儿童EB病毒感染首发症状及相关疾病谱分析

Analysis of primary symptoms and disease spectrum in Epstein-Barr virus infected children

目的 详细了解儿童EBV感染的首发症状及疾病诊断情况 ,以提高临床诊断水平 ,并探讨EBV感染临床多样性的机制。方法 对本院经酶联免疫吸附法 (ELISA)测定EBV VCA IgM阳性的 190例EBV感染患儿的首发症状、疾病诊断及预后进行前瞻回顾性分析。结果 EBV感染患儿起病症状不一 ,首发症状中以发热多见 (6 6 8% ) ,其他依次为咳嗽 (14 2 % )、皮疹 (7 9% )、淋巴结肿大(5 3% )、眼睑浮肿 (3 2 % )、咽痛 (1 6 % )、惊厥 (1 6 % )、肉眼血尿 (0 5 % )等。可累及全身各个系统 ,引起疾病多样 ,但以呼吸道感染最多见 (40 5 % ) ,其次为传染性单核细胞增多症 (17 9% )、川崎病(6 3% )、特发性血小板减少性紫癜 (ITP) (5 8% )、病毒性心肌炎 (2 6 % )、病毒性脑炎 (2 6 % )、噬血细胞综合征 (1 6 % )、类风湿性关节炎 (1 0 % )、急性淋巴结炎 (1 0 % )、面神经炎 (1 0 % )、Evans综合征(0 5 % )、系统性红斑狼疮 (SLE) (0 5 % ) ,亚急性坏死性淋巴结炎 (0 5 % )等。EBV感染预后不一 ,1例病人因患噬血细胞综合征而死亡。结论 儿童EBV感染症状多样 ,累及系统多 ,临床医生应该综合分析 ,及早作相应的检查才能作出正确诊断及减少误诊率 ,并进行合理治疗。

Objective To improve the clinical diagnostic standard and explore the mechanism of multiple clinical manifestation of Epstein Barr virus (EBV) infection by studying the primary symptom and related disease spectrum in EBV infected children Methods The primary symptom, disease spectrum and prognosis of 190 EBV infected children whose serum EBV VCA IgM was positive detected by enzyme linked immunosorbent assay (ELISA) were retrospectively reviewed Results The primary symptoms of EBV infection were diverse, the most common primary symptom was fever (66 8%), and followed by cough (14 2%), skin eruption (7 9%), lymphadenopathy (5 3%), eyelid edema (3 2%), pharyngalgia (1 6%), cardiac arrhythmia (1 6%), convulsion (1 6%), arthralgia (1 0%), gross hematuria (0 5%), etc Most systems and organs were involved in the disease, including liver, spleen, lymph nodes, kidney, heart, lung, bone marrow, brain etc., which made the disease spectrum diverse The most common disease caused by EBV infection was respiratory tract infection (40 5%), followed by infectious mononucleosis (17 9%), Kawasaki disease (6 3%), idiopathic thrombocytopenic purpura (5 8%), viral myocarditis (2 6%), viral encephalitis (2 6%), hemophagocytic syndrome (1 6%), rheumatoid arthritis (1 0%), acute lymphadenitis (1 0%), facial neuritis (1 0%), Evans syndrome (0 5%), systemic lupus erythematosus (0 5%), subacute necrotizing lymphadenitis (0 5%), non Hodgkin′s lymphoma (0 5%), acute aplastic anemia (0 5%), infantile hepatitis syndrome (0 5%), etc ; 9 5% of patients were ultimately diagnosed as EBV infection after long term fever, and 10% of patients suffered from mixed infection The prognosis of EBV infction was different due to involvement of different systems and organs One patient died of hemophagocytic syndrome Conclusion The systems and organs impaired by EBV infection in children were diverse, and almost all the systems and organs were involved Pediatricians should comprehensively analyze the clinical data and order corresponding laboratory examinations early to make the correct diagnosis and reduce the misdiagnosis rate and to treat appropriately