CAJ | 학술논문

目的：回顾性观察单纯性EB病毒（EBV）感染引起肝功能损伤患者的临床特点、肝功能变化及预后。方法回顾性分析本院2004年8月至2012年8月诊治的104例EB病毒感染所致肝损害患者。根据流行病学史、病毒学、血清学和肝脏影像学检查等，所有患者均排除了其他原因引起的肝功能损伤，观察患者肝脏生化指标、凝血机制、血液常规和腹部超声等，了解患者的临床特点以及预后。结果本研究104例患者中，男性54例，女性50例，平均年龄37.33岁；平均发病天数为17.51 d，最早的发病后2 d即出现转氨酶增高，患者丙氨酸氨基转移酶（ALT）和天门冬氨酸氨基转移酶（AST）水平均升高，分别为正常值的19倍和11倍；γ-谷氨酰转移酶（γ-GT）增高至正常值的3.5倍，碱性磷酸酶（ALP）有不同程度的升高。血总胆红素（TBil）异常者70例（67.3%），最高达426.5μmol/L。TBil与GGT、ALP水平均呈正相关关系（r =0.374、P＜0.001，r =0.328，P=0.001）；ALP和GGT呈正相关关系（r =0.525、P＜0.001）。4例患者凝血酶原时间活动度（PTA）低于40%，3例患者行人工肝血浆置换治疗。7例患者发展为慢性肝炎，最长时间维持2年1个月。所有患者预后良好，肝功能均恢复正常。无死亡病例，无1例发展为肝硬化。结论 EBV感染所致肝能损伤为自限性肝炎，可引起胆汁淤积，少数可发展为慢性肝炎及肝功能衰竭。
목적：회고성관찰단순성EB병독（EBV）감염인기간공능손상환자적림상특점、간공능변화급예후。방법회고성분석본원2004년8월지2012년8월진치적104례EB병독감염소치간손해환자。근거류행병학사、병독학、혈청학화간장영상학검사등，소유환자균배제료기타원인인기적간공능손상，관찰환자간장생화지표、응혈궤제、혈액상규화복부초성등，료해환자적림상특점이급예후。결과본연구104례환자중，남성54례，녀성50례，평균년령37.33세；평균발병천수위17.51 d，최조적발병후2 d즉출현전안매증고，환자병안산안기전이매（ALT）화천문동안산안기전이매（AST）수평균승고，분별위정상치적19배화11배；γ-곡안선전이매（γ-GT）증고지정상치적3.5배，감성린산매（ALP）유불동정도적승고。혈총담홍소（TBil）이상자70례（67.3%），최고체426.5μmol/L。TBil여GGT、ALP수평균정정상관관계（r =0.374、P＜0.001，r =0.328，P=0.001）；ALP화GGT정정상관관계（r =0.525、P＜0.001）。4례환자응혈매원시간활동도（PTA）저우40%，3례환자행인공간혈장치환치료。7례환자발전위만성간염，최장시간유지2년1개월。소유환자예후량호，간공능균회복정상。무사망병례，무1례발전위간경화。결론 EBV감염소치간능손상위자한성간염，가인기담즙어적，소수가발전위만성간염급간공능쇠갈。
Objective To investigate the Epstein-Barr virus (EBV) infection causes liver damage in patients with clinical features and prognosis of liver function, retrospectively.Method The data of 104 cases with liver damage caused by EB virus infection from August 2004 to August 2012 in our hospital were analyzed, retrospectively. According to epidemiological history, virology, serology and liver image, etc, all patients were ruled out other causes of liver injury. Observed in patients with liver biochemistry, blood clotting mechanisms, routine blood and abdominal ultrasound, in order to analyze the patients’ clinical features and prognosis.Result Among the 104 patients, there were male 54 cases, female 50 cases, with an average age of 37.33 years, with the mean number of days of onset was 17.51 d. The ifrst two days of onset appears elevated transaminase. The levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) of the 104 patients were elevated with 19 times and 11 times the normal value, respectively. The levels of γ- glutamyl transferase (γ-GT) increased to 3.5 times of the normal value. Alkaline phosphatase (ALP) had exaltation in varying degrees. Serum bilirubin (TBil) abnormal with 70 (67.3%) cases, up to 426.5 μmol/L. The levels of TBil and GGT, ALP were with positively correlated (r= 0.374,P < 0.001;r = 0.328,P < 0.001). The levels of ALP and GGT were positively correlated (r = 0.525,P < 0.001). There were 4 patients’ with prothrombin time activity (PTA) less than 40% while 3 cases underwent plasma exchange therapy. There were 7 patients develop chronic hepatitis, most maintain for 2-year and 1 month. All patients had good prognosis, all with liver function returned to normal. Among the 104 cases, there were no deaths and no cases develop cirrhosis.Conclusions Liver damage caused by EBV infection could cause is self-limited hepatitis, could cause cholestasis, a few patients may develop to chronic hepatitis and liver failure.