Analysis Of CD8~+CD28~- Changes And Clinical Features In Children With Liver Function Impairment In Infections Mononucleosis

Objective:Study on clinical features and CD8+CD28-changes of Infectious Mononucleosis(IM)with liver function impairment in children,to provide evidence for treatment and prognostic judgment for IM.Methods:The data of 525 children with IM who were hospitalized in pediatrics department of Affiliated Hospital of North Sichuan Medical College during January 2015 to October 2020 were collected.They were divided into liver function impairment group and no liver function impairment group.The clinical features,abnormal lymphocytes,urine routine and T lymphocyte subsets including CD8+CD28-were statistically analyzed.Results:1.There were 525 children with IM in this study.There were 322 males(61%)and 203 females(39%).Their age ranges from 6 months to 13 years.The average age was 4.2 years.The mean length of hospital stay was 8.8±2.7 days.There were 448 cases(85.3%)with fever and 415(79%)of white discharge from pharynx.There were 311 cases(59.2%)with eyelid edema,440 cases(83.8%)with lymphadenopathy,192 cases(36.6%)with hepatomegaly,138 cases(26.3%)with splenomegaly and 285 cases(55.1%)with the percentage of abnormal lymphocytes>10%.There were 266 cases(50.7%)with liver function impairment,including 211 cases(40.2%)with mild liver function impairment,49 cases(9.3%)with moderate liver function impairment,6 cases(1.1%)with severe liver function impairment and 2 cases(0.4%)with TBIL greater than 34.2umol/L.In the impaired liver function group,the age,eyelid edema,hepatomegaly and detection rate of abnormal lymphocyte percentage>10%were higher than in non-impaired liver function group.2.Routine urine examination was performed on 471 IM children after admission.47 cases(10%)had renal damage,There were 29 cases(6.2%)in the impaired liver function group and 18 cases in the non-impaired liver function group(3.2%),there was no significant difference between the two groups.3.The T lymphocyte subsets in peripheral blood of 76 children with IM were examined at admission,of which 40 cases had liver function impairment and 36 cases had no liver function impairment,36 cases of mild liver function impairment and 4 cases of moderate liver function impairment.In the impaired liver function group,the percentage of CD3、the percentage of CD8、the percentage and count of CD8+CD28-were higher than in non-impaired liver function group,there was no statistical difference between mild and moderate liver function impairment group.T lymphocyte subsets of 35 children with IM were reviewed.The percentage of CD4,CD4/CD8 ratio,the percentages of CD4+CD45RA+and CD4+CD45RO+ were increased,while the percentage of CD8,the percentage and count of CD8+CD28+,the percentage and count of CD8+CD28-,the count of CD4+CD45RO+ were decreased after treatment.The reexamination of T lymphocyte subsets in 35 cases showed that 15 cases had liver function impairment and 20 cases had no liver function impairment at admission.After the therapy,there was no statistical difference in T lymphocyte subsets between the liver function impaired group and non-impaired liver function group.Conclusion:1.Liver function impairment is a common complication of infectious mononucleosis,which is mainly mild to moderate.In children with IM,older age,hepatomegaly,eyelid edema and the percentage of abnormal lymphocyte>10%are more likely to have liver function impairment.2.Liver function impairment in children with IM does not significantly increase the risk of renal damage.3.CD8+CD28-may be involved in the immune process of liver function impairment in children with IM and play a protective role.