Research Advances in Infectious Mononucleosis Caused by Epstein-Barr Virus

Infectious mononucleosis (IM), primarily caused by the Epstein-Barr virus (EBV), manifests as the classic triad of fever, pharyngitis, and cervical lymphadenopathy. Severe cases may involve organ damage, most commonly affecting the liver. Diagnosis relies on a combination of clinical presentation and laboratory parameters, with commonly used indicators including EBV-specific antibodies, EBV-DNA load, and the ratio of atypical lymphocytes. Treatment primarily involves symptomatic supportive care, with a cautious approach to the routine use of antiviral medications. In recent years, significant research in traditional Chinese medicine has been conducted in China, showing promising advancements. This article provides a comprehensive review of EBV-induced infectious mononucleosis, offering insights for clinical diagnosis and treatment.

A Case of Infectious Mononucleosis Induced Jaundice Complicated by Possible Drug Induced Liver Injury (DILI)

In this case, a young female presented with non-specific features such as fever, sore throat, headache and fatigue. She went on to develop epigastric pain, darkening of urine and jaundice, with no resolution of prior symptoms. Physical and Laboratory tests confirmed the primary diagnosis of infectious mononucleosis, however, prior history of treatment with multiple drugs led to a diagnosis of DILI as a complication. Appropriate treatment with I.V. antibiotics, hepatoprotective agents, steroids as well as discontinuation of all potential hepatotoxic agents showed significant improvement in patients’ symptoms and overall condition.

Diagnosis of Infectious Mononucleosis by Combined Detection of Atypical Lymphocytes and Transaminase

In order to explore the value of combined detection of atypical lymphocytes （ATL） and transaminase （alanine aminotransferase, ALT＇ asparate aminotransferase, AST） in the diagnosis of infectious mononucleosis （IM）, The data of blood routine and liver function were collected from 54 IM patients, 34 acute hepatitis （AH） patients, 44 upper respiratory infection （URI） patients in Union Hospital during March 2002 to March 2005. Same data were also collected from 40 healthy children as normal control. These data were analyzed retrospectively. Both proportion of atypical lymphocytes and enzyme activity of transaminase were elevated simultaneously （ALT〉40 IU/L, AST〉45 IU/L） in 57.4% （31/54） IM patients. There was significant difference （P〈0.01） between IM group and the other groups. Combined detection of atypical lymphocytes and transaminase can be regarded as a diagnostic marker of infectious mononucleosis.

The Positivity Rate of Epstein-Barr Virus Anti-Viral Capsid Antigen IgG among Children with Infectious Mononucleosis in Diyala-Iraq

Background: Epstein-Barr virus (EBV) is a double-stranded linear DNA human herpesvirus that is transmitted primarily through saliva during childhood. Although the majority of primary EBV infections are clinically asymptomatic, clinical cases are presented as infectious mononucleosis (IMN) syndrome. Objectives: This study was conducted to explore the rate of EBV anti-VCA IgG among children who were clinically suspected as having IMNin Diyala province. Subjects and Methods: This is a cross sectional study that was carried out during 2018 in Diyala province-Iraq. A total of 370 blood samples were collected from 190 children under 15 years of age who were clinically suspected as having IMN, and 180 apparently healthy children as controls. The anti EBV VCA IgG antibodies were detected in serum using the VCA IgG ELISA kit (from Dia.Pro Diagnostic Bioprobessrl-Italy). Statistical analysis was carried out using the SPSS-version 25. A statistical significance was considered whenever the P value was ≤ 0.05. Results: The results showed that the IgG positivity rate among suspected IMN patients was insignificantly higher in the age group 10 - 14 years old children (80.8%, P = 0.364). In control subjects the highest positivity rate was in the age group of 1 - 4 years with a statistically significant difference (79.5%, P = 0.002). In suspected IMN patients, the age group of 10 - 14 years had the highest mean concentration ± SD of anti-VCA IgG 44.018 ± 38.644 arbitrary units per milliliter (arbU/ml), while in controls, the highest value 38.018 ± 34.908 (arbU/ml) was in the age group of 1 - 4 years, with insignificant difference in either group (P = 0.257 and 0.072, respectively). The results also showed that in both suspected IMN patients and control subjects, females showed higher IgG positivity rate (70.6%, and 75.5%) compared to males (64.8%, and 65.1%) with insignificant difference in both groups (P = 0.392 and 0.126) respectively. Similarly, the IgG mean concentration ± SD was insignificantly higher in females in both suspected IMN patients and control subjects (P = 0.447 and 0.256) respectively. 21 (87.5%) of IgM positive suspected IMN patients were also IgG positive with a statistically significant association (P = 0.028). Conclusion: The positivity rate of anti-EBV VCA IgG among apparently healthy subjects in Diyala province was 70.6%, which increases by age with slight association with clinical suspicion of infectious mononucleosis.

