本文選題：噬血細(xì)胞綜合征 + EBV感染　； 參考：《北京協(xié)和醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:探索噬血細(xì)胞綜合征患者中EBV感染患者的臨床特點,并且評價此類患者的免疫功能狀態(tài)。方法:回顧性分析我院2012年1月至2016年12月住院治療的符合入選及排除標(biāo)準(zhǔn)的298例成人噬血細(xì)胞綜合征患者的臨床資料和相關(guān)免疫學(xué)指標(biāo)。將血EBV-DNA500 copies/ml定義為EBV感染陽性。使用SPSS19.0軟件,比較EBV感染患者和非EBV感染患者的臨床特點和免疫學(xué)差異,并比較EBV-DNA滴度水平和各臨床指標(biāo)是否有相關(guān)性。結(jié)果:EBV陽性噬血細(xì)胞綜合征患者和EBV陰性噬血細(xì)胞綜合征患者比較,腫瘤發(fā)生率顯著升高(p=0.019)、死亡率升高(46.67%vs 34.97%)。同時血小板顯著減低(73.65±55.65 vs 113.41±108.57,p=0.041),APTT時間顯著延長(49.28±15.50 vs 37.70±13.97,p=0.000),總膽固醇顯著減低(3.32± 1.23 vs 4.14±1.68,p=0.013),低密度脂蛋白顯著減低(1.73±0.85 vs 2.18±1.09,p=0.040),鐵蛋白升高幅度顯著偏低(8536.23±10688.0 vs 15504.46±199446.73,p=0.048)。免疫學(xué)方面,EBV陽性噬血細(xì)胞綜合征患者補體C4更高(0.26±0.09 vs 0.21±0.10,p=0.018),CD3+T細(xì)胞計數(shù)顯著減低(525.48±445.69 vs 865.85±839.89,p=0.041),CD8+T細(xì)胞計數(shù)顯著減低(238.13±264.34 vs 539.51 ±774.84,p=0.035),CD4/CD8比值顯著升高(1.70± 1.79 vs 0.91 ±0.98,p=0.023)。相關(guān)性分析發(fā)現(xiàn),APTT和EBV-DNA滴度水平呈正相關(guān)(R=0.476,p=0.000);PT和EBV-DNA滴度水平呈正相關(guān)(R=0.218,p=0.007);總膽紅素和EBV-DNA滴度水平呈正相關(guān)(R=0.223,p=0.033);直接膽紅素和EBV-DNA滴度水平呈正相關(guān)(R=0.288,p=0.005);低密度脂蛋白和EBV-DNA滴度水平呈負(fù)相關(guān)(R=-0.219,p=0.046);免疫指標(biāo)方面CD8+T細(xì)胞水平和EBV-DNA滴度水平呈負(fù)相關(guān)關(guān)系(R=-0.359,p=0.002);CD4/CD8水平和EBV-DNA滴度水平呈正相關(guān)關(guān)系(R=0.402,p=0.000);補體C4和EBV-DNA滴度水平呈正相關(guān)(R=0.418,p=0.000)。結(jié)論:噬血細(xì)胞綜合征患者中EBV感染患者的臨床指標(biāo)具有鮮明的臨床特點,有更高的腫瘤發(fā)生率、更高的死亡率。同時在免疫功能狀態(tài)方面,EBV感染患者有明顯減低的CD3+T細(xì)胞和CD8+T細(xì)胞計數(shù)和更高的補體C4,且CD8+T細(xì)胞計數(shù)和補體C4都與EBV-DNA滴度顯著相關(guān)。且EBV在噬血細(xì)胞綜合征患者的肝臟功能損害中有可能發(fā)揮了重要作用。
[Abstract]:Aim: to investigate the clinical features of EBV infection in patients with hemophagocytic syndrome and to evaluate their immune function. Methods: the clinical data and immunological indexes of 298 adult hemophagocytic syndrome patients who were admitted to hospital from January 2012 to December 2016 were analyzed retrospectively. Blood EBV-DNA500 copies/ml was defined as positive for EBV infection. SPSS19.0 software was used to compare the clinical characteristics and immunological differences between EBV infected patients and non-EBV infected patients, and to compare the correlation between the titer of EBV-DNA and the clinical indexes. Results compared with the patients with EBV negative hemophagocytic syndrome, the incidence of tumor was significantly increased in patients with hematophagocytic syndrome and the mortality was increased by 46.67 vs 34.97m. At the same time, there was a significant decrease in platelet count (73.65 鹵55.65 vs 113.41 鹵108.57), a significant prolongation of the APTT time (49.28 鹵15.50 vs 37.70 鹵13.97), a significant decrease in total cholesterol (3.32 鹵1.23 vs 4.14 鹵1.68p0.013), a significant decrease in low density lipoprotein (LDL-C) 1.73 鹵0.85 vs 2.18 鹵1.09p0. 04040, and a significant decrease in ferritin (8536.23 鹵10688.0 15504.46 鹵199446.3p0.048). In immunology, the number of complement C4 was significantly higher in patients with EBV-positive hemophagocytic syndrome (0.26 鹵0.09 vs 0.21 鹵0.10p0.018). The number of CD3 T cells decreased significantly (525.48 鹵445.69 vs 865.85 鹵839.89.89) p0.041T cell count. The CD4CD8 ratio in patients with EBV-positive hemophagocytic syndrome was significantly decreased by 238.13 鹵264.34 vs 539.51 鹵774.84p0.035% CD4CD8 / T cell ratio was significantly increased by 1.70 鹵1.79 vs 0.91 鹵8p0.02.923. The results of correlation analysis showed that there was a positive correlation between the titer of EBV-DNA and the titer of EBV-DNA. The titer of PT and EBV-DNA was positively correlated with the titer of EBV-DNA, the total bilirubin and the titer of EBV-DNA were positively correlated with the titer of EBV-DNA, the titer of EBV-DNA was positively correlated with the titer of EBV-DNA, the low density lipoprotein and EBV-DNA titer were positively correlated with the titer of EBV-DNA. There was a negative correlation between CD8 T cell level and EBV-DNA titer, a positive correlation between CD4 / CD8 level and EBV-DNA titer level, and a positive correlation between complement C4 titer and EBV-DNA titer level. Conclusion: the clinical indexes of EBV infection patients with hemophagocytic syndrome have distinct clinical characteristics, higher tumor incidence and higher mortality. At the same time, the number of CD3 T cells and CD8 T cells and the higher complement C4 were significantly decreased in the patients with EBV infection, and the CD8 T cell count and complement C4 were significantly correlated with the EBV-DNA titer. EBV may play an important role in hepatic dysfunction in patients with hemophagocytic syndrome.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R593.2

