ABSTRACT
Objective:To investigate the clinical features of Epstein-Barr virus associated lymphoproliferative disease in children and to improve the understanding of this disease.Methods:This study included the children with Epstein-Barr virus associated lymphoproliferative disease admitted to the First Affiliated Hospital of College of Medicine of Zhejiang University from January 2014 to December 2018.Data of these children were collected, including age, clinical manifestations, laboratory results, treatment and outcome.The clinical features and therapeutic effects were analyzed.Results:A total of 114 cases(mean age 6 years, 0~17 years)were enrolled in this study, including 53 males and 61 females.There were 107 cases(93.86%) in the mild group (38 cases of EBV infection and 69 cases of infectious mononucleosis) and 7 cases in the severe group (6.14%). Six cases of the severe group were T cell or NK cell proliferation.Compared with the mild group, the load of EBV-DNA was higher in the severe group, but there was no significant difference( χ2=0.957, P>0.05). The IgM in severe group was significantly lower( Z=-2.041, P<0.05). But the differences in the level of immune function including IgA, IgG, CD4 + cell and CD8 + cell between the severe group and the mild group were not significant.The cases in the mild group had improved after antiviral treatments.Among the severe group, 3 cases survived after treatment, another 1 case was diagnosed as hydroa vacciniforme-like EBV-related proliferative disease (HV-like LPD). After antiviral treatment, the effect was not good, then after high-dose IVIG treatment and Bortezomib combined with methylprednisolone treatment, the EBV-DNA load decreased and the condition improved.While 1 case lost to follow-up, there were 2 cases with EBV-associated hemophagocytic syndrome and 1 case with EBV-associated lymphoma died after chemotherapy or transplantation. Conclusion:EBV-associated lymphoproliferative disease may manifest as a condition similar to infectious mononucleosis.High IgE, low IgM or high DNA load may indicate poor prognosis.Immune function after EBV infection may have different effects on prognosis.When the infected lymphocyte types are NK or T cells, it may indicate poor prognosis.The efficacy of transplantation and chemotherapy in severe cases is still uncertain.
ABSTRACT
Premature ovarian insufficiency (POI),previously known as premature ovarian failure (POF),is defined as the occurrence of premature ovarian failure in women under the age of 40 who may present with delayed puberty,primary or secondary (for 4 months or more) amenorrhea with two times and more of abnormal serum hormonal levels (low estradiol and raised gonadotrophins).And POI is not common in children and adolescents.It is generally believed that the etiologies of POI may be genetic,immunological,iatrogenic,etc.Hormone replacement therapy (HRT) is the primary treatment of POI in children and adolescents,and evaluation of therapeutic strategies to POI including cardiovascular,skeletal and emotional health is needed as well.Recently,the incidence of POI in children and adolescents has increased,therefore,early diagnosis and active treatment are urgent and necessary.Thus,this review will mainly be focused on the etiology and treatment of POI in children and adolescents.
ABSTRACT
Premature ovarian insufficiency(POI), previously known as premature ovarian failure(POF), is defined as the occurrence of premature ovarian failure in women under the age of 40 who may present with delayed puberty, primary or secondary(for 4 months or more)amenorrhea with two times and more of abnormal serum hormonal levels(low estradiol and raised gonadotrophins). And POI is not common in children and adolescents.It is generally believed that the etiologies of POI may be genetic, immunological, iatrogenic, etc.Hormone replacement therapy(HRT)is the primary treatment of POI in children and adolescents, and evaluation of therapeutic strategies to POI including cardiovascular, skeletal and emotional health is needed as well.Recently, the incidence of POI in children and adolescents has increased, therefore, early diagnosis and active treatment are urgent and necessary.Thus, this review will mainly be focused on the etiology and treatment of POI in children and adolescents.