婴幼儿巨细胞病毒感染的临床特点及转归

Clinical Characteristics and Outcome of Cytomegalovirus Infection in Infants

目的研究巨细胞病毒(CMV)感染住院婴幼儿的临床发病特点及疾病转归。方法对符合CMV感染的87例婴幼儿从感染CMV后的发病时间,CMV侵袭器官所致器官相应损害的临床发病类型,实验室及相关影像学检查包括头颅B超,胸部X线及脑干视、听觉诱发电位检查及疾病转归进行综合分析。结果87例CMV感染婴幼儿中先天性CMV感染占27.6%,围生期CMV感染占62.0%,生后CMV感染占16.6%;CMV肝炎是最常见的临床类型,发生率为41.3%,其中脾大发生率10.3%,多数患儿预后好,好转率80.5%;中枢神经系统异常的发生仅见于先天性和围生期感染患儿,本组神经系统异常发生率20.4%;先天性CMV感染中全身性感染占16.7%,围生期全身性感染占1.8%,生后感染者无全身性感染发生;先天性CMV感染的死亡率12.5%,围生期感染的死亡率1.85%。结论CMV感染是导致婴幼儿肝炎综合征的重要原因,是造成婴幼儿神经系统后遗症不可忽视的因素;先天性CMV感染中全身性感染病死率高,预后差。

Objective To study the clinical characteristics and outcome of cytomegalovirus （CMV） infection in infants. Methods All data including time of infection, clinical characteristics, laboratory tests and outcome of CMV infections in hospitalized infants were collected and analyzed from January, 1994 to July, 2004. Results In 87 infected infants, congenitally infected newborns, perinatal infection in infants and postnatal infection in infants accounted for 27.6 % ,62.0 %, 16.6 %, respectively. CMV hepatitis was the most frequent type of disease with the incidence of 41.3 %, in which the incidence of splenomegaly was 10.3 %. Most of CMV hepatitis infants had a good prognosis with the improved rate 80.5%. Central nervous system abnormality （including abnomal intension of muscle,convulsion,ocular and hearing abnormalities） occurred only in congenital and perinatal infection with the incidence of 20.4 %. Generalized infection, the incidence of congenital infection and perinatal infection was 16.7 %, 1.8 %, respectively. It did not occur in postnatal infection. The mortality rate of congenital infection and perinatal infection were 12.5% and 1.85%, respectively. Conclusions CMV infection is the main cause of infant hepatitis and it can also cause neurologic sequelae. The outcome of generalized infection in congenital infection is bad and the mortality rate is high.