巨细胞病毒肝炎患儿血浆D二聚体、血管性假血友病因子变化及复方甘草酸苷治疗的研究

Plasma levels of D-dimer and von Willebrand factor and the therapeutic effect of compound glycyrrhizin in children with cytomegalovirus hepatitis

目的探讨巨细胞病毒(CMV)肝炎患儿血浆D二聚体、血管性假血友病因子(vWF)变化的意义及复方甘草酸苷治疗的效果。方法取无症状CMV感染患儿16例,CMV肝炎患儿52例(其中肝炎型31例,淤胆型21例)及正常对照20例。检测血浆D二聚体和vWF水平。肝炎型及淤胆型患儿分别随机分为常规治疗组和复方甘草酸苷治疗组(后者在常规治疗的同时加用复方甘草酸苷),比较治疗前后D二聚体和vWF变化。结果(1)CMV肝炎患儿的D二聚体和vWF水平明显高于对照组和无症状CMV感染组(P<0.01),且淤胆型肝炎患儿的D二聚体和vWF水平明显高于肝炎型患儿(P<0.01);(2)CMV肝炎患儿治疗后D二聚体和vWF水平均显著低于治疗前(P<0.01);(3)CMV肝炎复方甘草酸苷治疗组患儿治疗后D二聚体和vWF显著低于常规治疗组(P<0.01)。结论检测CMV肝炎患儿D二聚体和vWF水平有助于及早对肝损害情况作出判断。复方甘草酸苷治疗可以降低血浆D二聚体和vWF水平,可能对CMV肝炎肝损害有保护作用。

Objective To study the significance of plasma D-dimer and von Willebrand factor （vWF） and the therapeutic effect of compound glycyrrhizin in children with cytomegalovirus （CMV） hepatitis.Methods Twenty healthy children,16 asymptomatic cases with CMV infection and 52 cases of CMV hepatitis （21 cholestatic and 31 non-cholestatic） were enrolled.The 52 children with CMV hepatitis were randomly administered with conventional treatment alone or conventional treatment plus compound glycyrrhizin treatment.Plasma D-dimer and vWF levels were measured before and after treatment.Results Plasma D-dimer and vWF levels in the CMV hepatitis group were markedly higher than those in the healthy control and asymptomatic CMV infection groups （P0.01）.The cholestatic hepatitis group had more increased plasma D-dimer and vWF levels compared with the non-cholestatic hepatitis group （P0.01）.Plasma D-dimer and vWF levels in the CMV hepatitis group were markedly reduced after conventional or compound glycyrrhizin treatment （P0.01）.Compound glycyrrhizin treatment decreased more significantly plasma D-dimer and vWF levels compared with the conventional treatment in children with CMV hepatitis （P0.01）.Conclusions The detection of plasma D-dimer and vWF is useful in the early assessment of liver damage in children with CMV hepatitis.Compound glycyrrhizin can decrease obviously plasma D-dimer and vWF levels and might thus provide protective effects against liver damage.