ObjectiveTo improve the understanding of the diagnosis and therapy of chronic active Epstein-Barr virus (CAEBV) infection. MethodsData of 9 cases of CAEBV infection diagnosed between October 2008 and January 2013 were analyzed retrospectively,including clinical and auxiliary examination results,pathological data,especially EB virus (EBV) antibodies and DNA in peripheral blood mononuclear cells (PBMC) and infected tissue,and follow-up information. ResultsThe major manifestations of the 9 patients were fever,splenomegaly,hepatomegaly,lymphadenopathy,and others,including general fatigue,nausea,skin rash,jaundice,and so on.The abnormalities of auxiliary examination were as follows:anemia,leucopenia,neutropenia,thrombocytopenia,elevated LDH and HBDH levels,liver dysfunction and abnormal chest CT findings.EBV serologic tests revealed high IgA antibody levels against EB viral capsid antigen (VCA) in 6 patients,and 8 patients had positive IgG antibody levels against early D antigen (EAD).The mean load of EBV-DNA detected by real time polymerase chain reaction (PCR) in the PBMC was 3.07×105 copies/mL.Six of the nine patients presented a poor clinical course.One of them died of intracranial hemorrhage,one of them died of multiple organ failure,one of them died of EBV-associated hemophagocytic syndrome,and one of them died of severe pulmonary infection.Four patients developed lymphoma.One of them died of hepatic failure and one of them died of severe infection in the process of anti-tumor treatment. ConclusionThe clinical feature of CAEBV infection is varied.More attention should be paid to the disease because of its severe complications,poor prognosis and high mortality.
This study aims to clarify host factors of IFN treatment in the treatment of chronic hepatitis B (CHB) patients by screening the differentially expressed genes of IFN pathway CHB patients with different response to interferon (IFN) therapy. Three cases were randomly selected in IFN-responding CHB patients (Rs), non-responding CHB patients (NRs) and healthy participants, respectively. The human type I IFN response RT2 profiler PCR array was used to detect the expression levels of IFN-related genes in peripheral blood monocytes (PBMCs) from healthy participants and CHB patients before and after Peg-IFN-α 2a treatment. The results showed that more differentially expressed genes appeared in Rs group than NRs group after IFN treatment. Comparing with healthy participants, IFNG, IL7R, IRF1, and IRF8 were downregulated in both Rs and NRs group before IFN treatment; CXCL10, IFIT1, and IFITM1 were upregulated in the Rs; IL13RA1 and IFI35 were upregulated in the NRs, while IFRD2, IL11RA, IL4R, IRF3, IRF4, PYHIN1, and ADAR were downregulated. The expression of IL15, IFI35 and IFI44 was downregulated by 4.09 (t = 10.58, P < 0.001), 5.59 (t = 3.37, P = 0.028) and 10.83 (t = 2.8, P = 0.049) fold in the Rs group compared with the NRs group, respectively. In conclusion, IFN-response-related gene array is able to evaluate IFN treatment response by detecting IFN-related genes levels in PBMC. High expression of CXCL10, IFIT1 and IFITM1 before treatment may suggest satisfied IFN efficacy, while high expression of IL13RA1, IL15, IFI35 and IFI44 molecules and low expression of IFRD2, IL11RA, IL4R, IRF3, IRF4, PYHIN1 and ADAR molecules may be associated with poor IFN efficacy.