先天性胆道闭锁与巨细胞病毒感染的临床研究

Clinical Investigations of Congenital Biliary Atresia Associated with CMV Hepatitis

为了探讨先天性胆道闭锁（ＣＢＡ）的原因，分析肝脏病理变化、临床预后与巨细胞病毒（ＣＭＶ）感染的关系。取１４例ＣＢＡ患儿术中肝脏及肝门淋巴结标本，一份进行多聚酶链反应巨细胞病毒基因（ＰＣＲ－ＣＭＶ－ＤＮＡ）检测，另一份肝脏标本做ＨＥ染色光镜检查。结果：１４例中ＣＭＶ阳性占８例。肝脏病理检查表明随手术时日龄增加，胆管增生明显。比较ＣＭＶ阳性组与ＣＭＶ阴性组肝细胞病变、淤胆无差异，肝纤维化ＣＭＶ阴性组重于阳性组；肝细胞坏死ＣＭＶ阳性组重于阴性组。随访８～２０个月，生存６例，其中ＣＭＶ阳性５例，死亡８例。ＣＭＶ感染可能是ＣＢＡ的病因之一，肝纤维化程度、术后胆管炎发生的频率和程度与预后关系密切。从临床归转看ＣＭＶ感染阳性组预后较好。

In order to investigate the etiology . pathologic changes of congenital biliary atresia (CBA) and the relations of its prognosis with the infection of cytomegalovirus (CMV ) , 14 cases with CBA including those associated with CMV hepatitis are studied. The liver tissues and lymph nodes of porta hepatis obtained through operation were -both detected of CMV by polytnerase chain reaction (PCR-CMV-1DNA ) and examined microscopically with HE stain. Eight being PCR-CMV- 1DNA positive meant the incidence of CMV infection was 57. 1% . The pathological changes in CBA and the degree of hyperplasia of bile ducts correlated with the increase of patients, age. There was no significant difference in cholestasis , liver cell necrosis , and giant cell changes between CMV positive group and negative group. Liver fibrosis was obviously remarkable in CMV negative group , but the necrosis of liver was severe in CMV positive group. On following-up of 8-20 months . 5/6 cases survived in CMV positive group. Conclusion , Some of CMA might be a causative factor and. give rise to a better prognosis of CBA.