A case of acute infectious mononucleosis presenting with very high ferritin

Hepatitis is an important but uncommon manifestation of acute Epstein Barr infection. Infectious mononucleosis is usually a disease of young adults. We report a case of infectious mononucleosis in a 72-year old jaundiced gentleman with ferritin level of 2438 that normalised on clinical improvement.

Recurrence of infectious mononucleosis in adults after remission for 3 years:A case report

BACKGROUND Infectious mononucleosis(IM)is a disease caused by Epstein–Barr virus(EBV).EBV infection is common in children;however,it can cause IM in adults.Studies on recurrence of IM in adults after remission are limited.CASE SUMMARY We report a 28-year-old man who presented with IM-like symptoms with mild liver damage after initial remission of IM for 3 years.He was first diagnosed with IM and treated in 2015.Follow-up tests in 2016 and 2017 did not show any abnormalities.In November 2018,he presented with swelling of the tonsils.He was misdiagnosed with acute suppurative tonsillitis and treated for 5 d.No signs of improvement were observed.He was readmitted with recurrent fever,pharyngalgia,fatigue,and systemic muscle pain.Examinations revealed enlargement of the tonsils and cervical lymph nodes.Blood tests revealed elevated transaminase levels.Anti-EBV test was positive,indicating virus reactivation.IM recurrence was confirmed on the basis of laboratory tests and clinical manifestations.He was treated with antiviral,anti-infective,and hepatoprotective drugs and vitamin supplements.His condition improved and no abnormalities were observed during follow-up.CONCLUSION Recurrence of IM after remission is possible in adults;therefore,long-term followup and monitoring are essential.

Expression and clinical significance of miRNA-146a and IRF-3 in children with infectious mononucleosis

Objective:To investigate the expression levels of interferon regulatory factor 3(IRF-3)and miRNA146a in peripheral blood of children with infectious mononucleosis and the effect of miRNA146a on IRF-3 expression.Methods:In an in vivo experiment,the expression levels of IRF-3 and miRNA146a in peripheral blood of 45 children with infectious mononucleosis and 34 healthy controls were detected by real-time PCR.The in vitro experiment was performed to examine the effect of miRNA146a on IRF-3 expression levels by transfecting miRNA146a mimics and their inhibitors.Results:There was significant difference in IRF-3 gene expression in peripheral blood between healthy controls and children with infectious mononucleosis(t=30.340,P<0.001)while miRNA146a expression was significantly increased compared with healthy controls(t=34.659,P<0.001),and there was a negative correlation between the two groups(r=-0.960,P<0.05).In HeLa cells,transfection with miRNA146a mimics significantly decreased the expression of IRF-3 mRNA(t=8.270,P<0.001)and protein(t=46.170,P<0.001),while miRNA146a inhibitor significantly up-regulated the expression of IRF-3 mRNA(t=8.582,P<0.001)and protein(t=25.891,P<0.001).Conclusion:miRNA146a may be involved in the down-regulation of IRF-3 gene expression by Epstein-Barr virus in children with infectious mononucleosis and then involved in the pathogenesis of infectious mononucleosis.

A Case of Infectious Mononucleosis Complicated by Severe Thrombocytopenia and Hyperuricemia

Infectious mononucleosis (IM) by Epstein-Barr virus is usually a benign, self-limiting disease. Mild to moderate immune thrombocytopenia in the setting of IM is very common and appears in approximately half of these patients, however it rarely presents in severe form and troublesome haemorrhage is even rarer. Rapid spontaneous resolution is possible, with the role of steroids being controversial. Furthermore, elevation of the levels of uric acid because of immune thrombocytopenia is observed in high frequency;however this finding is usually not mentioned. It is attributed to a transient increase in purine turnover, it appears more often in men (with its peak within the first 2 weeks of IM) and it is treated with intravenous fluids and bicarbonates. The present case report describes the case of a young female patient who develops severe thrombocytopenia and intense hyperuricemia following an Epstein-Barr infection. No severe bleeding appeared, levels of uric acid normalised within the first two weeks of treatment and platelet levels rise back to normal within a month under corticosteroid therapy.

