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血清CD19+、白细胞介素-4与EB病毒DNA载量交互作用对小儿传染性单核细胞增多症发病的影响

Effect of interactions among serum CD19+, interleukin-4 and Epstein-Barr virus DNA load on occurrence of pediatric infectious mononucleosis

    摘要
  • 摘要:
    目的 探讨血清CD19+、白细胞介素-4(IL-4)与EB病毒(EBV)DNA载量交互作用对小儿传染性单核细胞增多症(IM)发病的影响。
    方法 选取100例IM患儿作为研究组, 另选取同期200例健康体检儿童作为对照组，比较2组儿童的基线资料、EBV-DNA载量、CD19+及IL-4表达水平。采用多因素Logistic回归模型分析IM发病的影响因素，基于相加模型分析EBV-DNA载量与CD19+、IL-4的交互作用, 并绘制受试者工作特征(ROC)曲线分析EBV-DNA载量、CD19+、IL-4单一及联合检测对IM的诊断效能。
    结果 2组儿童EBV-DNA载量、CD19+、IL-4、中性粒细胞与淋巴细胞比值(NLR)、单核细胞与淋巴细胞比值(MLR)、红细胞分布宽度(RDW)、异型淋巴细胞比率及VCA-IgM阳性率比较, 差异有统计学意义(P < 0.05)。多因素Logistic回归分析结果显示, EBV-DNA载量、CD19+、IL-4、RDW、异型淋巴细胞比率、VCA-IgM阳性均为IM发病的独立影响因素(P < 0.05)。相加交互作用分析表明, EBV-DNA载量与IL-4同时暴露时，交互效应超额相对危险度(RERI)为63.888, 交互作用归因比(API)为77.312, 交互效应指数(S)为4.532; EBV-DNA载量与CD19+同时暴露时, RERI为2.655, API为16.773, S为1.210。ROC曲线分析结果显示, EBV-DNA载量、CD19+、IL-4三者联合诊断IM的曲线下面积为0.945, 诊断效能优于单一指标诊断及两两联合诊断。
    结论 血清CD19+、IL-4与EBV-DNA载量在IM发病中存在相加交互作用, 且同时暴露可增加IM发病风险，联合检测有助于提高IM诊断效能，为临床诊治提供参考依据。

     

    Abstract:
    Objective To explore the impact of interactions among serum CD19+, interleukin-4 (IL-4), and Epstein-Barr virus (EBV) DNA load on the occurrence of pediatric infectious mononucleosis (IM).
    Methods A total of 100 IM pediatric patients were enrolled as study group, and 200 healthy pediatric controls were recruited during the same period. Baseline characteristics, EBV-DNA load, CD19+levels, and IL-4 expression were compared between the two groups. A multivariate Logistic regression model was used to analyze the influencing factors of IM. The interactions between EBV-DNA load and CD19+, IL-4 were analyzed based on an additive model. Receiver operating characteristic (ROC) curves were plotted to assess the diagnostic performance of EBV-DNA load, CD19+, IL-4 alone and their combination for IM.
    Results Significant differences were observed between the two groups in terms of EBV-DNA load, CD19+ levels, IL-4 expression, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), red cell distribution width (RDW), atypical lymphocyte ratio, and VCA-IgM positivity (P < 0.05). Multivariate Logistic regression analysis revealed that EBV-DNA load, CD19+, IL-4, RDW, atypical lymphocyte ratio, and VCA-IgM positivity were independent influencing factors for IM occurrence (P < 0.05). Additive interaction analysis showed that when EBV-DNA load and IL-4 were simultaneously exposed, the relative excess risk due to interaction (RERI) was 63.888, the attributable proportion due to interaction (API) was 77.312, and the synergy index (S) was 4.532; when EBV-DNA load and CD19+ were simultaneously exposed, RERI was 2.655, API was 16.773, and S was 1.210. ROC curve analysis indicated that the area under the curve (AUC) for the combined diagnosis of IM using EBV-DNA load, CD19+, and IL-4 was 0.945, which was superior to that of single indicator and dual combination.
    Conclusion Serum CD19+, IL-4, and EBV-DNA load exhibit additive interactions in the occurrence of IM, and simultaneous exposure increases the risk of IM. Combined detection of these biomarkers enhances the diagnostic performance for IM, providing a reference for clinical diagnosis and treatment.

     

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