短程间歇更昔洛韦治疗婴儿巨细胞病毒肝炎临床疗效观察

Therapeutic effects of short-term intermittent ganciclovir treatment on infants with cytomegalovirus hepatitis

目的观察短期更昔洛韦间歇治疗婴儿巨细胞病毒（CMV）肝炎的临床疗效。方法回顾性分析短程、间歇更昔洛韦治疗婴儿CMV肝炎的疗效，观察治疗组85例和对照组37例治疗前、后肝功能（TBil、直接胆红素、ALT、AST、γ-GT）的变化和治疗过程中更昔洛韦的不良反应。计量资料采用方差分析，计数资料采用卡方检验。结果短程更昔洛韦治疗后，治疗组TBil从（109．1±77．8）μmol／L降至（62．9±68．1）μmol／L（F=15．34，P〈0．01），ALT从（160．2±395．3）U／L降至（68．1±56．0）U／L（F=4．73，P〈0．05）；对照组TBil从（94．9±47．4）μmol／L降至（49．2±31．5）μmol／L（F=14．80，P〈0．01），但ALT从（131．6±206．2）U／L降至（55．3±31．2）U／L（F=3．50，P=0．067）。治疗组再次入院率为10．6％，明显低于对照组的21．6％。仅1例（0．8％）患儿间歇更昔洛韦治疗3次，最长住院日6周。结论短程、间歇更昔洛韦可能更适用于治疗婴儿CMV肝炎，未见明显药物不良反应，可减少住院日。

Objective To observe the clinical effects of short-term intermittent ganciclovir treatment on infants with cytomegalovirus （CMV） hepatitis. Methods The clinical data of infants with CMV hepatitis were analyzed retrospectively. The liver functions including total bilirubin （TBil）, direct bilirubin （DBil）, alanine aminotransferase （ALT）, aspartate aminotransferase fAST） and γ-glutamyhransferase （γ-GT） of the patients in treatment group （85 cases） and control group （37 cases） were collected before and after treatment. Meanwhile, the side effects of ganciclovir during treatment were observed. The measurement data were compared by analysis of variance and numeration data were compared by chi-square test. Results After short-term intermittent ganciclovir treatment in treatment group, TBil level was decreased from （109.1±77.8） μmol/L to （62.9±68.1） μmol/L （F=15.34,P〈 0. 01）; ALT level was decreased from （160.2±395.3） U/L to （68.1±56.0） U/L （F=4.73, P〈0.05）. In control group, TBil level was decreased from （94.9±47.4） μmol/L to （49.2 ± 31.5） μmol/L （F= 14.80, P〈0.01） ; while ALT level was decreased from （131.6±206.2） U/L to （55. 3±31. 2） U/L （F= 3.50, P = 0. 067）. The readmission rate in control group was significantly higher than that in treatment group （21. 6% vs 10. 6%）. Only one case （0.8%） received three times of intermittent ganciclovir treatment. The longest hospitalization time was six weeks. Conclusions Short-term intermittent ganciclovir treatment may be more suitable for infants with CMV hepatitis. There is no obvious side effect observed during the treatment and the hospitalization time can be shortened.