Clinical analysis of acute liver damage in children with acute Epstein-Barr virus infection

Abstract

Objective To study the clinical manifestations and laboratory findings like liver function, immunoglobulin and peripheral blood lymphocyte subsets, and to provide evidence for diagnosing and the therapy for acute Epstein-Barr virus (EBV) infection. Methods From July 2012 to June 2015, clinical data from 321 patients with acute EBV infection admitted to Children′s Hospital of Fudan University for treatment were retrospectively analyzed.The clinical characteristics and the findings by liver function test, detection of virus, immunoglobulin and lymphocyte subsets were analyzed.The patients were divided into an abnormal liver function group (186 cases) and the normal liver function group (135 cases). The copy number of EBV-DNA, serum EBV-IgM, immunoglobulin, CD series between the 2 groups were analyzed.Stata 12.0 software was used for statistical analysis. Results (1) There were 321 cases diagnosed with acute EBV infection.Among them, the gender of 183 cases were boys, 138 cases were girls, male to female ratio was 1.33∶1.00.The average age of onset was (52.07±35.05) months.There were 186 cases (57.94%) with abnormal liver function and 135 cases (42.06%) with normal liver function.(2) Clinical course was (9.11±8.21) days, and period of fever lasted (7.12±5.00) days; 281 cases (87.54%) had fever, and the highest temperature reached (39.04±0.69) ℃; lymphadenectasis occurred in 267 cases (83.18%), 245 cases (76.32%) had angina, hepatomegaly occurred in 235 cases (73.21%), 142 cases (44.24%) had splenomegaly, and rash occurred in 60 cases (18.69%); 155 cases (48.29%) occurred trilogy of fever, lymphadenectasis and angina.(3) There were 186 cases had abnormal liver function without jaundice, and their levels of total bilirubin, direct bilirubin, total bile acid, albumin and coagulation function were normal.Alanine aminotransferase (ALT) increased from 40 to 400 IU/L in 125 cases, 400 to 800 IU/L in 2 cases, and more than 800 IU/L in 6 cases.Aspartate aminotransferase(AST) increased from 40 to 400 IU/L in 157 cases, 400 to 800 IU/L in 5 cases, more than 800 IU/L in 1 case.Ninety-seven cases were followed up for liver function, and the recovery time was 21-74 days.(4) In comparison of the abnormal liver function group to the normal liver function group, the differences were statistically significant in age, IgG, IgA, CD4+ T cell, the ratio of CD4+ T cell and CD8+ T cell (all P 0.05). Conclusions Children with acute EBV infection may have a high incidence of liver damage.The clinical manifestations are characterized by elevated transaminase and self-limiting.The occurrence of liver damage may be related to case of cell-mediated immunity Key words: Epstein-Barr virus; Liver function damage; Child