摘要
目的探究EB病毒(Epstein Barr virus,EBV)DNA载量与CD4^(+)T淋巴细胞在儿童传染性单核细胞增多症(infectious mononucleosis,IM)预后不良中的诊断价值,为临床决策提供有力支持。方法选取2022年1月至2024年1月常熟市第二人民医院儿科收治的120例IM患儿作为IM组,同时期选取100例EBV感染但未发展为IM的患儿作为非IM组,以及90例健康体检儿童作为对照组。收集三组受试者的临床资料、外周血T淋巴细胞亚群及EBV DNA载量等指标。根据治疗14d后EBV DNA转阴情况,将IM组患儿进一步分为预后良好组(93例)和预后不良组(27例),统计分析比较各组间的差异,并通过多因素Logistic回归分析和ROC曲线评估各指标的诊断价值。结果与非IM组相比,IM组患儿治疗前EBV DNA载量较高(P<0.05),CD4^(+)T淋巴细胞水平较低(P<0.05)。治疗14d后,IM组中有77.5%的患儿EBV DNA转阴。与预后良好组相比,预后不良组患儿治疗前的EBV DNA载量较高(P<0.05),CD4^(+)T淋巴细胞水平较低(P<0.05)。多因素Logistic回归分析指出,EBV DNA载量、白细胞、淋巴细胞、异常淋巴细胞计数及中性粒细胞计数、CD4^(+)T淋巴细胞、CD4^(+)/CD8^(+)T淋巴细胞水平均为IM患儿预后不良的影响因素;ROC曲线分析显示,EBV DNA载量与CD4^(+)T淋巴细胞联合预测预后的诊断效能优于单一指标。结论EBV DNA载量与CD4^(+)T淋巴细胞水平是预测儿童IM预后的重要指标,且二者联合检测能够显著提高诊断效能。
Objective To explore the diagnostic value of Epstein Barr virus(EBV)DNA load and CD4^(+)T lymphocytes in poor prognosis of infectious mononucleosis(IM)in children,so as to provide strong support for clinical decision-making.Method 120 children with IM admitted to the Department of Pediatrics of our hospital from January 2022 to January 2024 were selected as the IM group,100 children with EBV infection who did not develop into IM were selected as the non-IM group,and 90 healthy children with physical examination were selected as the control group.Clinical data,peripheral blood T lymphocyte subsets and EBV DNA load were collected.According to the EBV DNA turned negative after 14 days of treatment,the children in IM group were further divided into a good prognosis group and a poor prognosis group.The differences among the groups were statistically analyzed and compared,and the diagnostic value of each index was evaluated by multivariate Logistic regression analysis and ROC curve.Result Before treatment,EBV-DNA load in IM group was significantly higher than that in non-IM group(P<0.05),and CD4^(+)T lymphocyte level was lower(P<0.05).After 14 days of treatment,77.5%of the children in the IM group had negative EBV-DNA.The EBV-DNA load before treatment in the poor prognosis group was significantly higher than that in the good prognosis group(P<0.05),and the CD4^(+)T lymphocyte level was lower(P<0.05).Multivariate Logistic regression analysis showed that EBV DNA load,white blood cell(WBC),lymphocyte(Lym),abnormal lymphocyte count,norepin ephrine(NE),CD4^(+)T lymphocytes,CD4^(+)/CD8^(+)T lymphocytes levels were all factors affecting the poor prognosis of children with IM.ROC curve analysis showed that EBV DNA load combined with CD4^(+)T lymphocytes was more effective in predicting prognosis than a single indicator.Conclusion EBV DNA load and CD4^(+)T lymphocyte level are important indicators to predict the prognosis of children with IM,and the combined detection of EBV DNA load and CD4^(+)T lymphocyte level can significantly improve the diagnostic efficiency.
作者
牛文泽
杨文燕
张红强
Niu Wenze;Yang Wenyan;Zhang Hongqiang(Pediatrics Department,Changshu No.2 People's Hospital,Jiangsu Changshu 215500,China;Clinical Inspection Center,Changshu No.2 People's Hospital,Jiangsu Changshu 215500,China;Image Center,Changshu No.2 People's Hospital,Jiangsu Changshu 215500,China)
出处
《新发传染病电子杂志》
2024年第5期47-52,共6页
Electronic Journal of Emerging Infectious Diseases
基金
江苏省重点实验室开放课题资助项目(XZSYSKF2021019)
苏州市“科教兴卫”青年科技项目(KJXW2020065)。
