Epstein–Barr virus

EB 病毒
  • 文章类型: Journal Article
    EB病毒(EBV)是一种广泛存在的致癌病毒,与多种恶性肿瘤和非恶性肿瘤相关,EBVDNA检测被广泛用于这些疾病的诊断和预后预测。干血点(DBS)采样方法具有巨大的潜力,可以替代偏远地区的静脉血样本。对于残疾人来说,或新生儿采血。因此,这项研究的目的是评估从DBS检测EBVDNA负载的可行性。收集匹配的全血和DBS样品用于EBVDNA提取和定量检测。在DBS中的EBVDNA检测呈现100%的特异性。在全血中不同的EBVDNA病毒载量下,在DBS中检测EBVDNA的灵敏度为38.78%(≥1拷贝/mL),43.18%(≥500拷贝/mL),58.63%(≥1000拷贝/mL),71.43%(≥2000拷贝/mL),82.35%(≥4000拷贝/mL),和92.86%(≥5000拷贝/毫升),分别。这些结果表明,随着病毒载量的增加,DBS中EBVDNA检测的灵敏度增加。此外,在全血和DBS中测量的EBVDNA水平之间存在良好的相关性,平均而言,在全血中测得的病毒载量比DBS高约6倍.我们的研究首次证明了使用DBS定性和半定量检测EBVDNA用于诊断和监测EBV相关疾病的可行性。
    Epstein-Barr virus (EBV) is a ubiquitous and oncogenic virus that is associated with various malignancies and non-malignant diseases and EBV DNA detection is widely used for the diagnosis and prognosis prediction for these diseases. The dried blood spots (DBS) sampling method holds great potential as an alternative to venous blood samples in geographically remote areas, for individuals with disabilities, or for newborn blood collection. Therefore, the objective of this study was to assess the viability of detecting EBV DNA load from DBS. Matched whole blood and DBS samples were collected for EBV DNA extraction and quantification detection. EBV DNA detection in DBS presented a specificity of 100 %. At different EBV DNA viral load in whole blood, the sensitivity of EBV DNA detection in DBS was 38.78 % (≥1 copies/mL), 43.18 % (≥500 copies/mL), 58.63 % (≥1000 copies/mL), 71.43 % (≥2000 copies/mL), 82.35 % (≥4000 copies/mL), and 92.86 % (≥5000 copies/mL), respectively. These results indicated that the sensitivity of EBV DNA detection in DBS increased with elevating viral load. Moreover, there was good correlation between EBV DNA levels measured in whole blood and DBS, and on average, the viral load measured in whole blood was about 6-fold higher than in DBS. Our research firstly demonstrated the feasibility of using DBS for qualitative and semi-quantitative detection of EBV DNA for diagnosis and surveillance of EBV-related diseases.
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  • 文章类型: Journal Article
    与单纯疱疹病毒1和2(HSV-1和2)有关的信息,水痘-带状疱疹病毒(VZV),EB病毒(EBV)法国缺乏巨细胞病毒(CMV)血清阳性率,不完整,或过时,尽管他们的公共卫生负担。
    我们使用2018年至2022年之间常规收集的血清学数据来估计HSV-1,HSV-2,VZV,EBV,和法国的CMV血清阳性率。为了解释我们的分析样本和法国人口之间的人口统计学差异,并获得对稀疏样本地区和年龄组的估计,我们使用了多级回归和后分层方法,并结合了通过堆叠权重进行贝叶斯模型平均。
    观察到的血清阳性率(阳性测试次数/测试次数)为64.6%(93,294/144,424),16.9%(24,316/144,159),93.0%(141,419/152,084),83.4%(63,199/75,781),和49.0%(23,276/47,525),分别,对于HSV-1,HSV-2,VZV,EBV,CMV。在2018年至2022年之间,法国的基于模型的平均(等尾间隔为95%)预期血清阳性率等于61.1%(60.7,61.5),14.5%(14.2,14.81),89.5%(89.3,89.8),85.6%(85.2,86.0),和50.5%(49.3,51.7),分别,对于HSV-1,HSV-2,VZV,EBV,和CMV感染。我们发现,除了VZV之外,法国大都会地区的所有病毒的预期血清阳性率几乎都比海外地区低,几乎肯定更大。对于所有病毒,女性的预期血清感染率可能更高。
    我们的结果依赖于这样的假设,即个体被随机有条件地抽样到用于构建后分层表的变量。
    该分析突出了血清阳性率的空间和人口模式,应在设计量身定制的公共卫生政策时予以考虑。
    UNASSIGNED: Information related to herpes simplex virus 1 and 2 (HSV-1 and 2), varicella-zoster virus (VZV), Epstein-Barr virus (EBV), and cytomegalovirus (CMV) seroprevalence in France is either lacking, incomplete, or outdated, despite their public health burden.
