14例成人EBV感染致肝损伤临床特点分析并文献复习

Clinical feature analysis of 14 adult patients with liver injury related to EBV infection and literature review

目的探讨成人EBV感染致肝损伤的临床特点,提高临床医生对成人EBV感染合并肝损伤的认识。方法收集2015年9月—2020年9月首都医科大学附属北京佑安医院收治的14例成人EBV感染致肝损伤患者作为研究对象,回顾性分析其临床特点,并结合该病研究进展进行文献复习。结果14例患者临床表现主要以发热、咽痛、淋巴结肿大为主,分别占92.8%、78.6%、35.7%,其余症状包括畏寒(35.7%)、恶心(28.6%)、呕吐(21.4%)、寒战(14.3%)、尿黄及皮肤黄染(14.3%)。实验室检查以外周血淋巴细胞计数、异型淋巴细胞比例、ALT、AST升高(100%)及PTA、INR正常为主(100%),其余表现包括ALP、GGT升高伴TBIL、DBIL正常或升高,分别占42.8%、35.7%。腹部超声主要表现为脾大(85.7%),少数表现为肝脾大(7.1%)。14例患者(100%)均给予保肝对症治疗,其中5例(35.7%)联合更昔洛韦治疗,1例(7.1%)联合阿昔洛韦治疗,1例(7.1%)联合短效重组人干扰素α-1b治疗。14例患者(100%)均好转出院。结论成人EBV相关肝损伤的临床表现以发热、咽痛、淋巴结肿大为主,实验室检查以转氨酶升高为主,多数呈现脾肿大。目前以对症支持治疗为主,总体预后良好。

Objective To investigate the clinical features of adult patients with liver injury related to EBV infection,and improve the clinician’s understanding of EBV infection with liver injury in adults.Methods Fourteen adult patients with liver injury related to EBV infection who were admitted to Beijing Youan Hospital,Capital Medical University from September 2015 to September 2020 were included in this study.Their clinical features were analyzed retrospectively.The literatures also were reviewed based on the research progress of this disease.Results The main clinical manifestations of 14 patients included fever,pharyngitis and lymphadenectasis,accounting for 92.8%,78.6%,and 35.7%respectively.Other symptoms included chills(35.7%),nausea(28.6%),vomiting(21.4%),shivering(14.3%),yellow urine and yellowing of the skin(14.3%).Laboratory tests mainly showed the elevation of peripheral lymphocyte count,abnormal lymphocyte ratio,ALT,and AST(100%),with normal PTA and INR(100%).Other manifestations included the elevation of ALP and GGT with normal or elevated TBIL(42.8%)and DBIL(35.7%).The manifestation of abdominal ultrasound was splenomegaly in predominant cases(85.7%)and hepatosplenomegaly in rare case(7.1%).All 14 patients(100%)received liver-protection symptomatic treatment,including 5 cases(35.7%)combined with ganciclovir,1 case(7.1%)combined with acyclovir,and 1 case(7.1%)combined with short-acting recombinant human interferonα-1 b.All 14 patients(100%)improved and were discharged from the hospital.Conclusions The main clinical manifestations of adult patients with liver injury related to EBV include fever,pharyngitis,and lymphadenectasis.Laboratory tests mainly include the elevation of aminotransferase,often accompanied by splenomegaly.At present,a symptomatic supportive treatment is recommended and the overall prognosis is good.