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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=0.001)为TBil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。
Objective To investigate the clinical features of adult patients with acute Epstein-Barr virus (EBV) infection, liver function, peripheral blood lymphocyte subsets and other laboratory features to provide a basis for diagnosis and treatment of adult liver injury associated with EBV infection. Methods The clinical data of 115 patients with abnormal liver function in adult patients with acute EBV infection from June 2009 to March 2016 in Beijing Ditan Hospital were retrospectively analyzed. According to the presence or absence of jaundice, the clinical data were divided into jaundice group (n = 46) and non-jaundice group Jaundice group (n = 69), and analyzed the influencing factors of jaundice increase. The t-test was used to compare the normalized distribution of measurement data between groups. Wilcoxon test was used to compare the groups that did not meet the normal distribution. Logistic regression analysis was used to analyze multivariate analysis. Results Of the 115 patients, 106 (92.2%) had fever, 97 (84.3%) had angina, 73 (63.5%) had enlarged tonsils, 73 (63.5%) had superficial lymph nodes and 74 Example (64.4%). The percentage of peripheral blood lymphocytes in the jaundice group and non-jaundice group was significantly higher than that in the non-jaundiced group (t = -2.51, P = 0.014), ALT (Z = 4.93, P <0.001) 5.26, P <0.001), ALP (Z = 5.29, P <0.001). Logistic regression analysis showed that the ratio of ALT (odds ratio = 1.008, 95% confidence interval: 1.003-1.013, P = 0.001) was significantly higher for TBil l (odds ratio = 1.008, 95% CI: 1.003-1.0112, High independent risk factors. Conclusions The ALT and AST levels in adults with acute liver injury associated with EBV infection are the most common. The clinical manifestations such as fever, angina, tonsil enlargement, cervical lymph node enlargement and splenomegaly are common. AST and ALP are elevated in TBil Independent risk factors provide the basis for clinical diagnosis.