EB病毒DNA载量与患儿机体免疫及肝肾功能的相关性研究

Correlation between EB virus DNA load and immune function,liver and kidney function in children

目的探讨EB病毒(EBV)感染患儿EBV-DNA载量与机体免疫及肝肾功能的相关性。方法选择该院2016年5月至2019年5月收治的EBV-DNA阳性患儿90例为研究对象,按照EBV-DNA载量的差异分成低载量组(<5×10^(4) copy/mL)44例、中载量组(5×10^(4)~5×10^(5) copy/mL)24例和高载量组(>5×10^(5) copy/mL)22例,另取同期于该院接受体检的健康儿童50例作为对照组。比较各组T淋巴细胞亚群、免疫球蛋白(Ig)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBil)、尿素(BUN)、血清肌酐(Scr)、尿酸(UA)水平。分析EBV-DNA载量与T淋巴细胞亚群、Ig、ALT、AST、TBil、BUN、Scr、UA的相关性。采用受试者工作特征(ROC)曲线分析EBV-DNA载量对EB病毒感染患儿肝肾功能异常和免疫状态的预测价值。结果随着EBV-DNA载量升高,CD3^(+)T细胞、CD8^(+)T细胞、IgM、ALT、AST、TBil、BUN、Scr、UA水平逐渐升高(P<0.05),而CD4^(+)T细胞、CD4^(+)/CD8^(+)、IgA水平逐渐降低(P<0.05);低载量组、中载量组、高载量组的IgG水平高于对照组(P<0.05);EBV-DNA载量与CD3^(+)T细胞、CD8^(+)T细胞、IgM、IgG、ALT、AST、TBil、BUN、Scr、UA均呈正相关(P<0.05),与CD4^(+)T细胞、CD4^(+)/CD8^(+)、IgA均呈负相关(P<0.05)。EBV-DNA载量预测患儿免疫状态异常的曲线下面积(AUC)为0.849,灵敏度为85.46%,特异度为82.53%;预测患儿肝功能异常的AUC为0.754,灵敏度为82.20%,特异度为80.37%;预测患儿肾功能异常的AUC为0.701,灵敏度为79.24%,特异度为80.02%。结论EBV感染患儿EBV-DNA载量与机体免疫状态及肝肾功能存在一定关联,随着EBV-DNA载量的增加,机体免疫及肝肾功能下降。

Objective To investigate the correlation of Epstein-Barr virus-DNA(EBV-DNA)load with immunity,liver and kidney function in children with Epstein-Barr virus(EBV)infection.Methods A total of 90 EBV-DNA positive children admitted to our hospital from May 2016 to May 2019 were selected as the research subjects.According to the difference of EBV-DNA load,44 cases were divided into low load group(<5×10^(4) copy/mL),24 cases in medium load group(5×10^(4)-5×10^(5) copy/mL)and 22 cases in high load group(>5×10^(5) copy/mL),and another 50 healthy children who received physical examination in the hospital during the same period were selected as the control group.T lymphocyte subsets,immunoglobulin(Ig),alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil),and urea(BUN),serum creatinine(Scr),and uric acid(UA)levels were compared in each group.The correlation between EBV-DNA load and T lymphocyte subsets,Ig,ALT,AST,TBil,BUN,Scr,UA was analyzed.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of DNA load on abnormal liver and kidney function and immune status in children with EB virus infection.Results With the increase of EBV-DNA load,the levels of CD3^(+)T cells,CD8^(+)T cells,IgM,ALT,AST,TBil,BUN,Scr and UA gradually increased(P<0.05),while the levels of CD4^(+)T cells,CD4^(+)/CD8^(+),IgA gradually decreased(P<0.05).The IgG levels in the low-load group,medium-load group and high-load group were higher than those in the control group(P<0.05).EBV-DNA load was positively correlated with CD3^(+)T cells,CD8^(+)T cells,IgM,IgG,ALT,AST,TBil,BUN,Scr,and UA(P<0.05),and negatively correlated with CD4^(+)T cells,CD4^(+)/CD8^(+),IgA(P<0.05).The area under the curve(AUC)of EBV-DNA load for predicting abnormal immune status in children was 0.849,the sensitivity was 85.46%,and the specificity was 82.53%;the AUC for predicting abnormal liver function in children was 0.754,the sensitivity was 82.20%and the specificity was 80.37%;the AUC for predicting abnormal renal function in children was 0.701,the sensitivity was 79.24%,and the specificity was 80.02%.Conclusion The EBV-DNA load in EBV-infected children has a certain relationship with the immune status and liver and kidney functions.With the increase of EBV-DNA load,the body′s immune and liver and kidney functions decrease.