烧伤患者巨细胞病毒复发感染及其对患者预后的评估价值

Analyses on the current status and significance of human cytomegalovirus reactivation in burn patients

目的观察烧伤病人巨细胞病毒(human cytomegalovirus,HCMV)复发感染情况及对预后的影响。方法对96例烧伤总体表面积(total body surface area,TBSA)>15%的患者进行动态观察。试验分组:(1)按烧伤面积将患者分为三组:Ⅰ组39例(TBSA 15%-49%),Ⅱ组32例(TBSA 50%-69%),Ⅲ组25例(TBSA 70%-99%);(2)根据脓毒血症诊断标准,将患者进一步分为脓毒症组(33例)和非脓毒症组(63例);(3)根据脓毒症组患者的预后情况,将其分为死亡组(11例)和生存组(22例)。入院24h内采集患者外周静脉血筛查抗HCMV IgG及HCMV-DNA,而后每隔1周左右采集病人血清标本,采用实时荧光定量PCR方法检测血清中HCMV-DNA水平。结果 (1)Ⅰ组、Ⅱ组和Ⅲ组的HCMV复发感染率分别为53.8%、50.0%和80.0%,Ⅲ组与其他两组之间差异有统计学意义(χ2=6.069,P<0.05)。(2)三组烧伤患者HCMV首次复发时间及每次复发持续时间差异无统计学意义(P>0.05)。HC-MV平均首次复发时间为入院后第14天,每次复发持续时间约为12天。(3)脓毒症组HCMV的复发感染率明显高于非脓毒症组(χ2=4.431,P<0.05),HCMV复发感染率与死亡率不相关(χ2=0.688,P>0.05)。结论烧伤患者HCMV复发感染率高,HCMV复发感染可能对烧伤后脓毒症的发生具有一定影响。

Objective To investigate the current status and significance of human cytomegalovirus reactivation in burn patients. Methods （1） A total of 96 patients with total burn surface area （TBSA） larger than 15 % were included in the study and divided into three groups according to the burn area：Group I （TBSA of 15%-49% ,n=39）,Group Ⅱ （TBSA of 50%-69% ,n=32） and Group Ⅲ （TBSA of 70%-99% ,n=25）. （2） According to whether there Was development of sepsis or not,patients were divided into sepsis group （n= 33） and non-sepsis group （n= 63）. （3） The patients with sepsis were further divided into non-survival group （n=11） and survival group （n= 22）. The periphery blood samples from 96 patients were collected on admission and then once a week until the patients were discharged from the hospital. We assessed HCMV viremia by real time polymerase chain reaction and clinical outcome in burn patients. Re- suits （1） The rate of HCMV reactivation in Group Ⅰ ,Group Ⅱ and Group Ⅲ is 53. 8%,50.0% and 80.0%,and Group Ⅲ is higher than the other two groups （x^2 = 6. 069,P〈0.05）. （2） There was no significant difference in time of HCMV reactivation and duration of HCMV viremia among the patients with different burn size. The average day to first detectable HCMV viremia is about 14 days after admission. Duration of HCMV viremia is around 12 days. （3） HCMV reactivation was associated Sepsis （x^2 =4. 431 ,P〈0.05）. There were no differences oh mortality rate between patients with and without HCMV reactivation （x^2=0. 688,P〉0.05）. Conclusion HCMV reactivation rate is consid- erable in burn patients and might influence the development of severe sepsis in patients with burn.