婴儿巨细胞病毒肝炎临床特征及治疗转归分析

Clinical features and treatment outcome of cytomegalovirus hepatitis in infants

目的探讨婴儿巨细胞病毒(cytomegalovirus, CMV)肝炎的临床特征及治疗转归。方法回顾性分析2014年1月至2017年6月在首都医科大学附属北京儿童医院住院治疗的121例婴儿CMV肝炎的发病特点、临床表现、实验室检查、影像学改变及更昔洛韦联合中药治疗的转归情况。结果患儿中男85例(70.2%),女36例(29.8%);发病年龄为(2.30±0.94)个月。96例(79.3%)以黄疸为首发症状,60例(49.6%)合并支气管肺炎。ALT升高108例(89.3%),T-BIL升高96例(79.3%),D-BIL升高94例(77.6%),GGT升高105例(86.8%),总胆汁酸(TBA)升高109例(90.1%)。其中黄疸组和无黄疸组在ALT峰值、凝血功能、免疫功能的差异无统计学意义(P>0.05)。随访全部患儿,疑似先天性胆道闭锁者18例,1例治愈,3例好转,肝硬化6例,死亡8例;其余患儿中,治愈68例,好转32例,肝硬化2例,死亡1例。结论婴儿CMV肝炎临床以淤胆型肝炎最常见,可合并多脏器损害。经更昔洛韦联合中药治疗,大多数患儿预后良好,但合并胆道闭锁者预后不良。

Objective To investigate clinical features and treatment outcome of cytomegalovirus(CMV)hepatitis in infants.Methods The characteristics,clinical manifestation,laboratory results,imaging changes and treatment outcome of121 patients in Beijing Children’s Hospital from January 2014 to June 2017 were retrospectively analyzed.Results There were 85 males(70.2%)and 36 females(29.8%),the average age was(2.30±0.94)months.Jaundice was the initial symptom in 96 cases(79.3%)and 60 patients(49.6%)had bronchitis.ALT increased in 108 patients(89.3%),T-BIL increased in 96 patients(79.3%),D-BIL increased in 94 patients(77.6%),GGT increased in 105 patients(86.7%),TBA increased in 109 patients(90.1%).There was no significant difference in ALT peak value,coagulation function and immune function between jaundice group and non-jaundice group(P>0.05).All cases were followed up.Eighteen cases were suspected diagnosed as congenital biliary atresia,1 case cured,3 cases improved,6 cases progressed to liver cirrhosis,8 cases died.Sixty-eight cases cured,32 cases improved,2 cases progressed to liver cirrhosis,and 1 case died in the rest patients.Conclusions Cholesteric hepatitis is the most common type of CMV hepatitis in infants.CMV hepatitis could be combined with multiple organ damage.The prognosis is good in most of the children after the treatment of ganciclovir and traditional Chinese medicine,but the prognosis is poor in biliary atresia patients.