67例成人EB病毒感染临床及实验室特征分析

Analysis of clinical and laboratory characteristics of EB virus infection in 67 adult patients

目的:检测成人Epstein-Barr病毒(EB病毒)感染患者的EB病毒相关抗体及EB病毒DNA、血常规、血生化指标,对其临床症状进行分析,探讨成人EB病毒感染的临床特点。方法:收集67例成人EB病毒感染患者的临床资料及实验室检测结果,并将其按年龄分为青中年组(18~59岁,19例)和老年组(≥60岁,48例);另收集同期的49名健康体检者,按前述年龄分为2组,分别作为年龄对照组。分析成人EB病毒感染的临床特点及不同年龄段患者间的异同。结果:67例成人EB病毒感染患者中,最常见的症状为发热(37例,55.2%);其次为淋巴结肿大(13例,19.4%)、脾肿大(9例,13.4%)、肝脏肿大(8例,11.9%)、咽部充血(6例,9.0%)和皮疹(5例,7.5%)。EB病毒感染的青中年患者与老年患者相比较,发热(84.2%比43.8%)、咽部充血(26.3%比2.1%)、皮疹(21.1%比2.1%)、肝脏肿大(31.6%比4.2%)的临床症状明显(χ^2值分别为9.012、7.057、4.612、7.295,P均<0.05)。19例青中年患者中有2例伴发恶性肿瘤性疾病;而48例老年患者中有2例(4.1%)伴发嗜血细胞淋巴组织细胞增生症,17例(34.7%)伴发恶性肿瘤性疾病,2组间的恶性肿瘤患病构成比差异有统计学意义(χ^2=4.15,P=0.042)。EB病毒感染老年组的T淋巴细胞总数、CD4+T淋巴细胞计数、B淋巴细胞计数均低于健康老年组(t分别为4.525,5.960,2.999,P均<0.05),而EB病毒感染青中年组的淋巴细胞亚群数与健康青中年组比较,差异无统计学意义(P>0.05)。青中年EB病毒感染患者与老年患者比较,EB病毒相关抗体表达水平及肝功能指标差异无统计学意义(P均>0.05)。结论:成人EB病毒感染患者的临床表现各异,青中年患者的急性感染症状较老年患者明显,而老年患者的细胞免疫及体液免疫功能降低,且EB病毒相关肿瘤患病者构成比高。

Objective: To study the clinical characteristics of Epstein-Barr virus(EB virus) infection in adult patients by detecting EB virus-associated antibodies, EB virus DNA, blood routine, blood biochemistry and analyzing clinical symptoms. Methods: A total of 67 adults with EB virus infection were enrolled. Patients were divided into two age groups:young and middle-aged group(18-59 years old, 19 cases) and elderly group(60 years old and above, 48 cases), and 49 healthy subjects including 30 young and middle-aged and 19 elderly people were served as aged group controls. The clinical characteristics of EB virus infection were studied and the differences between the two age groups were compared.Results: Fever was the most common presenting symptom(37 cases, 55.2%), and followed by enlarged lymph nodes(13 cases,19.4%), splenomegaly(9 cases,13.4%), liver enlargement(8 cases, 11.9%), pharyngeal congestion(6 cases, 9.0%),and rash(5 cases, 7.5%). Fever(84.2% vs 43.8%), pharyngeal congestion(26.3% vs 2.1%), rash(21.1% vs 2.1%), liver enlargement(31.6 % vs 4.2%) in young and middle-aged patients were more common than in elderly group( χ^2 values:9.012, 7.057, 4.612, 7.295, P<0.05). Two cases in young and middle-aged group had malignant tumor diseases(10.5%),while 2 cases(4.1%) in elderly group had hematopoietic lymphohistiocytosis and 17 cases(34.7 %) had malignant tumor diseases. The constituent ratio of cases with malignant tumor diseases between the two groups was significantly different( χ^2=4.15, P=0.042). The total number of T lymphocytes, count of CD4+T lymphocytes, and B lymphocytes in the elderly group were lower than those in the healthy control group(t=4.525, 5.960, 2.999, P all <0.05), while the number of lymphocyte subsets in the young and middle-aged group was not significantly different from that in the healthy controls(P>0.05). There were no statistical differences in liver function indices and levels of EB virus-related antibodies between young and middle-aged and elderly patients(P>0.05). Conclusions: Clinical manifestations of EB virus infection in adults are varied. The symptoms of acute infection are more common in young and middle-aged patients than in the elderly patients. The cellular immunity and humoral immunity are decreased in elderly patients, and the constituent ratio of cases with EB virus-related tumors is high.