    UNASSIGNED: We used routinely collected serological data between 2018 and 2022 to estimate HSV-1, HSV-2, VZV, EBV, and CMV seroprevalence in France. To account for demographic differences between our analytic samples and the French population and get estimates for sparsely sampled districts and age classes, we used a multilevel regression and poststratification approach combined with Bayesian model averaging via stacking weights.
    UNASSIGNED: The observed seroprevalence (number of positive tests/number of tests) were 64.6% (93,294/144,424), 16.9% (24,316/144,159), 93.0% (141,419/152,084), 83.4% (63,199/75, 781), and 49.0% (23,276/47,525), respectively, for HSV-1, HSV-2, VZV, EBV, and CMV. Between 2018 and 2022, France had a model-based average (equal-tailed interval at 95%) expected seroprevalence equal to 61.1% (60.7,61.5), 14.5% (14.2,14.81), 89.5% (89.3,89.8), 85.6% (85.2,86.0), and 50.5% (49.3,51.7), respectively, for HSV-1, HSV-2, VZV, EBV, and CMV infections. We found an almost certain lower expected seroprevalence in Metropolitan France than in overseas territories for all viruses but VZV, for which it was almost certainly greater. The expected seroprevalences were likely greater among females for all viruses.
    UNASSIGNED: Our results relied on the assumption that individuals were sampled at random conditionally to variables used to build the poststratification table.
    UNASSIGNED: The analysis highlights spatial and demographic patterns in seroprevalence that should be considered for designing tailored public health policies.
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  • 文章类型: Journal Article
    T淋巴细胞上的程序性死亡-1(PD-1)与其配体程序性死亡配体1(PD-L1)和肿瘤细胞和/或肿瘤相关巨噬细胞上的程序性死亡配体2(PD-L2)的相互作用导致T细胞受体途径的抑制信号,从而导致肿瘤免疫逃逸。PD-L1/PD-L2目前在临床实践中用作预测性组织生物标志物。实际上,肿瘤细胞表达的PD-L1水平与针对PD-1/PD-L1轴的免疫检查点阻断疗法的良好反应相关。这些疗法通过从肿瘤细胞的抑制作用中释放T淋巴细胞来恢复T细胞抗肿瘤免疫应答。免疫检查点疗法已经完全改变了实体癌患者的管理。这种治疗策略在血液恶性肿瘤中使用较少,尽管在某些情况下取得了良好的效果,如难治性/复发性经典霍奇金淋巴瘤和原发性纵隔大B细胞淋巴瘤。在弥漫性大B细胞淋巴瘤和T细胞淋巴瘤中已经获得了可变的结果。免疫组织化学代表了评估肿瘤细胞上PD-L1表达的主要技术。这篇综述旨在描述PD-L1在各种类型淋巴瘤中表达的最新知识,关注PD-L1过表达的主要机制,其预后意义和有关评估淋巴瘤PD-L1免疫组织化学结果的实际问题。
    The interaction of programmed death-1 (PD-1) on T lymphocytes with its ligands Programmed Death Ligand 1 (PD-L1) and Programmed Death Ligand 2 (PD-L2) on tumor cells and/or tumor-associated macrophages results in inhibitory signals to the T-cell receptor pathway, consequently causing tumor immune escape. PD-L1/PD-L2 are currently used as predictive tissue biomarkers in clinical practice. Virtually PD-L1 levels expressed by tumor cells are associated with a good response to immune checkpoint blockade therapies targeting the PD-1/PD-L1 axis. These therapies restore T-cell antitumor immune response by releasing T-lymphocytes from the inhibitory effects of tumor cells. Immune checkpoint therapies have completely changed the management of patients with solid cancers. This therapeutic strategy is less used in hematological malignancies, although good results have been achieved in some settings, such as refractory/relapsed classic Hodgkin lymphoma and primary mediastinal large B-cell lymphoma. Variable results have been obtained in diffuse large B-cell lymphoma and T-cell lymphomas. Immunohistochemistry represents the main technique for assessing PD-L1 expression on tumor cells. This review aims to describe the current knowledge of PD-L1 expression in various types of lymphomas, focusing on the principal mechanisms underlying PD-L1 overexpression, its prognostic significance and practical issues concerning the evaluation of PD-L1 immunohistochemical results in lymphomas.
