×10^9/Lvs.(177.47±14.27)×10^9/L;t=33.213、P<0.001),而PDW和MPV水平显著高于对照组[(30.43±2.89)flvs.(18.92±3.14)fl,t=24.423、P<0.001;(35.13±2.79)flvs.(24.53±2.36)fl,t=26.267、P<0.001)],差异均有统计学意义;EBV感染患儿的IgM[(3.68±0.91)g/L]、IgG[(7.75±2.73)g/L]和IgA[(5.83±1.46)g/L]均显著高于对照组[(1.25±0.28)g/L、(5.23±2.16)g/L和(4.35±1.18)g/L](t=23.112、6.555、7.139,P均=0.001);补体C3和C4水平[(0.63±0.26)g/L和(0.43±0.18)g/L]均显著低于对照组[(1.25±0.25)g/L和(0.65±0.21)g/L](t=15.565、P=0.001,t=7.203、P=0.001),较对照组,EBV感染患儿的CD4^+T淋巴细胞显著减少[(18.24±4.40)%vs.(24.87±5.61)%],而CD8+T细胞显著增加[(62.83±7.21)%vs.(46.34±6.45)%](t=8.421、P=0.001,t=15.435、P=0.001)。结论EBV感染导致患儿出现凝血功能障碍和免疫功能失衡,临床诊治时应予以重视。

Objective To investigate the changes and clinical significance of indexes of coagulation function and immune function of children infected with EB virus(EBV). Methods Total of 82 children infected with EBV from February 2017 to February 2018 in Qinghai Red Cross Hospital were selected as observation group, while 82 healthy children who were examined in our hospital were selected as control group. Blood samples of enrolled cases were collected. Thrombin time(TT), prothrombin time(PT), activated partial prothrombin time(APTT) and fibrinogen(FIB) were detected and compared between the two groups by unified method, respectively.The levels of coagulation indexes such as DD dimer(D-D) and immune indexes such as IgG, IgM, IgA and CD4^+T cells were also detected, respectively. Results The levels of TT, PT and APTT of children with EBV infection were(19.31 ± 2.72) s,(15.93 ± 1.96) s and(40.43 ± 5.68) s, respectively, which were significantly longer than those of the control group [(16.65 ± 2.10) s,(13.46 ± 1.72) s,(37.15 ± 5.14) s;t = 7.010, 8.577, 3.877;all P = 0.001].The level of FIB was also significantly lower than that of the control group [(1.17 ± 0.19) g/L vs.(1.53 ± 0.21) g/L;t = 11.511, P = 0.001], and the level of D-D dimer was significantly higher than that of the control group [(0.76 ±0.11) mg/L vs.(0.16 ± 0.06) mg/L;t = 43.362, P < 0.001]. Compared with the control group, PLT level decreased significantly [(105.32 ± 13.54) × 10~9/L vs.(177.47 ± 14.27) × 10~9/L;t = 33.213, P < 0.001), but the levels of PDW and MPV were significantly higher than those of the control group [(30.43 ± 2.89) fL vs.(18.92 ± 3.14) fL;t =24.423, P < 0.001.(35.13 ± 2.79) fL vs.(24.53 ± 2.36) fL;t = 26.267, P < 0.001)]. The levels of IgM [(3.68 ± 0.91) g/L],Ig G [(7.75 ± 2.73) g/L] and IgA [(5.83 ± 1.46) g/L] in children with EBV infection were significantly higher than those of control group [(1.25 ± 0.28) g/L,(5.23 ± 2.16) g/L and(4.35 ± 1.18) g/L](t = 23.112, 6.555, 7.139;all P =0.001). The levels of complement C3 and C4 [(0.63 ± 0.26) g/L and(0.43 ± 0.18) g/L] were significantly lower than those of the control group [(1.25 ± 0.25) g/L and(0.65 ± 0.21) g/L](t = 15.565, 7.203;both P = 0.001). Compared with the control group, the number of CD4^+ T lymphocytes [(18.24 ± 4.40)% vs.(24.87 ± 5.61)%] decreased significantly, but the number of CD8^+ T cells [(62.83 ± 7.21)% vs.(46.34 ± 6.45)%] of children with EBV infection increased significantly, with significant difference(t = 8.421, 15.435;both P = 0.001). Conclusions EBV infection could lead to coagulation dysfunction and imbalance of immune function of children, which should cause attention in clinical diagnosis and treatment.