EB病毒感染患者肝脏病理及临床特征分析

Analysis of liver pathology and clinical features in patients with Epstein-Barr virus infection

目的 了解EB病毒感染患者临床及肝脏病理特征。方法 收集2015年7月至2020年7月就诊于昆明医科大学第二附属医院同时行肝穿刺活检、原位分子杂交检测EBV编码的小RNA(EBV-encoded RNA,EBER)表达情况及EBV DNA血清学检测的患者。根据EBV DNA结果将患者分为EBV感染组15例及未感染组41例。分析EBV感染患者就诊原因、出院情况、组织病理学特征及EBER结果,并比较两组患者基本信息及实验室指标。结果 感染组患者以不同症状或仅有肝酶学异常就诊,出院时除EBV感染外,有9例合并其他肝脏疾病,其中有3例合并自身免疫性肝病;所有行EBER检查的患者中,仅感染组1例患者EBER阳性,其余均为阴性,EBER阳性患者并无EBV肝炎肝窦内淋巴细胞呈串珠样排列等相关特征;EBV感染组与未感染组相比较,年龄(P=0.012)、球蛋白(P=0.032)差异有统计学意义。结论EBV感染临床表现无特异性,当患者合并肝损伤时,需考虑EBV感染可能。EBV肝炎病理学特征并无特征表现,当EBV感染患者存在发热、肝脾肿大时,EBER是诊断EBV肝炎的重要辅助手段。

Objective To Study the liver pathology and clinical features of patients with Epstein-Barr virus(EBV)infection,and provide ideas for diagnosis and treatment of EBV hepatitis.Methods Patients’information were collected from July 2015 to July 2020 in the Second Affiliated Hospital of Kunming Medical University.These patients all underwent liver biopsy,in situ hybridization staining of EBV-encoded RNA(EBER)and EBV DNA serology.According to the EBV DNA results,the patients were divided into EBV infection group and non-infected group.There were 15 patients in the EBV infection group and 41 patients in the non-infected group.The reasons for visits,discharge diagnosis,histopathological characteristics and EBER results of patients with EBV infection were analyzed,and the basic information and laboratory indicators of two groups were compared.Results Patients in the infection group came to our hospital with different symptoms or only abnormal liver enzymes.In addition to EBV infection,9 people had other liver diseases at the time of discharge,and 3 of them had autoimmune liver diseases(all of which were newly diagnosed).Among all the patients undergoing EBER examination,only one patient in the infection group was EBER positive,and the other were negative.The EBER-positive patient didn’t have characteristic microscopic findings related to EBV hepatitis including a diffuse lymphocytic sinusoidal infiltrate in a“string of beads”pattern.There were significant differences in age(P=0.012)and globulin(P=0.032)between the EBV infection group and the non-infected group.Conclusion The clinical manifestations of EBV infection are not specific,the possibility of EBV infection should be considered especially when patients with liver injury.Although there are many patients with EBV infection,EBV hepatitis is rare,and the pathological features may not be characteristic.When patients with EBV infection have fever,hepatosplenomegaly and so on,the EBER is an important auxiliary method for diagnosing EBV hepatitis.EBV infection with autoimmune liver disease is not rare,and EBV may play an important role in the occurrence and development of autoimmune liver disease.Further research is still needed to determine whether EBV is just an innocent bystander or a real pathogen.