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  • 文章类型: Journal Article
    先前暴露于爱泼斯坦-巴尔病毒(EBV)与多发性硬化症(MS)的发展密切相关。相比之下,过去的巨细胞病毒(CMV)感染可能没有关联,或与MS呈负相关。这项研究旨在调查意大利人群中疱疹病毒感染与MS的关系。来自意大利多发性硬化症(PwMS)患者的血清样本(n=200)被分类为复发缓解临床表型和(n=137)健康对照(HC)从CRESMBiobank获得,Orbassano,意大利。PwMS和HCs样本均按年龄组(20-39岁,和40年或更长时间)和性别。EBV病毒衣壳抗原(VCA)IgG,EBV核酸-1抗原(EBNA-1)IgG,CMVIgG,单纯疱疹病毒(HSV)IgG,使用商业ELISA进行水痘带状疱疹病毒(VZV)IgG测试。EBVVCAIgG和EBNA-1IgG血清阳性率在PwMS中分别为100%和93.4%和92.4%,分别,在HC中。与HC相比,PwMS中的EBVVCAIgG和EBNA-1IgG水平更高(p<0.001)。对于PwMS,EBNA-1IgG水平随着年龄的增长而下降,尤其是女性。CMVIgG血清阳性率在PwMS中为58.7%,在HC中为62.9%。CMVIgG血清阳性率随年龄增加而增加。HSVIgG血清阳性率在PwMS中为71.2%,在HC中为70.8%。与HC相比,PwMS中的HSVIgG水平较低(p=0.0005)。VZVIgG血清阳性率在PwMS中为97.5%,在HC中为98.5%。在研究的人群中,一些疱疹病毒感染标志物可能受到研究组的年龄和性别的影响.缺乏MS与CMV感染的负相关性,观察到PwMS中HSVIgG水平低于HCs,值得进一步研究。
    Previous exposure to Epstein-Barr virus (EBV) is strongly associated with the development of multiple sclerosis (MS). By contrast, past cytomegalovirus (CMV) infection may have no association, or be negatively associated with MS. This study aimed to investigate the associations of herpesvirus infections with MS in an Italian population. Serum samples (n = 200) from Italian people with multiple sclerosis (PwMS) classified as the relapsing-and-remitting clinical phenotype and (n = 137) healthy controls (HCs) were obtained from the CRESM Biobank, Orbassano, Italy. Both PwMS and HCs samples were selected according to age group (20-39 years, and 40 or more years) and sex. EBV virus capsid antigen (VCA) IgG, EBV nucleic acid-1 antigen (EBNA-1) IgG, CMV IgG, herpes simplex virus (HSV) IgG, and varicella zoster virus (VZV) IgG testing was undertaken using commercial ELISAs. EBV VCA IgG and EBNA-1 IgG seroprevalences were 100% in PwMS and 93.4% and 92.4%, respectively, in HCs. EBV VCA IgG and EBNA-1 IgG levels were higher (p < 0.001) in PwMS compared with HCs. For PwMS, the EBNA-1 IgG levels decreased with age, particularly in females. The CMV IgG seroprevalence was 58.7% in PwMS and 62.9% in HCs. CMV IgG seroprevalence increased with age. The HSV IgG seroprevalence was 71.2% in PwMS and 70.8% in HCs. HSV IgG levels were lower (p = 0.0005) in PwMS compared with HCs. VZV IgG seroprevalence was 97.5% in PwMS and 98.5% in HCs. In the population studied, several herpesvirus infections markers may have been influenced by the age and sex of the groups studied. The lack of a negative association of MS with CMV infection, and the observation of lower levels of HSV IgG in PwMS compared with HCs are findings worthy of further investigation.