Livedo Reticularis in a Patient with EBV Mononucleosis

A 23-year-old woman with serologically confirmed EBV mononucleosis presented with fever, exudative pharyngitis, periorbital and lid edema, cervical lymphadenopathy, and splenomegaly. Two weeks after the onset of symptoms she developed a generalized symmetrical reticular eruption of unbroken hexagons characteristic of livedo reticularis that resolved over several weeks as her condition improved. To our knowledge, this is the first reported case of livedo reticularis to occur in a patient with EBV mononucleosis.

Notch信号通路在成人EB病毒感染所致传染性单核细胞增多症中的作用

目的:观察成人传染性单核细胞增多症(IM)患者Notch信号通路分子和Th22细胞的变化,检测抑制Notch信号通路对Th22细胞的调控作用。方法:纳入42例IM患者和21例健康对照者,采集外周血,分离血浆和外周血单个核细胞,酶联免疫吸附试验检测血浆白细胞介素(IL)-17和IL-22水平,流式细胞术检测CD3+CD4+IL-17+Th17细胞和CD3+CD4+IL-22+Th22细胞比例,实时定量PCR法检测Th17转录因子维甲酸相关孤独核受体γt(RORγt)、Th22转录因子芳香烃受体(AhR)及Notch信号通路分子(包括Notch受体、Notch配体、Notch下游分子)mRNA相对表达量。纯化CD4+T细胞,使用γ-分泌酶抑制剂(GSI)刺激培养,检测GSI刺激后细胞增殖、Th17和Th22细胞比例、IL-17和IL-22分泌、转录因子mRNA相对表达量变化。结果:IM组外周血单个核细胞中Notch1和Notch2 mRNA的相对表达量分别为13.58±3.18、4.73±1.16,均明显高于对照组的1.09±0.12、1.07±0.15(均P<0.001),而Notch3和Notch4 mRNA相对表达量在IM组和对照组之间的差异无统计学意义(P>0.05)。IM组Notch配体DLL1和Jagged1 mRNA相对表达量、Notch信号下游分子Hes1、Hes5和Hey1 mRNA相对表达量均高于对照组(均P<0.001)。IM患者Th17和Th22细胞比例分别为5.03%±1.15%、4.48%±1.29%,均高于对照组的4.36%±0.82%、3.83%±0.55%(均P<0.05);血浆IL-17和IL-22水平分别为(301.1±53.82)pg/ml、(101.2±16.45)pg/ml,均高于对照组的(237.2±72.18)pg/ml、(84.75±11.83)pg/ml(均P<0.001);RORγt和AhR mRNA相对表达量分别为1.25±0.22、1.21±0.12,均高于对照组的0.99±0.15、1.04±0.11(均P<0.001)。CD4+T细胞增殖水平、Th17细胞比例、IL-17分泌和RORγt mRNA相对表达量在无GSI刺激组和经GSI刺激组之间的差异无统计学意义(P>0.05)。经GSI刺激后Th22细胞比例、IL-22分泌和AhR mRNA相对表达量较无GSI刺激降低(均P<0.05)。结论:Notch信号通路通过AhR调控IM患者CD4+T细胞分泌IL-22,Notch-AhR-Th22细胞通路可能参与IM发病。

IM患儿尿五蛋白水平及其与EB病毒核酸载量CD4^(+)T/CD8^(+)T的相关性

目的分析传染性单核细胞增多症(IM)患儿的尿五蛋白水平及其与EB病毒(EBV)核酸载量以及CD4^(+)T/CD8^(+)T的相关性。方法回顾性分析2018年5月至2021年8月中国科学技术大学附属第一医院(安徽省立医院)儿科收治的77例IM患儿临床资料,根据丙氨酸氨基转移酶(ALT)检测结果,将患儿分为肝功能正常组34例(ALT≤40 U/L)和异常组43例(ALT>40 U/L),比较两组患儿尿五蛋白以及CD4^(+)T/CD8^(+)T,分析尿五蛋白与EBV核酸载量以及CD4^(+)T/CD8^(+)T的相关性。结果肝功能异常组CD4^(+)T/CD8^(+)T低于肝功能正常组(P<0.05),肝功能异常组尿α1-微球蛋白(α1MG)、尿β2-微球蛋白(β2MG)水平高于肝功能正常组(P<0.05)。IM患儿尿微量白蛋白(MA)、尿免疫球蛋白IgG(IgGU)与EBV核酸载量呈正相关性(r=0.866、0.289)。尿α1MG、尿β2MG与CD4^(+)T/CD8^(+)T呈负相关(r=-0.312、-0.308)。结论IM患儿早期肾小球滤过功能损害与EBV核酸载量正相关,肾小管重吸收功能受损与CD4^(+)T/CD8^(+)T呈负相关,且合并有肝功能损害的IM患儿更易表现为肾小管重吸收功能受损。

