婴儿肝炎综合征的病毒病因学分析

AN ANALYSIS OF VIRAL ETIOLOGY OF INFANTILE HEPATITIS SYNDROME

目的探讨婴儿肝炎综合征(IHS)的病毒病因学及其临床特点。方法采用酶联免疫吸附法(ELISA),检测47例IHS病儿血清肝炎病毒系列指标(包括抗-HAV抗体,抗-HCV抗体和乙型肝炎五项)以及HSV-IgM、HCMV-IgM和EBV VCA-IgM;留取晨尿标本用于CMV基因定量检测;PCR-Southern检测病儿外周血和咽分泌物EBV DNA。结果47例IHS病儿HCMV DNA阳性率为68.1%(32/47),HCMV-IgM阳性率为44.7%(21/47);血标本EBV DNA阳性率为19.1%(9/47),咽分泌物EBV DNA阳性率为34.0%(16/47);EBVVCA-IgM阳性率为14.9%(7/47);HBsAg阳性1例,HBsAg和HBeAg阳性1例,感染率为4.3%;HSV-IgM、抗-HAV、抗-HCV检测均为阴性。47例中治愈18例,好转25例,无变化2例,死亡2例。结论HCMV感染是引起IHS的主要原因;EBV感染与IHS的发生、发展密切相关;HAV、HCV和HSV与IHS无明显关系。

Objective To explore the viral etiology of infantile hepatitis syndrome （HIS）. Methods Anti-HAV IgM, anti-HCV IgM,anti-HBV IgM, HCMV-IgM and EBV VCA-IgM were tested by enzyme-linked immunosorbent assay （ELISA） in 47 infants with IHS and 40 healthy infants. HCMV-DNA in morning urine samples was tested by PCR. EBV-DNA in nasopharyngcal secretions and PBMC was tested by PCR-Southern in two groups. Results Of these 47 patients, the positive rates of HCMV-DNA was 68.1%（32/47）, of HCMV-IgM was 44. 7% （21/47）. The positive rates of EBV-DNA in blood sample was 19.1%（9/47）, of EBV-DNA in nasopharyngeal secretions was 34.0% （16/47）, of EBV VCA-IgM was 14.9% （7/47）. HBsAg positive in one case, and both HbsAg and HbeAg positive in one case, the positive rate was 4.3%. However, HSV-IgM, HAV- IgM and HCV-IgM were negative. Of all 47 patients,18 were cured, 25 improved, two unchanged, and two died. Conclusion HCMV infection was the main reason of IHS, and EBV infection has intimate correlation with HIS. HAV, HCV, Hsv and German measles virus have no obvious connection with IHS.