Immunoregulatory therapy restores T cell subset balance and reveals risk factors for liver injury in children with infectious mononucleosis.

OBJECTIVE

To investigate changes in T-cell subset profiles and factors associated with liver injury in patients with infectious mononucleosis (IM) before and after treatment.

METHODS

Clinical data of 152 children with IM treated at Xijing Hospital from August 2024 were retrospectively analyzed. They were divided into a group with liver injury (n = 78) and a group without liver injury (n = 74). All patients received ganciclovir and pidotimod. T-cell subsets were measured before and after treatment, and factors associated with liver injury were assessed.

RESULTS

After treatment, the proportions of CD3+ and CD8+ T cells were (72.44±6.52)% and (42.84±7.58)% respectively, significantly lower than the pretreatment values of (78.42±6.79)% and (54.49±8.42)% (P < 0.05). In contrast, the proportion of CD4+ T cells and the CD4+/CD8+ ratio increased to (24.38±7.62)% and (0.66±0.14)%, compared with (21.68±6.24)% and (0.43±0.09)% before treatment (P < 0.05). Univariate analysis indicated that age, season of onset, disease duration, fever duration, and disease severity were associated with liver injury in children with IM. Multivariate analysis revealed that older age, onset in spring or autumn, prolonged disease course, longer fever duration, moderate to severe disease, and elevated CD8+ percentage were independent risk factors for liver injury, whereas higher CD4+ percentage and increased CD4+/CD8+ ratio were protective factors (P < 0.05).

CONCLUSION

Immunoregulatory therapy can effectively improve T-cell subset profiles and promote immune recovery in children with IM. Liver injury in IM is associated with age, season of onset, disease duration, fever duration, and disease severity.