The Epidemiology And Clinical Features Analysis Of EBV Infection Associated Liver Injury

Purpose:To discuss epidemiological characteristics and clinical characteristics about EBV infection complicated with liver injury,thus to provide the scientificbasis for prevention and control of EBV infection.Methods:772 cases of patients with serum EBV-DNA positive in the pediatric and infections department in the first affiliated hospital of kunming medical university were enrolled between January 2010 and December 2014,divided in to apparent EBV infection group 193cases,complicated with liver injury 120cases;and latent EBV infection group 579cases.The epidemiological data of two groups and the clinical characteristics of apparent EBV infection group were retrospectively analyzed. Clinical data include main symptoms and signs,laboratory examination, treatment,and outcome.SPSS 17.0 statistical softwpackage was used to analysisdata.Results:The first part The epidemiological characteristics of 772 cases of EBV infection1,772 cases of EBV infection patients, in which, there are 489/772 male patients (63.3%),283/772women patients (36.7%), the sex ratio of 1.73:1.2,772 cases of EBV infection patients, in which,minimum age 43 days, the biggest age 86 years, the median age 30.5 years, the most patients in<10group,237/772 cases(30.7%).3, EBV infection has happened all the year round, January-December infection cases distribution is:43 cases(5.6%),38 cases(4.9%),54 cases(7.0%),62 cases(8.0%),70 cases(9.1%),59 cases(7.6%),79 cases(10.2%),83 cases(10.8%),57 cases(7.4%),77 cases(10.0%),84 cases(10.9%),66 cases(8.5%).4, Spatial distribution:the number of cases of brucellosis in our province states ( city) as follows:339 cases of Kunming City(43.9%),145 cases of Qujing City(18.8%),56 cases of Zhaotong City(7.3%),39 cases of HonghePrefecture (5.1%),32 cases of Chuxiong Prefecture(4.1%),31 cases of Yuxi City(4.0%),27 cases of Dali Prefecture(3.5%),25 cases of Lijiang City(3.2%),24 casesof Puer City (3.1%),13 cases of Baoshan City(1.7%),12 cases of Lincang City(1.6%),10 cases of Wenshan City(1.3%),7 cases of Xishuangbanna Prefecture (0.9%),6 cases of Dehong Prefecture(0.8%),3 cases of Nujiang Prefecture (0.4%),3 cases of DiQing Prefecture(0.4%).The second part The clinical features of 193 patients with apparent EBV infection1, In 772 cases of EBV infection,latent infection 579 cases (75%); apparent EBV infection 193 cases (25%), in which Generally EBV infection 125 cases (64.8%), the infectious mononucleosis 31 cases (16.1%), EBV hepatitis 24 cases(12.4%), hemophagocytic syndrome 11 cases (5.7%), EBV infection meningitis 1 case (0.5%), EBV infection meningoencephalitis 1 case (0.5%).2,The EBV infection complicated with liver injury has 120/193 cases (62.2%),patients in 80 u/L< ALT 200 u/L group have 43 patients (35.8%),which is most.Concurrent ASTelevations has 133 patients (68.9%), patients in 40 u/L< AST 80 u/L group have 52 cases (39.1%),which is most; the patients which give priority to with AST rise have 57 cases;Concurrent TB elevations has 57/193 patients (29.5%), patients inULN<TB≤2ULNgroup are most.3, There was statistical difference of degree with ALT elevationby age(P<0.05). there wasstatistical difference of EBV infection complicated with jaundice(P<0.05),but there was no statistical difference ofdegree with TB elevationsby age(P>0.05).4, male patients who complicated with ALT elevation have 63 cases(59.4%), female patients who complicated with ALT elevation have 57 cases (65.5%), all of them in 80 u/L<ALT≤200 u/L group are most, accounts for 41.3%,29.8% respectively.male patients who complicated with TB elevation have 28 cases(26.4%), female patients who complicated with liver damage have 29 cases (33.3%), respectivelyin ULN<TB≤2ULN,2ULN<TB≤5ULN group are most, accounts for 53.6%,37.9% respectively.There was nostatistical difference ofEBV infectioncomplicated with ALT,TB elevations andliver function (ALT,TB) levels by gender(P> 0.05).5, the major clinical manifestations:feverl36cases(70.5%);pharyngalgia 50 cases(25.9%);lymphadenectasis 94 cases(48.7%);Headache 14 cases(7.3%);skin rash 17 cases(8.8%);fatigue 36 cases(18.7%);poor appetite 27 cases(14.0%); hydroblepharon23 cases(24.7%);hepatomegaly 37 cases(19.2%);slenomegaly31 cases (16.1%);stomachache 16cases(8.3%), diarrhea 2cases(1.0%).6, The peripheral blood test results in 193 cases of EBV infection:WBC>10×109/L were76/193 (39.4%), WBC<4×109/L were 29/193(15.0%), abnormal lymphocytes count≥10% were 37/193 (19.2%), hemoglobin< 100g/L were 20/193(10.4%), platelet <100×109/L were 18/193(9.3%).Conclusion1, EBV infection has happened all the year round,the infected personare most in summer, autumn (July, August, October and November).Children and adult all can be infect EBV, but mainly within<10years old, more man than women patients.2, Apparent EBV infection rate was 25% in this investigation, among them, the combined liver damage was 62.2%, jaundice cases accounted for 29.5%.EBV infection complicated with liver damage mainly perform ALT,AST lightly elevated(respectively80-200u/L,40-80u/L).Jaundice cases also is given priority to with moderately elevated (ULN-2ULN).3, EBV infection related to clinical manifestations manilyis fever, The second was pharyngalgia, lymphadenectasis, others includeheadache, skin rash, fatigue, poor appetite, hepatosplenomegaly, hydroblepharon, stomachache, diarrhea, etc.5, The patients with EBV infection related liver damage can improveby antiviralandprotecting liver,other symptomatic supporttreatment, the prognosis is good, but a minority of EBV infection cases can lead to liver failure, and poor prognosis.A minority of patients complicated withhemophagocytic syndrome or nervous system lesions, less faorable outcomes after treatment, the prognosis is poor.