巨细胞病毒性肝衰竭的临床特征及预后分析

Analysis of clinical features and prognosis of cytomegalovirus-associated liver failure

目的 探讨巨细胞病毒性肝衰竭患者的临床特征及预后.方法 回顾性分析总结38例巨细胞病毒性肝衰竭患者的临床资料.结果 患者年龄在2个月- 75岁,成人12例（31.58％）,除外各种诱因后仍有6例发病前为健康成人（15.79％）.临床分型以急性、亚急性为主（76.32％）,症状以纳差（60.53％）、发热多见（57.89％）,生化指标恶化组患者白蛋白、胆碱酯酶低于改善组,总胆红素高于改善组（P＜0.05）,而凝血酶原活动度间无明显差异.并发症以肝性脑病、腹水、上呼吸道感染为主.经治疗总体改善率31.58％,其中成人患者的改善率仅为16.67％.患者的年龄、肝性脑病是影响预后的独立危险因素.结论 巨细胞病毒性肝衰竭以急性、亚急性为主,年龄不同临床表现不尽相同.健康成人感染巨细胞病毒后可进展为肝衰竭,预后差.患者的年龄、肝性脑病是影响预后的独立危险因素.

Objective To investigate clinical features and prognosis of patients with cytomegalovirus （CMV）-associated liver failure.Methods The clinical data on 38 patients with CMV-associated liver failure from two hospitals were retrospectively analyzed.Results The range of patients＆#39; ages were from 2 months to 75 years,12 adults（31.58%）,including 6 patients （15.79%） were healthy previously.The predominant types of liver failure were acute and subacute liver failure （76.32%）.The most frequent symptoms were anorexia （60.53%）,fever （57.89%）.The test results of albumin （ALB） and cholinesterase （CHE） in the deteriorated group were lower than those in the improved group,total bilirubin （TBIL） in the deteriorated group was increased more than that in the improved group,but prothrombin activity （PA） had no significant differences.The most common complications were hepatic encephalopathy,ascites,and upper respiratory tract/lung infection.The overall improved rate was 31.58%,but,the improved rate was only 16.67% in adults.Age and hepatic encephalopathy were the independent risk factor of prognosis.Conclusions The predominant types of patients with cytomegalovirus-associated liver failure were acute and sub-acute liver failure,the clinical features varies in different age.The healthy adults infected with CMV could progress to liver failure,and the prognosis was poor.Age and hepatic encephalopathy were the independent risk factors of prognosis.