Hara Shinya, Hoshino Yo, Naitou Takehito, Nagano Kenichi, Iwai Masakatsu, Suzuki Kazuyuki, Yamamoto Kazuhide, Nagasaka Tetsuro, Morishima Tsuneo, Kimura Hiroshi
Department of Pediatrics, Toyota Memorial Hospital, Toyota, Japan.
J Clin Virol. 2006 Mar;35(3):250-6. doi: 10.1016/j.jcv.2005.07.009. Epub 2005 Sep 21.
Infectious mononucleosis owing to primary Epstein-Barr virus (EBV) infection sometimes causes hepatitis, which is usually self-limiting with mildly elevated transaminases, but can rarely develop into severe hepatitis with jaundice.
To clarify the pathogenesis of severe hepatitis by primary EBV infection.
We experienced four cases of severe hepatitis with jaundice caused by primary EBV infection. These cases were analyzed virologically and histologically, and compared with infectious mononucleosis patients without jaundice.
Using real-time PCR, more EBV-DNA was detected in peripheral blood from patients with severe hepatitis, as compared to those without jaundice. Furthermore, CD3+, CD4+ or CD8+ cells contained more EBV DNA than did other cell populations, indicating that in severe hepatitis, T cells harbor most of the EBV. By contrast, mainly B cells were infected in infectious mononucleosis patients without jaundice. The liver was biopsied in three of the four cases. An in situ hybridization study showed that EBV infected lymphocytes, not hepatocytes. In addition, in one patient, it was confirmed that the infected lymphocytes were CD8+ T cells. These results suggest that a large EBV burden and T cell infection may play major roles in the mechanism of severe hepatitis caused by primary EB virus infection.
原发性爱泼斯坦-巴尔病毒（EBV）感染所致传染性单核细胞增多症有时会引发肝炎，这种肝炎通常为自限性，转氨酶轻度升高，但极少会发展为伴有黄疸的严重肝炎。
阐明原发性EBV感染导致严重肝炎的发病机制。
我们诊治了4例由原发性EBV感染引起的伴有黄疸的严重肝炎病例。对这些病例进行了病毒学和组织学分析，并与无黄疸的传染性单核细胞增多症患者进行了比较。
采用实时聚合酶链反应（PCR）检测发现，与无黄疸患者相比，严重肝炎患者外周血中检测到的EBV-DNA更多。此外，CD3⁺、CD4⁺或CD8⁺细胞所含EBV DNA比其他细胞群体更多，这表明在严重肝炎中，T细胞携带了大部分EBV。相比之下，在无黄疸的传染性单核细胞增多症患者中，主要是B细胞受到感染。4例患者中有3例进行了肝脏活检。原位杂交研究显示，EBV感染的是淋巴细胞，而非肝细胞。此外，在1例患者中，证实受感染的淋巴细胞为CD8⁺T细胞。这些结果表明，大量的EBV负荷和T细胞感染可能在原发性EB病毒感染所致严重肝炎的发病机制中起主要作用。