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  • 文章类型: Journal Article
    这项研究调查了EB病毒(EBV)感染对不同疾病阶段儿童蛋白质组的影响,利用79份血液样本,分为三组:未接受EBV治疗的患者,急性传染性单核细胞增多症(IM)病例,IM后12个月,康复者随访。目的是鉴定受EBV感染影响的蛋白质,揭示病毒引发的慢性过程。结果显示,有39种蛋白质可区分初治患者和IM患者,包括肌动蛋白,Lumican,过氧化物酶2,腓骨蛋白1,凝溶胶蛋白,和α-2-巨球蛋白,参与免疫反应,细胞粘附,和炎症。IM患者中升高的氧化应激标志物,如过氧化物酶2,提示与EBV诱导活性氧的潜在联系。载脂蛋白A-I水平升高,A-IV,C-IV,IM期间的M意味着与病毒感染有关,而补体系统蛋白(C1q,C1r,和C8伽马链)也升高,反映了它们在免疫反应和病毒清除中的作用。这项针对儿童的研究为EBV对年轻人群的影响提供了独特的见解,强调蛋白质组学在揭示蛋白质关联和理解病毒的长期后果方面的作用。然而,鉴定的蛋白质与EBV感染之间的具体关系需要进一步研究.
    This study investigates the impact of Epstein-Barr virus (EBV) infection on children\'s proteomes across different phases of the disease, utilising seventy-nine blood samples categorised into three groups: EBV-naive patients, acute infectious mononucleosis (IM) cases, and convalescents followed up for 12 months post-IM. The aim is to identify proteins influenced by EBV infection, shedding light on the chronic processes triggered by the virus. The results reveal thirty-nine proteins distinguishing between naive patients and those with IM, including actin, lumican, peroxiredoxin-2, fibulin-1, gelsolin, and alpha-2-macroglobulin, which are involved in immune responses, cell adhesion, and inflammation. Elevated oxidative stress markers like peroxiredoxin-2 in IM patients suggest potential links to EBV\'s induction of reactive oxygen species. Increased levels of apolipoproteins A-I, A-IV, C-IV, and M during IM imply associations with viral infection, while complement system proteins (C1q, C1r, and C8 gamma chain) are also elevated, reflecting their role in the immune response and viral clearance. This study\'s focus on children provides unique insights into EBV\'s impact on young populations, emphasising proteomics\' role in uncovering protein associations and understanding the virus\'s long-term consequences. However, specific relationships between identified proteins and EBV infection require further investigation.
