巨细胞病毒所致婴儿肝脏损害的前瞻性研究

A PROSPECTIVE STUDY OF LIVER IM-PAIRMENT CAUSED BY CY-TOMEGALOVIRUS IN INFANCY

为探讨巨细胞病毒（ＣＭＶ）感染所致婴儿肝损害的频率及转归，对４７例血清抗ＣＭＶＩｇＧ阳性母亲所生婴儿于生后２周内、１、３、６、１２月龄定期随访，应用ＥＬＩＳＡ法监测皿清抗ＣＭＶＩｇＭ和ＩｇＧ、尿ＣＭＶＤＮＡ（应用原位杂交法）和动态观察肝脏病变；并除外胆道系统畸形、代谢性肝病、药物中毒性肝炎和甲、乙、丙型肝炎。结果表明，至周岁时４０例婴儿感染ＣＭＶ。其中５２．５％（２１／４０）有肝脏受累。先天和围生期感染组肝损害发生率为７５．０％（１８／２４），较生后感染组（３ｌ１６，１８．８％）明显为高，而未感染儿未见肝损害。除４例为显性肝炎外，多表现为亚临床型。近半数病例（１０／２１）伴脾肿大。周岁时随访除１例围生期和２例生后感染儿好转外，其余各例肝脏病变均已恢复。表明本组婴儿早期ＣＭＶ感染易累及肝脏，但肝损害多不重，预后较好。

orty-seven infants born to serum anti-cytomegalovirus(CMV) IgG positive mothers werelongitudinally followed up within 2 weeks and at 1,3,6and 12 months after birth for monitoring serum anti-CMV IgM and IgG(ELISA),urine CMV DNA(insitu hybridization) and liver function,Biliary malfor-mations,inherited metabolic and drug-induced liverdiseases and hepatitis A,B and C were all excludedfrom the study population. The results showed that 4 0infants (85.1%)had CMV infection during the firstyear of their life, Twenty-one of them(52.5%)developed liver impairment. The incidence of liver im-pairment in congenitally and perinatally infected groupwas 75%(18/24 ),significantly higher than that inpostnatally infected group (3/16,18.8%); mean-while,none of those who were not infected by CMVhad liver involvement.Clinicallv,most cases presentedsubclinical hepatitis except for 4 cases of icteric hepati-tis. Teir manifestations completely disappeared,exceptfor one perinatally and 2 postnatally infected.It wassuggested that the cases infected by CMV during earlyinfancy were very likely to have liver involvement,usually with a benign course.