儿童原发性EB病毒感染伴随转氨酶升高的相关因素及变化规律

Risk factors and regularity of transaminase elevation associated with primary Epstein-Barr virus infection in children

目的探讨影响儿童原发性EB病毒感染伴随转氨酶升高的相关因素及其变化规律。方法回顾性分析2016年9月至2017年10月复旦大学附属儿科医院门诊就诊的399例原发性EB病毒感染患儿的临床信息。对丙氨酸转氨酶(ALT)和天冬氨酸转氨酶(AST)是否升高与患儿年龄、性别、热程及血浆EB病毒-DNA病毒载量的可能相关性进行多元Logistic回归分析,计算转氨酶异常患儿各时间段累计恢复正常率。结果399例原发性EB病毒感染患儿中男219例、女180例,年龄(4.2±2.7)岁。51.9%(207例)发生转氨酶异常;轻(40~160 U/L)、中(>160~400 U/L)和重度升高(>400 U/L)ALT分别有74.5%(149/200)、21.0%(42/200)和4.5%(9/200),AST分别为83.8%(155/185)、11.9%(22/185)和4.3%(8/185)。年龄与发生转氨酶升高相关(OR=1.13、1.10,均P<0.05)。113例ALT异常和104例AST异常病例有复查转氨酶,共复查167次;ALT完全恢复正常(24±13)d,AST为(25±18)d。<1、1~<4、4~<8和≥8周ALT累计恢复正常率为2.7%(3/113)、54.0%(61/113)、79.6%(90/113)和81.4%(92/113),AST为1.9%(2/104)、48.1%(50/104)、71.2%(74/104)和74.0%(77/104)。结论年龄是儿童原发性EB病毒感染伴随转氨酶升高的相关危险因素;升高的转氨酶经3周后约半数恢复正常,8周后大部分恢复正常。

Objective To explore the risk factors and regularity of pediatric primary Epstein-Barr virus(EBV)infection accompanied with elevated transaminase.Methods Clinical data of 399 children diagnosed as primary EBV infection in the outpatient department,Children′s Hospital of Fudan University from September 2016 to October 2017 were analyzed retrospectively.Logistic regression analysis was performed to determine the potential correlations between elevated alanine transaminase(ALT)or aspartate transaminase(AST)and age,gender,course of fever and plasma EBV-DNA load.The cumulative rates of elevated transaminase recovery to nomal at different times were caculated.Results Among 399 children diagnosed with primary EBV infection,there were 219 males and 180 females.The age was(4.2±2.7)years.Among all cases,51.9%(207/399)had elevated transaminase.In patients who had elevated ALT,74.5%(149/200),21.0%(42/200)and 4.5%(9/200)had mild(40-160 U/L),moderate(160-400 U/L)and severe(>400 U/L)elevation of ALT,respectively.In patients who had elevated AST,83.8%(155/185),11.9%(22/185)and 4.3%(8/185)had mild(40-160 U/L),moderate(160-400 U/L)and severe(>400 U/L)elevation of AST,respectively.Only age was correlated with the occurrence of elevated transaminase(OR=1.13,1.10,both P<0.05).A total of 167 repeated tests were ordered in patients with elevated ALT and/or AST,including 113 cases with elevated ALT and 104 cases with elevated AST.The time of ALT and AST returned to normal were(24±13)days and(25±18)days respectively.The cumulative rates for ALT returned to normal within 1,1-<4,4-<8 weeks and more than 8 weeks were 2.7%(3/113),54.0%(61/113),79.6%(90/113)and 81.4%(92/113)respectively,and were 1.9%(2/104),48.1%(50/104),71.2%(74/104)and 74.0%(77/104)for AST.Conclusions Age is a risk factor for transaminase elevation associated with primary EBV infection in children.The transaminases returned to normal within 3 weeks in half of the cases,and within 8 weeks in most cases.