Effect of Compound Glycyrrhizin Injection on Liver Function and Cellular Immunity of Children with Infectious Mononucleosis Complicated Liver Impairment

Objective： To investigate the effects of Compound Glycyrrhizin Injection （CGI） on liver function and cellular immunity of children with infectious mononucleosis complicated liver impairment （IM-LI） and to explore its clinical therapeutic effect. Methods： Forty-two patients with IM-LI were randomly assigned, according to the randomizing number table, to two groups, 20 in the control group and 22 in the treated group. All the patients were treated with conventional treatment, but to those in the treated group, CGI was given additionally once a day, at the dosage of 10 ml for children aged below 2 years, 20 ml for 2-4 years old, 30 ml for 5-7 years old and 40 ml for 8- 12 years old, in 100-200 ml of 5% glucose solution by intravenous dripping. The treatment lasted for 2 weeks. T lymphocyte subsets and serum levels of alanine transaminase （ALT）, aspartate aminotransferase （AST） and total bilirubin （TBil） were detected before and after treatment. Besides, a normal control group consisting of 20 healthy children was also set up. Results： Baseline of the percentage of CD3^＋ , CD8^＋ lymphocyte and serum levels of ALT, AST, TBiL in the children with IM-LI were markedly higher, while the percentage of CD 4^＋ lymphocyte and the CD4^＋/CD8^＋ ratio was markedly lower in IM-LI children as compared with the corresponding indices in the healthy children （ P〈0.01 ）. These indices were improved after treatment in both groups of patients, but the improvement in the treated group was better than that in the control group （P〈0.01）. Conclusion： Cellular immunity dysfunction often occurs in patients with IM-LI, and CGI treatment can not only obviously promote the recovery of liver function, but also regulate the immune function in organism.

血常规参数在鉴别诊断儿童传染性单核细胞增多症与急性化脓性扁桃体炎中的价值

目的探究儿童传染性单核细胞增多症(IM)与急性化脓性扁桃体炎(AST)使用血常规参数鉴别诊断的价值。方法选取郑州大学附属儿童医院38例IM患儿作为实验组研究对象,另外选取38例AST患儿作为对照组研究对象。选取时间为2021年1月至2022年1月。对比两组血常规参数,主要包括炎性血清因子指标[白细胞(WBC)、中性粒细胞/淋巴细胞比值(NLR)、单核细胞/淋巴细胞比值(MLR)、血小板/淋巴细胞比值(PLR)]、血清淋巴细胞参数[淋巴细胞复杂程度(L-X)、淋巴细胞荧光强度(L-Y)、淋巴细胞大小(LZ)]与血清中性粒细胞参数[中性粒细胞复杂程度(N-X)、中性粒细胞荧光强度(N-Y)、中性粒细胞大小(N-Z)]。结果两组WBC检测水平对比差异无统计学意义(P>0.05),实验组NLR、MLR、PLR检测水平低于对照组,差异有统计学意义(P<0.05);两组L-X检测水平对比差异无统计学意义(P>0.05),实验组检测L-Y、LZ水平高于对照组,差异有统计学意义(P<0.05);两组N-Z检测水平对比差异无统计学意义(P>0.05),实验组检测N-X、N-Y水平低于对照组,差异有统计学意义(P<0.05)。结论临床可通过血常规参数NLR、MLR、PLR、L-Y、LZ、N-X、N-Y给予IM、AST辅助鉴别诊断,值得应用。