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  • 文章类型: Journal Article
    在近100%的非角化鼻咽癌(NPC)中检测到EB病毒(EBV),基于EBV的生物标志物用于流行地区的NPC筛查。针对EBV核抗原1(EBNA1)和病毒衣壳抗原(VCA)的免疫球蛋白A(IgA),和最近鉴定的抗BNLF2b抗体已被证明是最有效的筛选工具;然而,筛查效果仍有待提高。这项研究通过测试IgA和免疫球蛋白G(IgG)抗体来开发一种多重血清学测定,这些抗体针对在NPC中高度转录和/或在病毒再激活中起关键作用的代表性EBV抗原。包括BALFs,BNLF2a/b,LF1、LF2和Zta(BZLF1)。其中,BNLF2b-IgG具有区分NPC患者与对照组的最佳性能(曲线下面积:0.951,95%置信区间[CI]:0.913-0.990)。裂解抗原BALF2和VCA的抗体在晚期肿瘤中显着高于早期肿瘤;相反,潜伏蛋白EBNA1和早期裂解抗原BNLF2b的抗体与肿瘤进展无关.因此,提出了一种结合EBNA1-IgA和BNLF2b-IgG的新策略,并验证了将综合辨别力提高了15.8%(95%CI:9.8%-21.7%,p<.0001)与双抗体法相比。此外,我们发现与健康携带者相比,患者的EBV抗体谱更为复杂,其中观察到针对不同抗原相的抗体之间具有更强的相关性。总的来说,我们的血清学分析表明,鼻咽上皮细胞中EBV的异常潜伏感染可能是NPC发生的关键步骤,而更多的裂解蛋白表达可能与NPC进展有关。
    Epstein-Barr virus (EBV) is detected in nearly 100% of nonkeratinizing nasopharyngeal carcinoma (NPC) and EBV-based biomarkers are used for NPC screening in endemic regions. Immunoglobulin A (IgA) against EBV nuclear antigen 1 (EBNA1) and viral capsid antigen (VCA), and recently identified anti-BNLF2b antibodies have been shown to be the most effective screening tool; however, the screening efficacy still needs to be improved. This study developed a multiplex serological assay by testing IgA and immunoglobulin G (IgG) antibodies against representative EBV antigens that are highly transcribed in NPC and/or function crucially in viral reactivation, including BALFs, BNLF2a/b, LF1, LF2, and Zta (BZLF1). Among them, BNLF2b-IgG had the best performance distinguishing NPC patients from controls (area under the curve: 0.951, 95% confidence interval [CI]: 0.913-0.990). Antibodies to lytic antigens BALF2 and VCA were significantly higher in advanced-stage than in early-stage tumors; in contrast, antibodies to latent protein EBNA1 and early lytic antigen BNLF2b were not correlated with tumor progression. Accordingly, a novel strategy combining EBNA1-IgA and BNLF2b-IgG was proposed and validated improving the integrated discrimination by 15.8% (95% CI: 9.8%-21.7%, p < .0001) compared with the two-antibody method. Furthermore, we found EBV antibody profile in patients was more complicated compared with that in healthy carriers, in which stronger correlations between antibodies against different phases of antigens were observed. Overall, our serological assay indicated that aberrant latent infection of EBV in nasopharyngeal epithelial cells was probably a key step in NPC initiation, while more lytic protein expression might be involved in NPC progression.
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  • 文章类型: Journal Article
    EB病毒(EBV)与5-10%的胃癌有关,被认为是一种独特的分子亚型。EBV阳性在残胃癌(GRC)中特别高,这可以告知内窥镜检查的临床表现和发现模式。大多数数据来自东方,问题仍然是这如何适用于西方群体。我们在挪威中部进行了一项基于人群的研究,2001-2016年。从挪威癌症登记处确定了GRC患者(n=78)和非GRC近端癌症患者以及EBV状态的可用组织(n=116,对照组)。从个体患者日志收集相关数据。使用原位杂交评估EBV状态。从远端胃切除术到GRC的中位潜伏期为37.6年(范围15.7-68.0年)。GRC更常出现消化道出血,31.0%与16.1%,p=0.017,在内窥镜检查时很少出现溃疡,19.7%vs.38.2%,p=0.012,或肿瘤,40.8%与66.4%,p<0.001。对于GRC,18.7%的EBV阳性,而对照组为6.0%,p=0.006。EBV状态与患者年龄无关,性别,或Lauren组织学类型.GRC和对照组之间或EBV阳性与之间的长期生存率没有差异-阴性GRC。总之,GRC病例的比例更高,与对照组相比,EBV呈阳性,表明不同的致病因素。GRC患者的临床表现和内镜检查结果更为微妙。
    Epstein-Barr virus (EBV) is associated with 5-10% of gastric cancers and is recognized as a distinct molecular subtype. EBV positivity is particularly high in gastric remnant cancer (GRC), which may inform the mode of clinical presentation and findings at endoscopy. Most data are from the East, and the question remains how this applies to a Western cohort. We conducted a population-based study in Central Norway, 2001-2016. Patients with GRC (n = 78) and patients with non-GRC proximally located cancer and available tissue for EBV status (n = 116, control group) were identified from the Norwegian Cancer Registry. Relevant data were collected from the individual patient journals. EBV status was assessed using in situ hybridization. The median latency time from the distal gastrectomy to GRC was 37.6 (range 15.7-68.0) years. GRC more often presented with GI bleeding, 31.0% vs. 16.1%, p = 0.017, and at endoscopy more seldom with an ulcer, 19.7% vs. 38.2%, p = 0.012, or a tumour, 40.8% vs. 66.4%, p < 0.001. For GRC, 18.7% were EBV-positive compared to 6.0% among the controls, p = 0.006. EBV status was not associated with patient age, sex, or Lauren histological type. No difference in long-term survival rates between GRC and controls was found or between EBV-positive vs. -negative GRCs. In conclusion, a higher proportion of GRC cases, compared to controls, are EBV positive, indicating different causative factors. The mode of clinical presentation and findings at endoscopy were more subtle in the patients with GRC.
