Liu Can, Zou Aijun, Wang Xianyu, Huang Caizhi
Clinical Laboratory, The Affiliated Children's Hospital of Xiangya School of Medicine, Central South University (Hunan Children's Hospital), Changsha, 410007, China.
Immunol Res. 2025 Jan 30;73(1):43. doi: 10.1007/s12026-025-09597-7.
Epstein-Barr virus (EBV)-related hemophagocytic lymphohistiocytosis (EBV-HLH) and infectious mononucleosis (IM) are characterized by fever, hepatomegaly, and splenomegaly, but HLH has a 50% lethality rate. Therefore, this study aimed to compare the laboratory findings in differentiating EBV-HLH children from IM children who have fever, hepatomegaly, or splenomegaly. A total of 131 IM patients and 29 EBV-HLH pediatric patients with fever, hepatomegaly, or splenomegaly were enrolled in our study. The clinical traits and laboratory findings were analyzed, and a predictive regression analysis was also performed. EBV-HLH patients had a lower set of diagnostic markers, which included fibrinogen (FIB), white blood cells (WBC), hemoglobin (Hb), and platelet (PLT), compared to IM patients. Triglyceride (TG) and ferritin were elevated obviously in EBV-HLH patients compared to IM patients. CD4CD8 T cells are highly activated T cells. EBV-HLH patients experienced a significant decrease in the absolute number and ratio of CD4CD8T cells (CD4CD8T#, CD4CD8T%) compared to IM patients in our study. The AUC of CD4CD8 T # in the diagnosis of EBV-HLH was 0.920 with a sensitivity of 86.2% and a specificity of 90.1%. A logistic regression analysis was developed to improve sensitivity. The results revealed that lower levels of Hb, FIB, and CD4CD8T cells were risk factors for EBV-HLH. The regression model for separating EBV-HLH from EBV-IM had an AUC of was 0.996 with a sensitivity of 100% and a specificity of 95.3%. The ratio and absolute number of CD4CD8T cells were decreased in IM and EBV-HLH patients. EBV-HLH can be identified in IM patients with fever, hepatomegaly, or splenomegaly by detecting Hb, FIB, and the absolute number of CD4CD8T cells.
爱泼斯坦-巴尔病毒（EBV）相关噬血细胞性淋巴组织细胞增生症（EBV-HLH）和传染性单核细胞增多症（IM）的特征为发热、肝肿大和脾肿大，但HLH的致死率为50%。因此，本研究旨在比较区分发热、肝肿大或脾肿大的EBV-HLH儿童与IM儿童的实验室检查结果。共有131例IM患者和29例有发热、肝肿大或脾肿大的EBV-HLH儿科患者纳入我们的研究。分析了临床特征和实验室检查结果，并进行了预测性回归分析。与IM患者相比，EBV-HLH患者的一组诊断标志物水平较低，这些标志物包括纤维蛋白原（FIB）、白细胞（WBC）、血红蛋白（Hb）和血小板（PLT）。与IM患者相比，EBV-HLH患者的甘油三酯（TG）和铁蛋白明显升高。CD4CD8 T细胞是高度活化的T细胞。在我们的研究中，与IM患者相比，EBV-HLH患者的CD4CD8T细胞绝对数量和比例（CD4CD8T#、CD4CD8T%）显著下降。CD4CD8 T#诊断EBV-HLH的曲线下面积（AUC）为0.920，敏感性为86.2%，特异性为90.1%。开展了逻辑回归分析以提高敏感性。结果显示，较低水平的Hb, FIB和CD4CD8T细胞是EBV-HLH的危险因素。区分EBV-HLH和EBV-IM的回归模型AUC为0.996，敏感性为100%，特异性为95.3%。IM和EBV-HLH患者的CD4CD8T细胞比例和绝对数量均下降。通过检测Hb、FIB和CD4CD8T细胞绝对数量，可在发热、肝肿大或脾肿大的IM患者中识别出EBV-HLH。
