婴儿黄疸型人巨细胞病毒肝炎临床随访研究

Clinical follow-up study of jaundice type of human cytomegalovirus hepatitis in infants

目的探讨婴儿黄疸型人巨细胞病毒（HCMV）肝炎肝功能恢复时间及其影响因素。方法回顾性分析73例婴儿黄疸型HCMV肝炎患儿的临床资料。采用KaplanMeier法评估年龄、性别、肝脏肿大、总胆红素（TBil）、直接胆红素（DBil）、丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、总胆汁酸（TBA）和HCMVDNA载量各因素对患儿肝功能恢复的影响，并以Cox回归模型分析各变量与肝功能恢复的关系。结果年龄≤3个月（RR=0．27，95％CI：0．10—0．70）、DBil≤90umol／L（RR=0．16，95％CI：0．08～0．32）、男性（RR=0．49，95％CI：0．26～0．94）、肝脏肿大〈3cm（RR=0．50，95％CI：0．27-0．93）有利于缩短TBil恢复正常时间；AST≤120U／L（RR=0．16，95％CI：0．08—0．33）和肝脏肿大〈3cm（RR=0．28，95％CI：0．15～0．49）有利于缩短AST恢复正常时间。TBil恢复正常时间为（2．23±1．54）个月，早于AST恢复正常的时间（3．63±1．93）个月，差异有统计学意义（t=10．37，P〈0．001）。结论婴儿黄疸型HCMV肝炎患儿预后良好，病程长短不一，早期治疗有利于肝功能恢复；胆汁淤积和肝脏肿大程度以及AST水平对肝功能恢复有显著影响。

Objective To explore the recovery time of hepatic function in infants with jaundice type of human cytomega- lovirus （HCMV） hepatitis and its influencing factors. Methods The clinical data of 73 infants with jaundice type of HCMV hepa- titis admired to hospital from February 2005 to October 2012 were retrospectively analyzed. The effects on hepatic function of nine factors including age, sex, liver size, total bilirubin （TBil）, direct bilirubin （DBil）, alanine aminotransferase （ALT）, aspar- tate aminotransferase （AST）, total bile acid （TBA） and the loads of HCMV DNA were assessed by Kaplan Meier method, and further analyzed by Cox proportional hazards regression model. Results The results of Cox proportional hazards regression showed that age ≤ 3 month （RR=0.27, 95%CI： 0.10-0.70）, DBil ≤90 trnol/L （RR=0.16, 95%CI： 0.08-0.32）, male （RR=0.49, 95%CI： 0.26-0.94） and enlarged liver size 〈 3 cm （RR=0.50, 95%CI： 0.27-0.93） were independent factors that shorten the time for TBil back to be normal. Furthermore, AST ≤ 120 U/L （RR=0.16, 95%CI： 0.08-0.33） and enlarged liver size 〈 3 cm （RR= 0.28, 95%CI： 0.15-0.49） were independent factors that shorten the time for AST back to be normal. The time for TBil back to be normal was （2.23±1.54） months, which was significantly shorter than that [（3.63±1.93） months] of AST （t=10.37, P〈0.001）. Conclusions Jaundice type HCMV hepatitis had good outcome and varied in disease course. The recovery of hepatic function was significantly adversely affected by the degree of cholestasis and hepatomegaly as well as AST level, and early treatment was conducive to the recovery.