【參考文獻】

相關(guān)期刊論文 前10條

1 任碧瓊,朱浩穩(wěn),徐國鋒,鄒國英;急性創(chuàng)傷患者血清總膽固醇濃度的臨床評估[J];中國急救醫(yī)學(xué);2004年12期

2 余洪立;121例病毒性肝炎患者血脂水平觀察[J];廣西醫(yī)學(xué);2002年11期

3 葉中綠;龐偉君;黃秀蘭;;EB病毒感染患兒細(xì)胞因子水平與T細(xì)胞亞群檢測的臨床意義[J];現(xiàn)代預(yù)防醫(yī)學(xué);2008年12期

4 陳進國;李海燕;李居富;陳梅;;成人EB病毒感染的臨床特點及治療(附68例報告)[J];山東醫(yī)藥;2010年45期

5 宋紅梅;;兒童慢性活動性EB病毒感染[J];中國實用兒科雜志;2010年08期

6 劉洪軍;李春;;兒童慢性活動性EB病毒感染3例報告[J];安徽醫(yī)藥;2011年11期

7 任碧瓊;劉豐偉;賀軍宇;;動態(tài)觀察血清降鈣素原、總膽固醇及全血白細(xì)胞總數(shù)在急性創(chuàng)傷患者感染診治中的作用[J];臨床檢驗雜志;2010年06期

8 Liudmila S.Chesnokova;Lindsey M.Hutt-Fletcher;;Epstein-Barr virus infection mechanisms[J];Chinese Journal of Cancer;2014年11期

9 石秀珍;王會平;潘瑩;王芝濤;張家奎;翟志敏;;CD4~+CD25~+Treg細(xì)胞和T細(xì)胞亞群評估再生障礙性貧血患者免疫狀態(tài)的對比研究[J];臨床薈萃;2015年06期

10 陳丹;錢家鳴;;慢性活動性EB病毒感染[J];胃腸病學(xué)和肝病學(xué)雜志;2016年10期

相關(guān)碩士學(xué)位論文 前1條

1 陳溢;外周血EBV-DNA用于評估EBV相關(guān)非霍奇金淋巴瘤療效與預(yù)后的研究[D];福建醫(yī)科大學(xué);2015年

，

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