婴儿巨细胞病毒感染相关胆汁淤积性肝炎47例

Clinical Analysis of 47 Cases of Infantile Cytomegalovirus Hepatitis with Cholestasis

目的分析婴儿巨细胞病毒(CMV)感染相关胆汁淤积性肝炎患儿的临床特点及CMV感染引起的肝内胆汁淤积情况。方法淤胆型婴儿CMV肝炎47例。根据最初的总胆红素(TB)高低分组:≤136.8μmol/L(组Ⅰ)22例,>136.8μmol/L(组Ⅱ)25例。予更昔洛韦抗病毒及常规护肝退黄治疗,治疗前后常规行血生化检测。采用SPSS 13.0软件进行统计学分析。结果47例患儿均有不同程度的黄疸、肝大和(或)脾大,肝功能异常。二组血清ALT及AST有显著性差异,组Ⅱ血清γ谷氨酰转移酶(GGT)及碱性磷酸酶(ALP)指标略高于组Ⅰ,但二者无显著性差异。治疗后血清TB及结合胆红素(DB)显著下降,血清ALT及AST指标下降,GGT及ALP水平在治疗前后无明显变化。结论CMV肝炎可侵犯从肝细胞至各级胆管上皮细胞,从而在各个水平引起肝内胆汁淤积。发生在肝细胞水平的胆汁淤积也应引起重视并进行早期干预。更昔洛韦治疗婴儿CMV肝炎近期疗效安全有效。

Objective To analyze the clinical features of infantile cytomegalovirus（CMV） hepatitis with cholestasis and investigate intrahepatic cholestasis due to hepatocytic impairment caused by CMV infection. Methods Forty - seven children with CMV cholestatic hepatitis were divided into 2 groups according to the level of total bilirubin （TB） ：22 cases with serum TB lower than 135.8 μmol/L （group I ） ,and 25 cases with serum TB higher than 136.8μmol/L （group 11 ）. All children were treated with both gangciclovir and routine methods,and serum biochemistry were checked before and after treatment. SPSS 13.0 software was used to analyze the data. Results Forty - seven cases of infantile CMV eholestatic hepatitis had different degrees of jaundice, hepatosplenomegaly and abnormal liver functions, The differences of serum ALT and AST between the 2 groups had statistical significance ,the levels of serum gamma glutamy transferase（GGT） and alkaline phosphatase （ALP） were lightly higher in group Ⅱ compared with those in group Ⅰ ,but there were no statistical significance. TB,direct bilirubin（DB） ,ALT and AST were decreased in the 2 groups after treatment, GGT and ALP hadn＇t decreased significantly after treatment. Conclusions CMV infection can injure hepatocytes and epithelials on each grade of bile duct, thus CMV hepatitis causes intrahepatic cholestasis. Cholestasis due to hepatocytic impairment deserves emphasis and intervention should be done as early as possible. Gangciclovir therapy for CMV infection manifest effective and safe in short -term.