儿童130例人巨细胞病毒感染的血液学有关表现

Hematological manifestations of human cytomegalovirus infection: A retrospective study in 130 pediatric patients.

目的探讨儿童人巨细胞病毒(humancytomegalovirus,HCMV)感染的血液学表现。方法回顾性分析130例人巨细胞病毒感染患儿的临床特征、血象、骨髓象和免疫学指标的变化及治疗和转归。结果130例中有64例出现外周血象的改变(49·2%)。其中贫血46例(35,4%),血小板减少35例(26·9%),粒细胞减少4例(3·1%),全血细胞减少5例(3·8%),外周血出现异型淋巴细胞11例(8·5%)。29例出现血液系统并发症(22·3%),包括传染性单核细胞增多综合征、特发性血小板减少性紫癜(ITP)、自身免疫性溶血性贫血(AIHA)、病毒相关性噬血细胞综合征(VAHS)等。部分行免疫功能检查的患儿中,27·5%的病人存在体液免疫异常,71·4%存在细胞免疫异常。结论儿童是HCMV感染的易感人群。HCMV几乎可以感染人体所有组织,造血系统受累,可引起多种造血功能紊乱,甚至发生多种CMV感染相关性血液系统疾病。早期足疗程地应用更昔洛韦,配合对症、支持、免疫调节等综合治疗,可明显提高疗效。

Objective To investigate the hematological manifestations of human cytomegalovims （HCMV） infection in children. Methods 130 cases with HCMV infection were studied retrospectively. Their clinical features, hemogram, myelogram, immunological parameters, treatment and prognosis were analyzed. Results Among the total 130 patients, 64 cases were found the abnormity of the peripheral hemogram （49.2%）. 46 （35.4%） with anemia, 35（26. 9% ） with thrombocytopenia, 4（3.1% ） with neutropenia, 5 （3.8%） with pancytopenia and 11 （8.5%） with atypical lymphocyte. There were 29 cases （22.3%） who developed hematological complications including infectious mononucleosis syndrome, idiopathic thrombocytopenic purpura （ITP）, autoimmune hemolytic anemia （AIHA） and virus associated hemophagoeytic syndrome （VAHS）. Among the 40 patients taken immunofunctional examination, 27.5% of them presented humoral immunity abnormality and 71.4% had cell immunity abnormality. Conclusion Children are susceptible to HCMV infection. Almost all human tissues and organs could be infected. When hematopoietic system is involved, the multiple hemopoiesis disorders or hematological diseases related to HCMV infection might be occurred. The therapeutic effect could be significantly increased by applying the early treatment with full course of Ganciclovir. Combined supporting and immunoregulation therapies are also indispensable and effective.