The Clinical Characteristics Of 118 Children With Epstein-Barr Virus Infection

Objective To observe and analyze the results of the clinical manifestation ?laboratory examination?treatment and prognosis of the children with the EB virus infection,and explore their clinical significance in the diagnosis and treatment of EB virus infection in children,in order to improve the early diagnosis and treatment level,improve the prognosis.Methods To choose the 118 chailren with EBV infection who recieve the inpatient treatment in Children's Hospital Affiliated to Suzhou University from January 2015 to June2016 as the research object.Retrospective analysis the clinical data of the 118 children,including the gender,age,symptoms,signs,peripheral bloods,abnormal lymphocyte ratio and liver function,blood coagulation function,T lymphocyte subsets,CRP and EBV-DNA copy numbers,EBV antibodies,treatment and prognosis.The children are divided into three groups according to age: infants(0 to 3 years old)? preschool age(3to 7 years old)?school age and adolescence(7 years old or older),comparing the clinical data of the three groups.The clinical data of the infection mononucleosis(IM)and the atypical EBV infection were analyzed.Results(1)In children with EBV infection,the male is 65 cases,and the female is53 cases.The male to female ratio is 1.23:1.The onset age is from 11 months to 6 years old12 months,mean age is 4.31 ± 2.56 years old,median age is 3.92 years old;(2)The first clinical manifestation of symptoms are fever(82.20%),cough(48.31%)and rash(20.33%).The common signs are angina(95.76%),lymphadenopathy(83.90%),swollen eyes(43.37%),pharyngeal isthmus pseudomembranous and pus(40.68%),hepatomegaly(39.83%),splenomegaly(36.44%);(3)The auxiliary examination results: the percentage of patients whose peripheral blood WBC below 4×109/L is 3.39%,the percentage of patients whose peripheral blood WBC higher than 10×109/L is 67.80%,the percentage of patients who mainly depend on lymphocytes is 92.37%,the percentage of patients who has high abnormal lymphocytes is 73.52%,the percentage of patients whose abnormal lymphocyteratio ?10% is 35.29%.the percentage of patients whose abnormal red blood cells in urine accounted is 12.71%;CRP high take up 50.45%,the high serum ferritin account for10.13%;high D-dimer patients take up 73.12%,lower fibrinogen patients take up 53.19%;high ALT or AST patients take up 64.40%;the percentage of patients who hold low CD4+,high CD8+ or low CD4+/CD8+,low CD4+CD25+are 86.32 %,85.47%,82.05%,82.35%respectively.The percentage of CA-IgM antibody positive is 82.31%.The percentage of patients who hold the whole blood EBV-DNA-PCR is 98.31%,the plasma EBV-DNA-PCR is 72.03%.Two weeks after treatment,the plasma EBV-DNA and the whole blood EBV-DNA copy number fall or overcast,and plasma EBV-DNA copy number down faster than the whole blood EBV-DNA;(4)IM,atypical EBV infection,and HLH accounts for 75,39,4 cases,respectively.The most common diagnosis was "bronchitis"and "bronchial pneumonia”,it takes up 12 and 24 cases,respectively;(5)The ganciclovir and symptomatic supportive treatment had a good prognosis and fewer side effects;(6)There is no significant difference between the ratio of male and female,diagnosis,clinical manifestations of three different groups including infants(40 cases),preschool(61 cases),school age and adolescence(17 cases).The alanine amiotransferase(ALT)increasing of the preschool age were significant higher than the proportion of infants(P<0.05);(7)There is no significant difference of sex ratio and age distribution between IM group and atypical EB virus infection.However,the rate of the clinical manifestations of fever,angina,lymphadenopathy,hepatosplenomegaly in IM group is higher than the atypical EBV infection group,which are statistically significant(p<0.05);the ratio of the white blood cell count and specific lymphocyte in IM group was significantly higher than that in atypical EBV the infection group,which are statistically significant difference(P<0.01);the expression rate of CD4+ and CD4+CD25+,and the ratio of CD4+/CD8+ in IM group are lower than that in atypical EB virus infection group,the expression rate of CD8+ in IM group is higher than that in atypical EBV infection group,whose difference was statistically significant(p< 0.05);there was no significant difference in ALT,CRP,serum ferritin(P>0.05)between the two groups.Conclusion(1)EBV infection mainly infect the male is more sensitive,the peaks is3-7 years old.The clinical manifestations of EBV infection are various.involving the multiple system organs?The liver damage ratio of preshcool is higher than infants and young chaildren period.(2)Plasma EBV-DNA-PCR detection can help early diagnosis ofEBV acute infection.(3)EBV infection after antiviral and other comprehensive treatment,the effect is good;(4)The examination of cellular immune and peripheral blood lymphocyte percentage can help the early diagnosis of infection mononucleosis.