儿童传染性单核细胞增多症EB病毒抗体谱与肝功能损害的相关性分析

Analysis of the Correlation between EB Virus Antibody Profile and Liver Function Impairment in Pediatric Infectious Mononucleosis

摘要: 目的：探讨儿童传染性单核细胞增多症(IM) EB病毒(EBV)抗体谱中EA-IgG阳性与肝功能损害的关系，并评估其对肝损害的预测效能。方法：回顾性分析2024年12月至2026月5月邢台市人民医院收治的130例IM住院患儿的临床资料。收集EBV抗体四项(VCA-IgM, VCA-IgG, EA-IgG, EBNA-IgG)、肝功能指标、EBV-DNA载量及其他实验室指标。根据VCA-IgM状态将患儿分为EA-IgG阳性组(n = 54)和EA-IgG阴性组(n = 76)，比较两组间临床及实验室指标的差异。进一步将肝功能损害分为无损害、轻度、中重度三组，比较各指标在三组间的分布差异。计量资料以中位数(四分位数间距)表示，组间比较采用Mann-Whitney U检验；计数资料比较采用χ²检验及χ²趋势检验；采用二元Logistic回归分析肝功能损害的独立危险因素。结果：130例IM患儿中VCA-IgM均为阳性，EA-IgG阳性54例(41.5%)。EA-IgG阳性组ALT值显著高于阴性组，EBV-DNA载量亦显著升高。随着肝功能损害分级加重，EA-IgG阳性率呈阶梯式上升。多因素Logistic回归显示EA-IgG阳性是肝功能损害的独立危险因素。结论：EA-IgG阳性是IM患儿发生肝功能损害的独立危险因素，其机制可能与EBV活跃复制导致的高病毒载量及随之而来的免疫炎症反应有关，动态监测EBV抗体谱尤其是EA-IgG，有助于早期识别肝功能损害高危患儿。

Abstract: Objective: To investigate the association between EA-IgG positivity in the Epstein-Barr virus (EBV) antibody profile and liver function impairment in children with infectious mononucleosis (IM), and to evaluate its predictive value for hepatic damage. Methods: A retrospective analysis was conducted on clinical data of 130 hospitalized pediatric IM patients admitted to Xingtai People’s Hospital from December 2024 to May 2026. EBV antibody profiles (VCA-IgM, VCA-IgG, EA-IgG, EBNA-IgG), liver function tests, EBV-DNA viral load, and other laboratory parameters were collected. Patients were divided into an EA-IgG positive group (n = 54) and an EA-IgG negative group (n = 76) based on VCA-IgM status, and differences in clinical and laboratory indicators between the two groups were compared. Liver function impairment was further classified into three categories—no impairment, mild, and moderate-to-severe—and the distribution of each indicator across these groups was analyzed. Continuous variables were expressed as medians (interquartile ranges), and intergroup comparisons were performed using the Mann-Whitney U test; categorical variables were analyzed using χ² and χ² trend tests. Binary Logistic regression was used to identify independent risk factors for liver function impairment. Results: All 130 IM patients tested positive for VCA-IgM, with 54 (41.5%) showing EA-IgG positivity. The ALT levels in the EA-IgG positive group were significantly higher than those in the negative group, and EBV-DNA viral load was also significantly elevated. As the severity of liver function impairment increased, the rate of EA-IgG positivity rose in a stepwise manner. Multivariate Logistic regression revealed that EA-IgG positivity was an independent risk factor for liver function impairment. Conclusion: EA-IgG positivity is an independent risk factor for liver function impairment in children with IM. This may be associated with high viral loads due to active EBV replication and subsequent immune-inflammatory responses. Dynamic monitoring of the EBV antibody profile, particularly EA-IgG, can help identify pediatric patients at high risk for liver dysfunction early.