外周血NLR对IM患儿发生肝损伤风险的预测价值

目的探讨初诊传染性单核细胞增多症(IM)患儿外周血中性粒细胞与淋巴细胞比值(NLR)对其发生肝损伤风险的预测价值。方法选取70例住院IM患儿作为研究对象,患儿于入院当日采集空腹静脉血检测全血细胞计数,根据全血细胞计数结果计算得出NLR,并以中位数为临界值,将患儿分为高NLR组(NLR≥0.42)36例和低NLR组(NLR<0.42)34例。所有研究对象进行血清EB病毒(EBV)-DNA载量,丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、羟丁酸脱氢酶(HBDH)、总胆红素(TB)、直接胆红素(DB)和清蛋白水平检测。结果 2016-2018年EBV-DNA检出率分别为1.62%、3.49%、3.99%,呈逐年上升趋势,其中2018年6~15岁患儿检出率为2.18%,在各年龄组中最高。与低载量组患儿相比,中载量组和高载量组患儿NLR降低,LDH、HBDH表达水平升高,差异均有统计学意义(P<0.05);与低载量组相比,高载量组IM患儿清蛋白水平明显降低(P<0.05);两组ALT、AST、TB与DB表达水平差异无统计学意义(P>0.05)。与高NLR组比较,低NLR组ALT≥80U/L的患儿比例,ALT、AST、LDH和HBDH表达水平均明显升高,差异有统计学意义(P<0.05),TB、DB和清蛋白水平差异无统计学意义(P>0.05);IM患儿NLR与ALT、AST、LDH和HBDH表达水平均呈负相关(r=-0.586、-0.506、-0.577、-0.665,均P<0.05)。结论 IM患儿NLR越低,EBV-DNA载量越高,肝脏损伤越重。

传染性单核细胞增多症患儿合并肝功能损伤的临床特征和预后研究

目的分析传染性单核细胞增多症(IM)患儿合并肝功能损伤的临床特征和预后。方法选取2020年1月至2022年12月阜阳市人民医院收治的148例IM患儿作为研究对象,根据患儿病程中是否发生肝功能损伤,分为肝功能损伤组和肝功能正常组。收集并比较两组患儿一般临床特征和实验室检查指标,以及90 d随访的预后情况。结果148例IM患儿中发生肝功能损伤71例,发生率为48.0%。在一般临床特征和实验室检查指标中,肝功能损伤组患儿年龄、淋巴细胞百分比和表现出肝肿大、脾大、眼睑浮肿和皮疹的患者比例高于肝功能正常组,而中性粒细胞百分比、中性粒细胞/淋巴细胞比值(NLR)、CD8+细胞和CD4+/CD8+细胞比值低于肝功能正常组(P<0.05);随访结果表明,肝功能损伤组患儿发热持续时间、住院时间、淋巴结肿大持续时间、淋巴细胞比例恢复正常所需时间及血清EBV DNA转阴时间较肝功能正常组延长,且并发症的发生率高于肝功能正常组(P<0.05)。结论相较于肝功能正常的IM患儿,肝功能损伤患儿病情更为严重,预后恢复相对较慢,且并发症发生风险更高,其主要原因可能与该类患儿免疫应答反应强烈有关。

小儿IM患者细胞免疫的变化及更昔洛韦的干预

目的研究传染性单核细胞增多症(IM)患儿的外周血T细胞亚群的变化及更昔洛韦的干预作用。方法选取2010年1月至2014年1月期间温州医科大学附属育英儿童医院儿科收治的82例传染性单核细胞增多症患儿作为研究对象,将患儿随机分为两组,其中41例患儿在对症治疗基础上使用α-干扰素(IFN-α)治疗,为对照组,另外41例在对症治疗基础上应用IFN-α和更昔洛韦治疗,为观察组。选取同一时期的健康儿童50例作为空白组,比较各组外周血淋巴细胞亚群分布的变化。比较观察组和对照组患儿的EB病毒壳抗原IgM抗体(EB-VCA-IgM)转阴率、治疗有效率和不良反应发生率。结果与空白组相比,观察组和对照组患儿治疗前CD3^+和CD8^+比例升高,CD4^+比例和CD4^+/CD8^+降低,差异均具有统计学意义(F值分别为7.098、8.678、5.789、6.987,均P<0.05)。治疗后,观察组的CD3^+和CD8^+比例低于对照组,CD4^+比例和CD4^+/CD8^+高于对照组,差异均具有统计学意义(t值分别为7.61、8.12、10.12、5.77,均P<0.05)。观察组和对照组患儿治疗1个月和3个月的EB-VCAIgM转阴率均具有统计学差异(χ~2值分别为5.917和10.686,均P<0.05),治疗7天和6个月的EB-VCA-IgM转阴率具无统计学差异(χ~2值分别为0.988和0.534,均P>0.05)。观察组治疗有效率100.00%,对照组92.68%,差异具有统计学意义(P<0.05)。观察组不良反应发生率9.76%,对照组4.88%,差异无统计学意义(χ~2=1.712,P>0.05)。结论与健康儿童相比,传染性单核细胞增多症患儿的T细胞比例增加,CD4^+/CD8^+下降,细胞免疫出现异常。更昔洛韦的应用可以抑制病毒复制,促进细胞免疫功能的恢复,改善临床疗效。

