更昔洛韦联合人免疫球蛋白对婴儿巨细胞病毒肝炎的疗效观察

Efficacy of Ganciclovir and IVIG in Treatment of Infant with Cytomegalovirus Hepatitis

目的：观察更昔洛韦联合静注人免疫球蛋白（intrawenous immunoglobulin，IVIG）对婴儿巨细胞病毒肝炎（cytomegalo-virus，CMV）的临床疗效。方法：选取2011年3月～2014年5月在我院住院的确诊为婴儿巨细胞病毒肝炎的患儿58例，随机分为对照组28例：常规保肝、退黄治疗；治疗组30例：在常规治疗基础上给予更昔洛韦联合静注人免疫球蛋白治疗。观察2组肝功能、肝脾大小变化及CMV－IgM转阴率，并观察2组不良反应。结果：治疗4周后，治疗组肝功能为：TBIL（25．15±7．82）μmol／L， DBIL（11．45±3．07）μmol／L，ALT（28．75±11．19）U／L，GGT（24．35±7．51）U／L；对照组肝功能为：TBIL（48．61±9．52）μmol／L， DBIL（36．44±7．83）μmol／L，ALT（45．55±8．34）U／L，GGT（43．05±7．82）U／L，治疗组肝功能各项指标改善情况较对照组明显，差异有统计学意义（P＜0．01）。治疗组肝脏右肋下1．40±9．56cm，脾脏左肋下0．47±0．43cm；对照组肝脏右肋下2．51±0．59cm，脾脏左肋下1．58±0．75cm，治疗组肝脾回缩明显，差异有统计学意义（P＜0．01）。治疗组血CMV－IgM转阴率（86．7％）较对照组（53．5％）高，差异有统计学意义（P＜0．01）。结论：更昔洛韦联合免疫球蛋白治疗婴儿巨细胞病毒肝炎疗效好，不良反应少，值得临床推广。

Objective： To investigate therapeutic effects of ganciclovir and intravenous immune globulin（IVIG） on infants with cytomegalovirus hepatitis（CM V）.Methods： From March 2011 to May 2014,58 pediatric patients with cytomegalovirus hepatitis were divided into two groups,30 pediatric patients in treatment group and 28 pediatric patients in control group.The control group were treated with routine method,the treatment group were treated with routine method＋ganciclovir＋IVIG.The change of liver func-tion？liver and spleen size and the negative rates of CMV-IgM were obsered,and the adverse reactions were observed.Results：Af-ter 4 weeks treatment,TBIL[（25.15 ±7.82）μmol/L vs （48.61 ±9.52）μmol/L] and DBIL[（11.45 ±3.07）μmol/L vs （36. 44 ±7.83）μmol/L] and ALT[（28.75 ±11.19）U/L vs （45.55 ±8.34）U/L] and [（24.35 ±7.51）U/L vs （43.05 ±7.82） U/L] in the treatment group were less than those in the control group,the difference was statistically significant（ P ＜0.01）;Liver size[（1.40 ±0.71）cm vs （2.51 ±0.59）cm] and spleen size[（0.47 ±0.43）cm vs （1.58 ±0.75）cm] in the treatment group were less than those in the control group,the difference was statistically significant（P＜0.01）;The negative rates of CMV -IgM （86.7% vs 53.5%） in the treatment group was higher than that in the control group,the difference was statistically significant（ P＜0.01） .Conclusion： It is safe and effective to treat pediatric hepatitis caused by cytomegalovirus with Ganciclovir and intravenous immune globulin,which should be suggested in clinical practice.