115例成人急性EB病毒感染相关肝损伤临床特征分析

摘要

Objective To investigate the clinical manifestations and features of laboratory examinations including liver function and peripheral blood lymphocyte subsets of adult patients with acute Epstein-Barr virus (EBV) infection,and to provide a basis for the diagnosis and treatment of liver injury associated with acute EBV infection in adults.Methods A retrospective analysis was performed for the clinical data of 115 adult patients with acute EBV infection and abnormal liver function who were treated from June 2009 to March 2016,and these patients were divided into two groups according to the presence or absence of jaundice.The influencing factors for jaundice were analyzed.The t-test was used for comparison of normally distributed continuous data between groups,the Wilcoxon test was used for comparison of non-normally distributed continuous data between groups,and the logistic regression analysis was used for univariate analysis.Results Of all patients,106 (92.2％) had pyrexia,97 (84.3％) had angina,73 (63.5％) had swelling of the tonsil,73 (63.5％) had superficial lymph node enlargement,and 74 (64.4％) had splenomegaly.There were significant differences between the jaundice group and the non-jaundice group in terms of the percentage of peripheral blood lymphocytes (t =-2.51,P =0.014) and the levels of alanine aminotransferase (ALT) (Z =4.93,P ＜ 0.001),aspartate aminotransferase (AST) (Z =5.34,P ＜ 0.001),gamma-glutamyl transpeptidase (Z =5.26,P ＜ 0.001),and alkaline phosphatase (ALP) (Z =5.29,P ＜ 0.001).The logistic regression analysis showed that AST (OR =1.008,95％ CI:1.003-1.012,P ＜ 0.001) and ALP (OR =1.008,95％ CI:1.003-1.013,P =0.001) were independent risk factors for the increase in total bilirubin (TBil).Conclusion Liver injury associated with acute EBV infection mainly manifests as increases in ALT and AST,and common clinical manifestations include pyrexia,angina,swelling of the tonsil,cervical lymph node enlargement,and splenomegaly.AST and ALP are independent risk factors for the increase in TBil and provide a basis for clinical diagnosis.%目的 探讨成人急性EB病毒(EBV)感染者的临床表现、肝功能、外周血淋巴细胞亚群等实验室检查特征,为成人急性EBV感染相关肝损伤的诊治提供依据.方法 对北京地坛医院2009年6月-2016年3月因成人急性EBV感染伴发肝功能异常的115例患者临床资料进行回顾性分析,根据有无黄疸分为黄疸组(n=46)和非黄疸组(n=69),并对黄疸升高的影响因素加以分析.计量资料满足正态分布的组间比较采用t检验;不满足正态分布的组间比较采用Wilcoxon检验;多因素分析采用logistic回归分析.结果 115例患者中出现发热106例(92.2％),咽峡炎97例(84.3％),扁桃体肿大73例(63.5％),浅表淋巴结肿大73例(63.5％),脾肿大74例(64.4％).黄疸组和无黄疸组在外周血淋巴细胞的比例(t=-2.51,P=0.014)、ALT(Z=4.93,P＜0.001)、AST(Z =5.34,P＜0.001)、GGT(Z=5.26,P＜0.001)、ALP(Z=5.29,P＜0.001)水平差异均有统计学意义.logistic回归分析显示AST(比值比=1.008,95％可信区间:1.003～1.012,P＜0.001)、ALP(比值比=1.008,95％可信区间:1.003 ～1.013,P=0.00l)为TrBil升高的独立危险因素.结论 成人急性EBV感染相关肝损伤以ALT和AST升高为主,发热、咽峡炎、扁桃体肿大、颈部淋巴结肿大、脾肿大等临床表现较常见,AST、ALP为TBil升高的独立危险因素,为临床诊断提供依据.