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  • 文章类型: Journal Article
    鼻咽癌(NPC)在中国南方是一种高度流行的头颈部恶性肿瘤,由于微妙的早期症状和相关的转移,经常在晚期被诊断出来。血管生成是NPC进展的关键因素,许多血管生成相关因子显示异常表达并导致NPC肿瘤内新生血管形成增加。这些异常血管不仅滋养肿瘤的生长,而且促进转移,最终导致患者预后不佳。多项研究已经证明了各种成像技术用于评估NPC肿瘤中的血管生成的适用性。从而成为个性化治疗策略和预后评估的基础.抗血管生成疗法在抑制NPC血管生成和发挥抗肿瘤作用方面表现出显著的潜力。为了提高疗效,抗血管生成药物通常与其他治疗方式联合使用,以协同增强抗肿瘤作用,同时减轻与单药治疗相关的副作用。从而改善患者预后。确定NPC血管生成的潜在机制和关键靶标,探索更有效的检测和治疗方法,有望塑造NPC诊断的未来。治疗,和预后,从而为研究和临床实践提供新的途径和观点。
    Nasopharyngeal carcinoma (NPC) is a highly prevalent head and neck malignancy in southern China frequently diagnosed at advanced stages owing to subtle early symptoms and associated metastasis. Angiogenesis emerges as a pivotal factor in NPC progression, with numerous angiogenesis-related factors showing aberrant expression and contributing to increased neovascularization within NPC tumors. These abnormal vessels not only nourish tumor growth but also facilitate metastasis, culminating in unfavorable patient outcomes. Multiple studies have demonstrated the applicability of various imaging techniques for assessing angiogenesis in NPC tumors, thus serving as a foundation for personalized treatment strategies and prognostic assessments. Anti-angiogenic therapies have exhibited significant potential for inhibiting NPC angiogenesis and exerting anti-tumor effects. To enhance efficacy, anti-angiogenic drugs are frequently combined with other treatment modalities to synergistically enhance anti-tumor effects while mitigating the side effects associated with single-agent therapies, consequently improving patient prognosis. Identifying the potential mechanisms and key targets underlying NPC angiogenesis and exploring more effective detection and treatment approaches holds promise for shaping the future of NPC diagnosis, treatment, and prognosis, thereby offering new avenues and perspectives for research and clinical practice.
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  • 文章类型: Case Reports
    在有病毒感染症状和胆囊壁明显增厚的患者中,重要的是怀疑由EB病毒引起的传染性单核细胞增多症引起的非结石性胆囊炎.
    一名35岁的日本男子发烧,腹部右上腹疼痛,和肝功能障碍。观察到EB病毒免疫球蛋白M和-G抗体阳性和核抗原阴性。腹部超声检查显示胆囊壁明显增厚。诊断为由EB病毒引起的传染性单核细胞增多症引起的无结石性胆囊炎。
    UNASSIGNED: In patients with symptoms of viral infection and marked thickening of the gallbladder wall, it is important to suspect acalculous cholecystitis due to Epstein-Barr virus-induced infectious mononucleosis.
