Chinese Hepatolgy ›› 2024, Vol. 29 ›› Issue (11): 1418-1421.

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Analysis of peripheral blood CD19+ cells and serum C-reactive protein in pediatric infectious mononucleosis with liver complications

CHEN Lei-lei1, LIU Zhi-feng2   

  1. 1. Department of Pediatrics, Yancheng First Hospital Affiliated of Nanjing University Medical College, Jiangsu 224000, China;
    2. Department of Digestion, Nanjing Children’s Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Jiangsu 210000, China
  • Received:2024-07-19 Online:2024-11-30 Published:2025-01-10
  • Contact: LIU Zhi-feng, Email:zfliu@njmu.edu.cn

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Abstract: Objective To examine the changes in peripheral blood CD19+ cell percentage, along with serum procalcitonin (PCT) and C-reactive protein (CRP) levels, in children with infectious mononucleosis (IM) complicated by liver damage. Methods A total of 105 children diagnosed with IM were treated at Yancheng First Hospital, affiliated with Nanjing University Medical School, from March 2021 to March 2024. All patients received intravenous ganciclovir for one to two weeks. Those with liver injury were additionally managed with liver-protecting medicines until normalization of liver function tests. Peripheral blood CD19+ cell percentage were measured by flow cytometry (FCM), while serum procalcitonin (PCT) and C-reactive protein (CRP) levels were assayed throgh routine assays. Multivariate logistic regression analysis was used to identify risk factors associated with liver damage in children with IM. Results Among the 105 children with IM, liver injury was observed in 64 cases (61.0%). Children with liver injury had a significantly lower body mass index (BMI) [(21.7±1.2) kg/m2] compared to those without liver injury [(23.8±1.5) kg/m2, P<0.05]. The incidence of hepatomegaly, artificial feeding, and severe clinical type was markedly higher in children with liver injury (43.8%, 43.8% and 12.5%, respectively) than in those without (22.0%, 12.2% and 0.0% all P<0.05). Serum EBV DNA load was significantly elevated [(3.5±1.2) lg copies/mL] and antiviral therapy duration was longer [(7.4±1.1) days] in children with liver injury compared to those without [(2.0±0.6) lg copies/mL and (3.6±0.5) days, respectively, P<0.05]. Peripheral blood CD19+ cells percentage [(8.4±1.9) %] and serum CRP levels [(57.2±14.6) mg/L] were also significantly higher in children with liver injury than in those without [(4.6±1.5) % and (12.4±2.9) mg/L, respectively, P<0.05]. Multivariate logistic regression identified hepatomegaly [OR=1.020, 95% CI: 1.003-1.038, P=0.022], artificial feeding [OR=1.113, 95% CI: 1.011-1.226,P=0.028], duration of antiviral therapy [OR=10.502, 95% CI: 1.561-70.663,P=0.016], severe clinical type [OR=1.121, 95% CI: 1.009-1.245, P=0.033], BMI [OR=0.988, 95% CI:0.978-0.998, P=0.022], serum EBV DNA load [OR=1.777, 95% CI: 1.043-3.028, P=0.035], peripheral blood CD19+ cell percentage [OR=1.471, 95% CI: 1.093-1.980, P=0.011], and serum CRP level [OR=2.807, 95% CI: 1.121-7.028, P=0.027] as independent risk factors for liver injury in children with IM (P<0.05). Conclusion Liver injury is a potential complication in children with IM, and clinicians should carefully consider associated risk factors. Extended antiviral therapy may not be advisable, and elevated peripheral blood CD19+ cell percentages and serum CRP levels could serve as indicators of liver injury, warranting appropriate management.

Key words: Infectious Mononucleosis, Liver injuries, CD19+ cells, C-reactive protein