EB病毒感染的流行病学与临床特征分析

Epstein-Barr病毒（EBV）引发多种人类疾病，在不同人群中的患病率较高。分子流行病学研究的进展加深了我们对EBV相关病理的理解。本研究旨在分析中国重庆地区EBV感染的流行病学特征及临床表现。我们招募了2013年5月至2022年11月期间就诊于重庆医科大学第一附属医院、疑似EBV相关疾病的患者。纳入标准为接受EBV特异性免疫荧光或血浆EBV-DNA检测的患者。在13,584名住院患者中，EBNA-1-IgG、EBV-VCA-IgM、EBV-EA-IgG、EBV-EA-IgA、EBV-VCA-IgA及EBV-DNA的总体血清阳性率分别为91.89%、7.22%、18.00%、16.19%、30.78%和18.00%。EBNA-1-IgG的血清阳性率随年龄逐步升高。VCA-IgM作为急性EBV感染的指标，其阳性率在11-20岁患者中最高，为26.41%，在年长者中降低至2%-6%。此外，205名门诊患者中EBV-DNA阳性率为14.15%。在来自健康体检中心的3670人中，EBV-EA-IgA和EBV-VCA-IgA的阳性率分别为11.96%和28.09%，EBV-DNA阳性率为11.92%，均低于住院患者。762例EBV-DNA阳性患者中，年龄在31-40岁的成人受影响最少，血清阳性率为12.00%，随年龄增加而升高。原发性EBV感染最常见的疾病为传染性单核细胞增多症（IM）（35.49%），其次为EBV感染（14.15%）和肺炎（7.19%）。EBV再激活相关的最常见疾病包括肺炎（16.80%）、鼻咽癌（NPC）（11.02%）及自身免疫性疾病（7.04%）。淋巴组织细胞吞噬性细胞增多症（HLH）患者的病毒载量最高，明显高于NPC、肺炎和肝硬化患者。本大规模回顾性研究系统分析了各年龄段EBV感染的流行特征与疾病谱，为EBV感染的诊断与管理策略提供了重要依据。

The Epstein-Barr virus (EBV) is responsible for a spectrum of human diseases and demonstrates a considerable prevalence among various populations. Advances in molecular epidemiological research have enhanced our comprehension of EBV-related pathologies. In this study, our objective was to examine the epidemiological profile and clinical features of EBV infection in Chongqing, China. We enrolled patients suspected of EBV-related diseases who were admitted to the First Affiliated Hospital of Chongqing Medical University between May 2013 and November 2022. Inclusion criteria were based on those who underwent EBV-specific immunofluorescence or plasma EBV-DNA testing. Among 13 584 inpatients, the overall seropositivity rates for EBNA-1-IgG, EBV-VCA-IgM, EBV-EA-IgG, EBV-EA-IgA, EBV-VCA-IgA, and EBV-DNA were 91.89%, 7.22%, 18.00%, 16.19%, 30.78%, and 18.00%, respectively. The seropositivity rate for EBNA-1-IgG steadily increased with age. The seropositivity rate for VCA-IgM, an indicator of acute EBV infection, was highest in patients aged 11-20 years at 26.41%, decreasing to 2%-6% in older patients. Additionally, among 205 outpatients, the EBV-DNA positivity rate was 14.15%. In 3670 individuals from health check-up centers, the seropositivity rates for EBV-EA-IgA and EBV-VCA-IgA were 11.96% and 28.09%, respectively, and the EBV-DNA positivity rate was 11.92%, all of which were lower than those in inpatients. Among the 762 EBV-DNA positive inpatients, adults aged 31-40 years were the least affected, with a seropositivity rate of 12.00%, which increased with age. The most common diseases associated with primary EBV infection were infectious mononucleosis (IM) (35.49%), followed by EBV infection (14.15%) and pneumonia (7.19%). The most common diseases associated with EBV reactivation were pneumonia (16.80%), nasopharyngeal carcinoma (NPC) (11.02%), and autoimmune diseases (7.04%). Patients with hemophagocytic lymphohistiocytosis (HLH) had the highest viral load, significantly higher than those with NPC, pneumonia, and liver cirrhosis. This large-scale retrospective study explores the epidemiological characteristics and disease spectrum of EBV infection across all age groups. The findings contribute to the improvement of diagnostic and management strategies for EBV infection.