    UNASSIGNED: A 35-year-old Japanese man presented with fever, abdominal right upper quadrant pain, and liver dysfunction. Positive immunoglobulin M and -G antibodies and negative nuclear antigen for Epstein-Barr virus were observed. Abdominal ultrasonography revealed a markedly thickened gallbladder wall. Acalculous cholecystitis due to Epstein-Barr virus-induced infectious mononucleosis was diagnosed.
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  • 文章类型: Case Reports
    在非免疫缺陷个体中,慢性活动性EB病毒(EBV)感染相关性肠炎(CAEAE)很少见。报告一例CAEAE,通过数据库搜索相关文章。临床表现,内镜检查结果,治疗策略,预后,并对CAEAE患者的随访结果进行分析。包括这份报告,文献中的7篇引文对27例CAEAE进行了描述。有21名男性和6名女性,平均年龄40岁.主要临床表现为发热(25/27),腹痛(14/27),腹泻(16/27),便血或血便(13/27),血常规检查中血红蛋白和红细胞计数下降(14/27)。炎症标志物升高,白细胞(WBC)计数,C反应蛋白(CRP)是常见的。凝血常异常。组织病理学通过原位杂交证实了受影响组织中EBV编码的小核RNA(EBER)。平均血清EBVDNA载量为6.3×10^5拷贝/mL。所有患者在内镜下都有不同程度的肠溃疡,溃疡和病理特征不明,误诊为炎症性肠病(IBD)。病程进展,后来并发肠出血,肠穿孔,感染性休克,急诊手术率很高。然而,手术后患者的状况往往没有改善,一些患者很快因再穿孔或大量便血死亡。激素和抗病毒治疗均无明显效果。手术和非手术生存率有显著差异(p<0.05)。6个月内死亡的患者比例高达63.6%(7/11)。CAEAE属于一组罕见的,困难的条件,有一个阴险的临床过程,病死率很高,并可能后来发展为EBV阳性淋巴增生性疾病(EBV-LPD),进而导致致癌作用。临床医生应提高对病因不明的肠道多发溃疡患者的认识,应注意EBV血清学,和组织学尽可能早地做出诊断。
    Chronic active Epstein-Barr virus (EBV) infection-associated enteritis (CAEAE) in nonimmunodeficient individuals is rare. To report a case of CAEAE, relevant articles were searched through databases. The clinical manifestations, endoscopic findings, strategies of treatment, prognoses, and follow-up results of CAEAE patients were analyzed. Including this report, seven citations in the literature provide descriptions of 27 cases of CAEAE. There were 21 males and six females, with a mean age of 40 years. The main clinical manifestations were fever (25/27), abdominal pain (14/27), diarrhea (16/27), hematochezia or bloody stools (13/27), and decreased hemoglobin and red blood cell counts in routine blood tests (14/27). Elevations in inflammatory markers, white blood cell (WBC) counts, and C-reactive protein (CRP) were common. Coagulation was often abnormal. Histopathology confirmed EBV-encoded small nuclear RNA (EBER) in the affected tissue via in situ hybridization. The average serum EBV DNA load was 6.3 × 10^5 copies/mL. All patients had varying degrees of intestinal ulcers endoscopically, and the ulcers and pathology were uncharacterized and misdiagnosed mostly as inflammatory bowel disease (IBD). The course of the disease was progressive and later complicated by intestinal bleeding, intestinal perforation, septic shock, and a high rate of emergency surgery. However, the conditions of the patients often did not improve after surgery, and some patients soon died due to reperforation or massive hematochezia. Hormone and antiviral treatment had no obvious effect. There was a significant difference in surgical and nonsurgical survival (p < 0.05). The proportion of patients who died within 6 months was as high as 63.6% (7/11). CAEAE belongs to a group of rare, difficult conditions, has an insidious clinical course, has a high case fatality rate, and may later develop into EBV-positive lymphoproliferative disorder (EBV-LPD), which in turn leads to carcinogenesis. Clinicians should raise awareness that in patients with multiple ulcers in the intestine of unknown etiology, attention should be paid to EBV serology, and histology to make the diagnosis as early as possible.
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