不同疗程更昔洛韦治疗婴儿巨细胞病毒性肝炎的疗效

Therapeutic Effect of Different Ganciclovir Treatment Courses on Infantile Cytomegalovirus Hepatitis

目的观察不同疗程更昔洛韦（GCV）治疗婴儿巨细胞病毒性肝炎（CMV肝炎）的效果及不良反应。方法选取2009年1月-2010年12月在本科住院的1~4月龄CMV肝炎患儿48例,随机分为治疗1组（n=25）和治疗2组（n=23）。二组均予保肝、退黄治疗,治疗1组给予GCV5 mg.kg-1,每日2次,连用2周。治疗2组诱导期给予GCV5 mg.kg-1,每日2次,连用2周;维持期给予GCV5 mg.kg-1,每日1次,连用7 d。治疗前后常规检查肝、肾功能及心肌酶谱,所有患儿出院后随访2个月,监测其血CMV-IgM水平。结果二组患儿治疗后血清ALT、总胆红素、结合胆红素水平均显著下降,与治疗前比较差异均有统计学意义（Pa〈0.05）;治疗后二组ALT、总胆红素及结合胆红素水平比较差异亦有统计学意义（Pa〈0.05）。治疗后随访2个月,血CMV-IgM转阴率治疗2组高于治疗1组。血常规、肾功能及心肌酶谱二组比较无统计学差异（Pa〉0.05）。结论 GCV治疗婴儿CMV肝炎的疗效肯定,且3周二期治疗方案优于2周一期治疗方案,前者能够获得高病毒转阴率和较低复发率,同时较长程疗法更少引起不良反应,较经济且易于被小婴儿耐受,易于推广。

Objective To observe the clinical efficacy and side effects of different ganciclovir（GCV） treatment courses in treating infantile cytomegalovirus（CMV） hepatitis.Methods A total of 48 hospitalized infants aged from 1-4 months with CMV hepatitis from Department of Pediatrics of Dongguan Women and Children′s Hospital during Jan.2009 to Dec.2010 were recruited,and they were randomly divided into 2 groups.All the patients were given the same basic treatments including liver protection and jaundice treatment.Besides,patients in first study group were treated with GCV 5 mg·kg-1,twice a day for 2 weeks;patients in the second study group were treated with GCV 5 mg·kg-1,twice a day for 2 weeks during the induction period and 5 mg·kg-1,once a day for 7 days during the maintenance period.Liver function,kidney function and myocardium enzymes spectrum were checked before and after treatment.All the patients were followed-up and their serum CMV-IgM were monitored for 2 months after being discharged.Results Compared with before treatment,the levels of alanine aminotransferase（ALT）,serum bilirubin total and direct bilirubin after treatment decreased significantly in the both study groups（Pa0.05）.And the levels of ALT serum bilirubin total and direct bilirubin after treatment between the 2 study groups were significantly different（Pa0.05）.The negative conversion ratio of CMV-IgM in the second study group was higher than that in the first study group at 2 months after treatment.There was no significant difference of the changes of blood routine,kidney function and myocardium enzymes spectrum between the 2 study groups（Pa0.05）.Conclusions To treat infantile cytomegalovirus hepatitis with GCV is effective.The 3 weeks two periods treatment protocol is better than the 2 weeks one period treatment protocol.The negative conversion ratio of CMV-IgM is higher in the 3 weeks two periods treatment protocol,and the relapse rate is lower.Compared with the longer treatment protocol,the 3 weeks two periods treatment protocol has lesser side effects of GCV,and was oecumenical,easier to accept by little baby,so it is worth to recommend.