儿童传染性单核细胞增多症患者外周血T细胞、血浆PD-1和Tim-3水平表达检测的临床意义

目的探讨儿童传染性单核细胞增多症(infectious mononucleosis,IM)患者外周血T细胞、血浆PD-1和Tim-3表达检测的临床意义。方法采集67例IM患儿和20例健康对照者的外周血,流式细胞仪检测PD-1和Tim-3在CD4^(+)和CD8^(+)T细胞上的表达,ELISA法检测血浆PD-1和Tim-3的浓度。结果与对照组比较,IM组CD4^(+)T和CD8^(+)T细胞上PD-1和Tim-3表达百分比、血浆PD-1和Tim-3浓度均明显增加(t=7.646~23.161,均P<0.01)。ROC曲线分析,血浆PD-1和Tim-3诊断IM的界值分别为1.24 ng/ml和0.44 ng/ml,敏感度分别为62.7%和65.7%,特异度分别为85.0%和75.0%。结论IM患儿的免疫抑制与PD-1及Tim-3表达增高有关,血浆PD-1和Tim-3浓度对诊断IM具有一定的价值。

血清SIGIRR、sTRAIL与传染性单核细胞增多症患儿外周血T细胞亚群和肝脏损伤的关系研究

目的 探讨传染性单核细胞增多症(infectious mononucleosis, IM)患儿血清单免疫球蛋白白细胞介素1相关受体(single immunoglobulin interleukin-1 related receptor, SIGIRR)、可溶性肿瘤坏死因子相关的凋亡诱导配体(soluble tumor necrosis factor-related apoptosis-inducing ligand, sTRAIL)与外周血T细胞亚群和肝脏损伤的关系。方法 选取2020-01/2023-01月作者医院收治的95例IM患儿为IM组,另选取同期100例体检健康儿童为对照组。根据IM患儿是否发生肝脏损伤分为肝脏损伤组(n=49)和无肝脏损伤组(n=46)。采用酶联免疫吸附试验法检测血清SIGIRR、sTRAIL水平,流式细胞术检测外周血T细胞亚群(CD3^(+)、CD16^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))。通过多因素Logistic回归分析探讨IM患儿肝脏损伤的影响因素,受试者工作特征(receiver operating characteristic, ROC)曲线分析血清SIGIRR、sTRAIL对IM患儿肝脏损伤的预测价值。结果 与对照组健康儿童比较,IM组患儿血清SIGIRR水平和外周血CD16^(+)、CD4^(+)、CD4^(+)/CD8^(+)降低,血清sTRAIL水平和外周血CD3^(+)、CD8^(+)升高(P均<0.05)。Pearson相关性分析显示,IM患儿血清SIGIRR水平与外周血CD16^(+)、CD4^(+)、CD4^(+)/CD8^(+)呈正相关关系,与CD3^(+)、CD8^(+)呈负相关关系(P<0.05),血清sTRAIL水平与外周血CD16^(+)、CD4^(+)、CD4^(+)/CD8^(+)呈负相关关系,与CD3^(+)、CD8^(+)呈正相关关系(P<0.05)。单因素分析结果显示,病程、白细胞计数、CD3^(+)、CD16^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)、SIGIRR水平、sTRAIL水平为IM患儿肝脏损伤的影响因素(P均<0.05)。多因素Logistic回归分析结果显示,CD3^(+)、CD16^(+)、sTRAIL升高为IM患儿肝脏损伤的独立危险因素,CD4^(+)/CD8^(+)、SIGIRR升高为其保护因素(P<0.05)。ROC曲线分析结果显示,血清SIGIRR、sTRAIL单独和二者联合预测IM患儿肝脏损伤的曲线下面积(area under the curve, AUC)分别为0.786、0.737、0.836,二者联合对IM患儿肝脏损伤预测效能的AUC大于SIGIRR、sTRAIL单独的预测效能。结论 IM患儿血清SIGIRR水平降低和sTRAIL水平升高与外周血T细胞亚群异常、肝脏损伤密切相关,血清SIGIRR、sTRAIL水平联合检测对IM患儿肝脏损伤的预测价值更高。

