围生期巨细胞病毒感染与胆道闭锁的相关研究

The relationship between the prognosis of biliary atresia and the perinatal infection of cytomegalovirus.

目的分析探讨胆道闭锁(BA)患儿巨细胞病毒(CMV)感染对发病和预后的影响。方法对 36例胆道闭锁患儿进行CMV检测,29例进行Kasai手术,将其分为CMV阴性组(6例)、CMV-IgM阳性组(12例)和CMV-pp65阳性组(11例)三组,分析各组术后3个月患儿黄疸消退率和术后6个月内反流性胆管炎的发生率,检测肝门纤维块CMV-pp65抗原免疫组化染色,比较各组肝脏炎症和肝纤维化分级的病理改变。结果 CMV阴性组和CMV-IgM阳性组术后3个月内黄疸消退率显著高于CMV-pp65阳性组(P <0．05);两者术后反流性胆管炎的发生率亦显著低于后者(P<0．05)。CMV-pp65阳性组肝门纤维块 CMV-pp65抗原免疫组化染色的阳性率较高(72．7％),肝组织炎症程度和纤维化程度均较其他两组严重。结论围生期CMV正在复制可能加重胆道闭锁肝组织炎症和肝纤维化程度,影响患儿术后黄疸消退及反流性胆管炎的发生。

Objective To investigate the relationship between the infection of cytomegalovirus （CMV） and the prognosis of biliary atresia （BA）. Methods Thirty-six newborns of BA from Jan 2002 to March 2004 were selected. All of them and their mothers were measured for serum CMV-IgG, CMV-IgM and CMV-pp65. Twenty-nine of them underwent Kasai procedure and were divided into three groups： CMV negative group, CMV-IgM positive group, and CMV-pp65 infected group. The rate of jaundice disappearance and the incidence of reflux cholangitis were analyzed statistically. The histopathological changes of liver were examined. Results Positive expression of CMV-IgM and CMV-pp65 was more in patients than in their mothers. Compared to the other two groups, the rate of jaundice disappearance in CMV-pp65 infected group （36 % ） was significantly lower （P〈0. 05） and the incidence of reflux cholangitis was higher （P〈0.05）. The liver histopathologic examination showed that the degree of liver fibrosis and inflammation was more serious （P 〈 0. 05）. Conclusion BA patients with CMV-pp65 infection are strongly correlated with a lower rate of jaundice disappearance, a higher incidence of post-operational reflux cholangitis, and more severe liver fibrosis.