益生菌辅助更昔洛韦治疗新生儿人巨细胞病毒肝炎后的疾病转归观察

Effect of probiotic-assisted ganciclovir therapy on disease outcomes in neonatal human cytomegalovirus hepatitis

目的分析益生菌联合更昔洛韦治疗新生儿人巨细胞病毒(HCMV)肝炎后的疾病转归效果。方法将2020年3月至2023年3月成都市龙泉驿区妇幼保健院儿科收治的47例HCMV肝炎新生儿随机分为观察组(24例)和对照组(23例)。对照组接受更昔洛韦治疗,观察组采用益生菌联合更昔洛韦的治疗方案。对两组患儿的治疗效果、HCMV DNA负荷、肝生化指标[包括丙氨酸氨基转移酶(ALT)、总胆红素(TBil)、天冬氨酸氨基转移酶(AST)、总胆汁酸(TBA)]进行比较,并分析肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平、生长发育状况、恢复时间及不良反应发生率。结果观察组的总有效率为93.18%,高于对照组的76.74%(P<0.05)。对照组治疗2周后HCMV DNA载量为(8.44±1.42)拷贝/mL,恢复时间为(3.87±0.81)周,观察组治疗2周后HCMV DNA载量为7.41±1.25拷贝/mL,恢复时间为2.18±0.51周,观察组的HCMV DNA载量和恢复时间都显著低于对照组(P<0.05)。对照组治疗两周后,在ALT、TBil、AST和TBA的值分别为(6.33±8.13)U/L、(31.38±7.11)μmol/L、(58.42±12.18)U/L和(14.42±4.17)μmol/L。观察组治疗两周后,相应值分别为(40.92±6.09)U/L、(28.03±6.03)μmol/L、(52.96±10.11)U/L和(12.08±3.15)μmol/L,观察组的肝功能改善明显优于对照组(P<0.05)。治疗两周后,对照组体质量、身长和头围的增长分别为(3914.28±118.11)g、(53.25±2.23)cm和(36.28±0.24)cm,观察组相应增长为(3989.79±115.36)g、(54.61±1.29)cm和(36.74±0.18)cm,观察组优于对照组(P<0.05)。两组的不良反应发生率相似,差异无统计学意义(P>0.05)。结论益生菌联合更昔洛韦治疗新生儿HCMV肝炎效果较为优越,可降低病毒载量,改善肝功能,有助于新生儿的生长发育,缩短恢复时间,安全性良好。

Objective To evaluate the efficacy of combined probiotics and ganciclovir treatment on the outcomes of neonatal human cytomegalovirus(HCMV)hepatitis.Methods Between March 2020 and March 2023,47 neonates with HCMV hepatitis admitted to the Pediatrics Department of Longquanyi District Maternal and Child Health Hospital in Chengdu were randomly divided into an observation group(n=24)and a control group(n=23).The control group received ganciclovir treatment,while the observation group was administered a combination of probiotics and ganciclovir.Treatment efficacy,HCMV DNA load,liver function indicators(alanine aminotransferase[ALT],total bilirubin[TBil],aspartate aminotransferase[AST],total bile acids[TBA]),and levels of inflammatory factors(tumor necrosis factor-alpha[TNF-α],interleukin-6[IL-6])were compared between the groups.Additionally,growth and development status,recovery time,and the rate of adverse reactions were analyzed.Results The total effective rate of the observation group(93.18%)was significantly higher than that of the control group(76.74%)(P<0.05).After 2 weeks of treatment,the HCMV DNA load in the control group was 8.44±1.42 copies/mL,with a recovery time of 3.87±0.81 weeks.In the observtion group,The HCMV DNA load was 7.41±1.25 copies/mL,with a recovery time of 2.18±0.51 weeks.Both the HCMV DNA load and recovery time were significantly lower in the observtion group compared to the control group(P<0.05).After two weeks of treatment,the liver function indicators in the control group were as follows:ALT 46.33±8.13 U/L,TBil 31.38±7.11μmol/L,AST 58.42±12.18 U/L,and TBA 14.42±4.17μmol/L.In the observation group,the corresponding values were ALT 40.92±6.09 U/L,Tbil 28.03±6.03μmol/L,AST 52.96±10.11 U/L,and TBA 12.08±3.15μmol/L.The observation group showed significantly better improvement in liver function(P<0.05).After two week,the growth metrics in the control group were:body weight 3914.28±118.11 g,length 53.25±2.23 cm,and head circumference 36.28±0.24 cm.In the observation group,these values were:body weight 3989.79±115.36 g,length 54.61±1.29 cm,and head circumference 36.74±0.18 cm,indicating superior growth(P<0.05);The incidence of adverse reactions was similar between the two groups and not statistically significant(P>0.05).Conclusion The combination of probiotics and ganciclovir in the treatment of neonatal HCMV hepatitis is notably effective.Thhis approach reduces viral load,improves liver function,supports neonatal growth and development,shortens recovery time,and is well-tolerated,ensuring safety.