学龄前儿童传染性单核细胞增多症合并肝功能异常的临床特征及影响因素

目的分析传染性单核细胞增多症(IM)合并肝功能异常患儿的临床特征及影响因素。方法回顾性分析阜阳市人民医院2020年1月至2023年7月IM并接受治疗的140例学龄前儿童的临床资料。将患儿分为肝功能正常组和肝功能异常组,比较两组患儿的基本情况、临床症状、住院时间及实验室指标。logistic二元回归分析IM合并肝功能异常的影响因素。受试者工作特征曲线(ROC)分析相关指标的临床价值。结果IM合并肝功能异常的患儿61例,肝功能正常79例。两组患儿年龄、性别、发病季节,临床症状及EBV阳性病毒载量比较,差异无统计学意义(P>0.05)。肝功能异常组患儿住院天数为7(6,9)d、淋巴细胞计数为10.10(8.65,14.82)×10^(9)/L,CD8^(+)T淋巴细胞为7690.00(4585.37,11164.50)/μL,高于肝功能正常组的6(5,7)d、9.33(6.79,12.11)×10^(9)/L、5900.66(3637.12,8746.00)/μL,差异有统计学意义(P<0.05);而CD4^(+)/CD8^(+)比值为0.21(0.17,0.29)、中性粒细胞为2.7(2.06,4.12)×10^(9)/L、血小板计数为199(148,228.5)×10^(9)/L、系统炎症免疫指数(SII)为46.34(26.63,93.78),明显低于肝功能正常组患儿,差异均有统计学意义(P<0.05)。低SII与IM合并肝功能异常密切相关。SII诊断并发肝功能异常临界值为59.13,曲线下面积为0.758,诊断价值较高,且优于CD8^(+)T淋巴细胞及CD4^(+)/CD8^(+)比值。结论IM合并肝功能异常患儿存在明显的细胞免疫功能紊乱。当患儿存在高CD8^(+)T淋巴细胞,低SII和低CD4^(+)/CD8^(+)比值时合并肝功能异常的风险较高。

补体C3、C4及免疫球蛋白与传染性单核细胞增多症患儿EBV-DNA载量关系及联合诊断效能

目的探讨补体C3、C4及免疫球蛋白(immunoglobulin,Ig)A、IgG、IgM与传染性单核细胞增多症(infec-tious mononucleosis,IM)患儿EB病毒(epstein-barrvirus,EBV)-DNA载量的关系及联合诊断效能。方法选取2020年6月至2023年12月收治的76例IM患儿作为研究组,另按照1:1原则选择76例健康儿童作为对照组。比较2组不同性别、年龄、病程、系统损伤个数、EBV-DNA载量患儿血清补体C3、C4及IgA、IgG、IgM水平,采用Spearman分析IM患儿病程、系统损伤个数、EBV-DNA载量与血清补体C3、C4及IgA、IgG、IgM的相关性,绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析各指标单一及联合诊断IM的效能。结果与对照组比较,研究组血清补体C3.C4及IgA、IgG、IgM水平较高(P<0.01);研究组血清补体C3、C4及IgA、IgG、IgM水平比较:急性期>恢复期,1个系统损伤<多于1个系统损伤,EBV-DNA高载量>中等载量低载量,差异有统计学意义(P<0.01);IM患儿病程与血清补体C3、C4及IgA、IgG、IgM呈负相关,系统损伤个数、EBV-DNA载量与血清补体C3、C4及IgA、IgG、IgM呈正相关(P<0.01);血清IgA、IgG、IgM联合补体C3和(或)C4及五者联合诊断IM的曲线下面积(areaundercurve,AUC)优于各指标单一诊断的AUC,其中IgA+IgG+IgM+补体C4+补体C3联合为最佳组合,敏感度为0.908、特异度为0.842。结论IM患儿血清补体C3、C4及IgA、IgG、IgM水平异常升高,且与患儿病程、系统损伤个数、EBV-DNA载量密切相关;血清补体C3、C4及IgA、IgG、IgM联合诊断IM具有较高的价值。