目的:探讨成人EB病毒感染相关性疾病的临床特征及预后。方法:回顾性分析2017年1月至2019年8月于上海复旦大学附属华山医院住院的59例EB病毒感染相关性疾病患者的临床资料。比较传染性单核细胞增多症(infectious mononucleosis，IM)、慢性活动性EB病毒感染(chronic active Epstein-Barr virus infection，CAEBV)和淋巴瘤患者的临床表现。将患者分为急性病程组(IM)和慢性病程组(CAEBV＋淋巴瘤)，比较2组患者的实验室指标(血常规、肝功能、炎症指标、EB病毒DNA、EB病毒抗体和T淋巴细胞)检查结果。统计学处理采用曼-惠特尼n U检验、n χ2检验或Fisher确切概率法。n 结果:59例EB病毒感染相关性疾病患者中，IM 23例(39.0%)，淋巴瘤23例(39.0%)，CAEBV 13例(22.0%)；发热57例(96.6%)，淋巴结肿大37例(62.7%)、脾大36例(61.0%)。慢性病程组有17例患者合并噬血细胞性淋巴组织细胞增生症(hemophagocytic lymphohistiocytosis, HLH)。慢性病程组患者的白细胞计数、血红蛋白、血小板计数分别为4.07(1.94，8.35)×10n 9/L、89.5(74.5，108.0) g/L、100(37，161)×10n 9/L，分别低于急性病程组的9.91(6.75，17.38)×10n 9/L、132.5(118.2，152.0) g/L、197(129，233)×10n 9/L，差异均有统计学意义(n U＝3.69、5.22、3.61，均n P<0.01)。慢性病程组患者的降钙素原、C反应蛋白、血清铁蛋白分别为0.45(0.15，1.13) μg/L、47.75(17.57，84.67) mg/L、2 000(682，2 002) μg/L，分别高于急性病程组的0.12(0.07，0.28) μg/L、6.39(3.13，11.38) mg/L、482(159，1 271) μg/L，差异均有统计学意义(n U＝-2.95、-3.77、-4.16，均n P<0.01)。慢性病程组患者的CD4n ＋T淋巴细胞计数、CD8n ＋T淋巴细胞计数、CD19n ＋B淋巴细胞计数、自然杀伤细胞计数分别为259.15(101.98，509.26)、214.69(119.31, 529.47)、46.14(4.44，135.87)和81.09(41.53，118.46)/μL，分别低于急性病程组的738.88(592.20，893.94)、1 609.17(920.88，3 952.34)、144.52(83.65，215.14)和309.82(123.78，590.68)/μL，差异均有统计学意义(n U＝3.66、3.80、2.90、3.40，均n P<0.01)；而CD4n ＋/CD8n ＋T淋巴细胞比值为0.90(0.60，1.70)，高于急性病程组的0.45(0.10，1.28)，差异有统计学意义(n U＝-2.29，n P＝0.02)。IM组23例患者均治愈；淋巴瘤组死亡10例，进行化学治疗13例；CAEBV组死亡7例，好转6例。n 结论:成人EB病毒感染相关性疾病的临床特征以发热、淋巴结肿大、脾大为主，慢性感染可合并HLH。成人急性EB病毒感染预后较好，但长期慢性感染预后较差。“,”Objective:To investigate the clinical characteristics and prognosis of Epstein-Barr virus-related diseases in adults.Methods:The clinical data of 59 patients with Epstein-Barr virus-related diseases in Huashan Hospital, Fudan University, Shanghai from January 2017 to August 2019 were analyzed retrospectively. The clinical manifestations of patients with infectious mononucleosis (IM), chronic active Epstein-Barr virus infection (CAEBV) and lymphoma in patients were compared. Patients were divided into acute course group (IM) and chronic course group (CAEBV+ lymphoma), and the results of labratory indications (blood rontine, liver function, imflammatory indications, Epstein-Barr virus DNA, Epstein-Barr virus antibody and T lymphocyte) were compared between two groups. Statistical analysis was performed by Mann-Whitney n U test, chi-square test or Fisher exact probability test.n Results:Among the 59 patients, 23 cases (39.0%) were diagnosed with IM, 23 cases (39.0%) were lymphoma and 13 cases (22.0%) were CAEBV. The clinical manifestations of patients with Epstein-Barr virus-related diseases were fever (57/59, 96.6%), lymphadenopathy (37/59, 62.7%) and splenomegaly (36/59, 61.0%). There were 17 patients in the chronic course group experienced hemophagocytic lymphohistiocytosis (HLH). The white blood cell counts, hemoglobin levels and platelet counts of patients in the chronic course group (4.07(1.94, 8.35)×10n 9/L, 89.5(74.5, 108.0) g/L and 100(37, 161)×10n 9/L, respectively) were all lower than those in the acute course group (9.91(6.75, 17.38)×10n 9/L, 132.5(118.2, 152.0) g/L and 197(129, 233)×10n 9/L, respectively), with statistically significant differences (n U=3.69, 5.22 and 3.61, respectively, all n P<0.01). The levels of procalcitonin, C-reactive protein and serum ferritin in the chronic course group (0.45(0.15, 1.13) μg/L, 47.75(17.57, 84.67) mg/L and 2 000(682, 2 002) μg/L, respectively) were all higher than those in the acute course group (0.12(0.07, 0.28) μg/L, 6.39(3.13, 11.38) mg/L and 482(159, 1 271) μg/L, respectively), with statistically significant differences (n U=-2.95, -3.77 and -4.16, respectively, all n P<0.01). The counts of CD4n + T lymphocytes, CD8n + T lymphocytes, CD19n + B lymphocytes and natural killer cells in the chronic course group (259.15(101.98, 509.26), 214.69(119.31, 529.47), 46.14(4.44, 135.87) and 81.09(41.53, 118.46)/μL, respectively) were all lower than those in the acute course group (738.88(592.20, 893.94), 1 609.17(920.88, 3 952.34), 144.52(83.65, 215.14) and 309.82(123.78, 590.68)/μL, respectively), with statistically significant differences (n U=3.66, 3.80, 2.90 and 3.40, respectively, all n P<0.01), while the CD4n + /CD8n + T lymphocytes ratio in the chronic course group was higher (0.90(0.60, 1.70) n vs 0.45(0.10, 1.28))(n U=-2.29, n P=0.02). Twenty-three patients with IM were all cured, while 10 patients with lymphoma died and 13 received chemotherapy. Seven patients with CAEBV died and six improved.n Conclusions:The clinical characteristics of Epstein-Barr virus-related diseases in adults are fever, lymphadenectasis, splenomegaly.Chronic Epstein-Barr virus infection may be associated with HLH. The prognosis of adults with acute Epstein-Barr virus infection is good, while that of long-term chronic Epstein-Barr virus infection is poor.