人巨细胞病毒感染与肝炎综合征婴儿临床特点比较*

doi:10.3969/j.issn.1672-5069.2019.04.016

摘要/Abstract

摘要： 目的分析比较人巨细胞病毒（HCMV）感染与婴儿肝炎综合征（IHS）患儿临床特点的异同。方法 2015年9月~2017年7月我院收治的IHS患儿194例,HCMV感染婴儿212例,选择同期健康婴儿194例,采用PCR法检测尿HCMV DNA,采用ELISA法测定血清抗HCMV IgM。给予黄疸婴儿茵栀黄注射液治疗2 w,给予HCMV感染婴儿更昔洛韦治疗7 d。结果 HCMV感染婴儿发热、皮疹和淋巴结肿大发生率分别为82.1%、45.3%和50.5%,显著高于IHS婴儿的34.5%、21.1%和33.5%（P<0.05）,而黄疸和肝脾肿大发生率则分别为45.8%和37.3%,显著低于IHS婴儿的100.0%和67.5%（P<0.05）;HCMV感染患儿尿HCMV DNA阳性率为80.7%,血清抗HCMV-IgM阳性率为41.0%,显著高于IHS患儿的8.2%和3.6%或健康婴儿的1.5%和0.5%（P<0.05）;两组患儿血清转氨酶水平无显著性差异（P>0.05）,治疗前HCMV感染婴儿血清总胆红素（TBIL）水平为（32.6±8.4） μmol/L,治疗后降至正常,而IHS患儿血清TBIL水平由（73.9±8.6） μmol/L下降至（37.6±5.4） μmol/L;随访6个月,大多HCMV感染患儿痊愈,死亡5例（2.4%）,其中死于肺部感染3例,死于心力衰竭2例;IHS患儿均痊愈。结论 HCMV感染婴儿临床表现以发热、皮疹和淋巴结肿大为主,而IHS患儿以黄疸和肝脾肿大为主;HCMV感染可引起IHS,急性感染可出现危重病例,甚至导致死亡,而IHS的病因多样,以肝内胆汁淤积为主要表现,治疗以退黄为主,预后较好。

关键词: 婴儿肝炎综合征, 人巨细胞病毒感染, 临床特点, 预后

Abstract: Objective To compare the clinical features of infants with human cytomegalovirus （HCMV) infection and of infantile hepatitis syndrome（IHS）.Methods 212 infants with HCMV infection, 194 infants with HIS and 194 healthy infants were recruited in our hospital between September 2015 and July 2017. Urine HCMV DNA was detected by PCR,and serum anti-HCMV IgM was assayed by ELISA.Results The incidences of fever,rash and lymphadenectasis in infants with HCMV infection were 82.1%,45.3% and 50.5%,significantly higher than 34.5%,21.1% and 33.5% in infants with IHS,respectively（P<0.05）,while jaundice and hepatosplenomegaly were 45.8% and 37.3%,much lower than 100.0% and 67.5%,respectively,in infants with IHS（P<0.05）;urine HCMV DNA positive rate was 80.7% and serum anti-HCMV-IgM positive rate was 41.0% in infants with HCMV infection,significantly higher than 8.2% and 3.6% in infants with IHS or 1.5% and 0.5% in healthy infants（P<0.05）;serum alanine aminotransferase （ALT） and aspartate aminotransferase（AST） levels in the two groups were not significantly different（P>0.05）,while serum bilirubin level in infants with HCMV infection at presentation was （32.6±8.4） μmol/L,which decreased to normal level after treatment,and serum bilirubin level in infants with IHS at presentation was （73.9±8.6） μmol/L,which decreased to （37.6±5.4） μmol/L two weeks after treatment;at the end of six month followed-up,five （2.4%） died of pulmonary infection or cardiac failure in infants with HCMV infection and all infants with IHS recovered. Conclusion The clinical manifestations of infants with HCMV infection are characterized by fever rash and lymphadenectasis,obviously different from those with IHS,in which the jaundice and hepatosplenomegaly are outstanding. The HCMV infection might lead to IHS in infants,and the severe case might be fatal, while the outcomes of infants with IHS is good.

Key words: Infant hepatitis syndrome, Human cytomegalovirus infection, Clinical feature, Prognosis

庄太平, 尹杨艳, 谢蔓芳, 冯乃超, 陈彩华. 人巨细胞病毒感染与肝炎综合征婴儿临床特点比较^*[J]. 实用肝脏病杂志, 2019, 22(4): 514-517.

Zhuang Taiping, Yin Yangyan, Xie Manfang, et al. Comparison of clinical features of infants with human cytomegalovirus infection and of infantile hepatitis syndrome[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2019, 22(4): 514-517.

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人巨细胞病毒感染与肝炎综合征婴儿临床特点比较^*

Comparison of clinical features of infants with human cytomegalovirus infection and of infantile hepatitis syndrome

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