| Objective 1.The clinical characteristics and laboratory examination results of Epstein-Barr viral infectious mononucleosis in children were analyzed to improve the level of early diagnosis and provide evidence for treatment.2.To investigate the changes of lymphocyte subsets,cytokines IL-6,y-IFN and IL-10 in IM children infected with Epstein-Barr virus and their clinical significance.Methods 1.Clinical data of 320 children with Epstein-Barr virus infected infectious mononucleosis hospitalized in the Children’s Hospital of Soochow University from September 2018 to August 2020 were collected.The onset season,clinical manifestations,comorbidities and laboratory examination results were analyzed retrospectively.The differences of laboratory indicators and clinical manifestations in different age groups,different plasma viral load,whether or not patients with abnormal liver function were analyzed,and the correlation between plasma EBV-DNA viral load and lymphocyte subsets,fever duration,blood routine and liver function related indexes were analyzed.2.A total of 100 children with Epstein-Barr virus infected IM who were admitted to the Infectious Diseases Department of our hospital from September 2018 to August 2020 were selected as the experimental group.A total of 60 healthy children who underwent physical examination in the child health care department of our hospital during the same period were used as the control group.The levels of lymphocyte subsets and cytokines(IL-6,IL-10,γ-IFN)in peripheral blood of the children with IM and the control group were determined by flow cytometry and enzyme-linked immunosorbent assay.The correlation and diagnostic value of the above indexes with blood routine,percentage of peripheral blood isorrhea,liver function and plasma EBV-DNA viral load in children with IM were statistically analyzed.Results 1.320 cases of children with summer onset of IM accounted for 46.6%.The incidence rate in boys(58.1%)was higher than that in girls(41.9%).2.There were 309 cases(96.6%)of children with fever,and the difference of moderate and high fever symptoms among different age groups was statistically significant.The incidence of moderate and high fever symptoms was higher in older children over 3 years old,and the higher the age,the higher the incidence of moderate and high fever.The duration of fever,hepatomegaly,and rash were statistically significant among different age groups,the fever duration was the shortest and rashes are most common in the group under 3 years old..3.Increased white blood cells,mainly lymphocytosis,in children with IM,abnormal rates of ALT and AST were 54.4%and 32.2%,respectively.In terms of EBV antibody,the positive rate of VCA-IgG was 89.06%,and of EBNA-IgG was 5.94%.The affinity of VCA-IgG antibody was mainly low,accounting for 95.31%.4.The white blood cells,percentages of lymphocytes,alanine aminotransferase,aspartate aminotransferase,creatine kinase and prothrombin time were statistically significant among different age groups.The percentages of CD3~+and CD3~+CD8~+were significantly increased,while the percentages of CD3~+CD4~+and CD4~+/CD8~+were significantly decreased,and the percentages of CD19~+CD23~+,CD3~+,CD3~+CD8~+and CD3-CD19~+were statistically significant among different age groups(P<0.05).5.Plasma EBV-DNA viral load was positively correlated with the duration of fever,WBC,LC,ALT,AST,LDH,ferritin and D-dimer.6.Compared with non-liver damage group,liver damage group was older,fever lasted longer,plasma EBV-DNA copy number,WBC,LDH,ferritin,TT and D-dimer were significantly increased,while fibrinogen was lower,the differences were statistically significant(P<0.05).The percentages of CD3~+,CD3~+CD8~+,CD3-CD(16~+56)~+and IgM in the non-liver injury group were lower than those in the liver injury group,while the percentages of CD3~+CD4~+,CD3-CD19~+,CD19~+CD23~+and CD4~+/CD8~+were higher than those in the liver injury group,with statistical significance(P<0.05).7.Long duration of fever and high levels plasma EBV-DNA copy number,WBC,CD3~+,CD3~+CD8~+,IgM,and low levels of CD3~+CD4~+,CD3-CD 19~+,CD 19~+CD23~+and CD4~+/CD8~+were independent risk factors for liver damage.ROC curve analysis showed that CD3~+CD4~+,CD3-CD19~+,CD19~+CD23~+and CD4~+/CD8~+had higher value in the diagnosis of liver damage,with 13.15%,5.75%,4.1%and 0.65 as cut-off points,CD3~+CD4~+had higher specificity and sensitivity,0.76 and 0.56,respectively.The sensitivity of WBC,IgM,CD3~+and CD3~+CD8~+to possible liver damage were 0.81,0.62,0.76,0.78,and the specificity were 0.86,0.84,0,82,0.87,respectively.8.The levels of IL-6,IL-10 and y-IFN were significantly different between the case group and the control group(P<0.05).The percentages of CD3~+and CD3~+CD8~+in IM group were significantly higher,while the percentages of CD3~+CD4~+,CD19~+CD23~+,CD3-CD(16~+56)~+,CD3-CD19~+and the ratio of CD4~+/CD8~+in IM group were significantly lower than those in control group.There were statistically significant differences in percentage of isolymphosis,WBC,ALT,AST and LDH between the two groups(P<0.05).IL-6 and y-IFN were correlated with AST,γ-IFN was correlated with plasma EBV-DNA load.IL-6 was correlated with percentage of CD3~+,CD3~+CD4~+,CD3~+CD8~+,CD3-CD19~+,and CD4~+/CD8~+.IL-10 was correlated with percentages of CD19~+CD23~+,CD3~+,and CD3-CD19~+,y-IFN was negatively correlated with the percentages of CD3~+and CD3~+CD8~+.Conclusion 1.Infectious mononucleosis in children occured most frequently in boys and was most common in preschoolers,with a variety of clinical symptoms.2.To fully understand the clinical manifestations and laboratory characteristics of IM caused by EBV infection in different ages can improve the level of clinical diagnosis and treatment.3.The higher the load of the plasma EBV-DNA virus,the longer the fever duration,the higher the white blood cell count,and the greater the likelihood of combined liver damage.4.Immunological changes and inflammatory responses in children with IM are related to the occurrence and development of the disease,IL-6,IL-10 and y-IFN are involved in the immunological pathogenesis of IM. |
