目的：分析慢性活动性EB病毒感染病例的临床特征，以指导临床诊治。方法回顾性分析15例慢性活动性EB病毒感染患者的临床资料、实验室检查、治疗及随访结果。结果慢性活动性EB病毒感染常见临床表现为发热、肝脾肿大、淋巴结肿大，其他还有咳嗽、咯痰、皮疹、乏力、黄疸、鼻塞、流涕、咽痛、胸闷等症状。实验室检查异常最多见的是转氨酶升高，部分伴有胆红素升高，血液系统主要为全系或二系血细胞减少及淋巴细胞比例升高，包括贫血、白细胞降低、血小板减少，血清乳酸脱氢酶、铁蛋白升高多见，且危重者明显升高；所有患者均有抗EB病毒衣壳抗原IgG（ EBVCA-IgG）抗体的升高，而其IgM抗体均为阴性，14例患者检测了早期抗原EBEA-IgG抗体和核抗原EBNA-IgG抗体，EBEA-IgG抗体阳性12例，而EBNA-IgG抗体阳性10例；实时定量聚合酶链反应检测外周血EBV-DNA均为阳性，病毒载量（中位数）为4拻．3×106 copies/ml。15例患者中失访1例；死亡8例，死亡原因分别为噬血细胞综合征3例、间质性肺炎3例、肝衰竭1例、心功能衰竭1例；余6例仍随访中。结论慢性活动性EB病毒感染临床表现多样，预后差，病死率高，临床上遇到发热原因不明、肝脾或淋巴结肿大的病例应及时行EBV-DNA和EB相关抗体检测以尽早确诊。%Objective To investigate the clinical characteristics of chronic active Epstein-Barr virus ( CAEBV) infec-tion cases.Methods Retrospective analyzed the clinical data , laboratory tests, treatment and follow-up results of 15 patients with chronic active EB virus infection .Results Chronic active EB virus common clinical manifestations were fever , hepato-splenomegaly, lymphadenopathy, others including cough, expectoration, rash, fatigue, jaundice, nasal congestion, runny nose, sore throat, chest tightness and other symptoms , the most common laboratory abnormalities are elevated aminotransferas-es, some accompanied by elevated bilirubin , blood system mainly finding are the whole series or two lines cytopenia decreased and increased the proportion of lymphocytes , including anemia , leukopenia , thrombocytopenia ,increased serum lactate dehy-drogenase and ferritin more common , and were significantly elevated in critically ill patients .All patients had anti-EB virus capsid antigen IgG ( EBVCA-IgG) antibodies increased , while the IgM antibodies were negative , 14 patients in the early de-tection of antigen EBEA-IgG antibodies and nuclear antigen EBNA-IgG antibodies, EBEA-IgG antibody positive in 12 cases, while EBNA-IgG antibody positive in 10 cases.Real-time quantitative polymerase chain reaction detection of EBV-DNA in pe-ripheral blood were positive, viral load (median) of 4.3 ×106 copies/ml.In 15 patients, one case were lost of follow up;eight cases were dead , including three cases of hemophagocytic syndrome , interstitial pneumonia in three cases , one case of liver failure, heart failure in one case; rest 6 cases are still under follow-up.Conclusion Diagnosis of CAEBV infection is difficult due to the variety of clinical features .It is important to test EB virus antibody and DNA for diagnosis as early as possi-ble because of its severe complications , poor prognosis and high mortality .
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