Peripheral blood lymphocyte counts in patients with infectious mononucleosis or chronic active Epstein-Barr virus infection and prognostic risk factors of chronic active Epstein-Barr virus infection

Abstract

Objective: To explore the peripheral blood lymphocyte counts and analyze the prognostic risk factors for the death in patients with chronic active Epstein-Barr virus (CAEBV) infection.

Methods: Clinical data of 64 patients infected with CAEBV (CAEBV group) and 64 patients with infectious mononucleosis (IM group) in our hospital were retrospectively analyzed. Meanwhile, 64 healthy individuals came for physical examination were enrolled in the control group. The three groups were compared for white blood cell count, lymphocyte count, and levels of peripheral blood NK cells, B cells, CD3⁺, CD4⁺, CD8⁺, CD4⁺CD28⁺, CD8⁺CD28⁺, CD4⁺CD25⁺, DR⁺CD8⁺, CD38⁺CD8⁺, CD4⁺ and CD8⁺ naive T cells and subsets of memory T cells. Patients infected with CAEBV were further divided into a survival subgroup and a death subgroup according to the survival outcome. The data were processed using univariate analysis and multivariate logistic regression analysis.

Results: Compared with the control group, the IM group had higher levels of white blood cell count, lymphocyte count, CD3⁺, CD4⁺, CD8⁺, CD4⁺CD25⁺, DR⁺CD8⁺, CD38⁺CD8⁺, effector-memory CD4⁺CD62L^-CD45RO⁺ and effector-memory CD8⁺CD62L^-CD45RO⁺, but lower levels of NK cells, B cells, CD4⁺CD28⁺, CD8⁺CD28⁺, naive CD4⁺CD62L⁺CD45RA⁺ and naive CD8⁺CD62L⁺CD45RA⁺ (all P<0.05). Compared with the control group, the CAEBV group had lower levels of white blood cell count, lymphocyte count, CD3⁺, CD4⁺, CD8⁺, NK cells, B cells, CD4⁺CD28⁺, CD8⁺CD28⁺, naive CD4⁺CD62L⁺CD45RA⁺ and naive CD8⁺CD62L⁺CD45RA⁺, but higher levels of CD4⁺CD25⁺, DR⁺CD8⁺, CD38⁺CD8⁺, effector-memory CD4⁺CD62L^-CD45RO⁺ and effector-memory CD8⁺CD62L^-CD45RO⁺ (all P<0.05). Univariate analysis and multivariate logistic regression analysis showed that EBV DNA>105 copies/mL, platelet count <50×10¹²/L, albumin <30 g/L and serum ferritin >5000 μg/L were independent risk factors for the death of patients with CAEBV.

Conclusion: Patients infected with CAEBV showed imbalance of lymphocyte subsets and immune dysfunction. EBV DNA>105 copies/mL, platelet count <50×10¹²/L, albumin <30 g/L and serum ferritin >5000 μg/L are risk factors of death in patients with CAEBV.

Keywords: Chronic active Epstein-Barr virus; lymphocyte subsets; peripheral blood; prognosis.