婴儿巨细胞病毒肝炎临床分析及更昔洛韦疗效评价

Evaluating the effect of ganciclovir therapy on infant cytomegalovirus hepatitis

目的 分析婴儿巨细胞病毒 (CMV)肝炎的临床特征及观察更昔洛韦的治疗效果。方法 ①回顾性分析 12 1例婴儿CMV肝炎的临床特征。②观察更昔洛韦正规治疗的 5 3例婴儿CMV肝炎治疗前后血清总胆红素水平、肝脾大小、肝酶 (ALT、AKP、γ GT)变化 ,定量检测 (FQ PCR法 )尿CMV DNA ,同时观察药物不良反应。结果 婴儿CMV肝炎绝大部分以黄疸为首发表现就诊 (90 9% ) ,但亦有以其他不典型症状就诊者。多伴有肝脾肿大 (96 7%和 49 6 % ) ,先天性感染者易合并先天畸形 (39 7% )。病程中可并发机会致病菌败血症、呼吸道感染、血液系统受累、维生素K缺乏等。应用更昔洛韦 5mg/kg每 12h静滴 1次 ,用 (14± 2 )d后 ,血清胆红素下降、肝脾回缩、血清ALT降低、尿CMV DNA定量减少 ,所有指标均差异显著 (P <0 0 1)。未见更昔洛韦的明显副作用。结论 对以黄疸为首发症状就诊的患儿应警惕CMV肝炎的发生 ,治疗中除应用特异抗病毒药物外应同时进行抗细菌、预防出血治疗。并加强母孕期监测及保健。更昔洛韦 5mg/kg每 12h用 1次静滴治疗 ,安全、有效、副作用小 ,值得推广。

Objective To investigate the clinical features of cytomegalovirus(CMV)hepatitis and the effect of Ganciclovir(GCV)on it.Methods (1)The clinical features of 121 infants with CMV hepatitis were retrospected.(2)Serum TBIL,AKP,ALT,γ GT,urine CMV DNA and the size of liver and spleen were detected before and after GCV therapy.Results Jaundice was the most common symptom in CMV hepatitis infants hapetomegaly and spleenomegaly were noted in 96 69% and 49 59% of the patients.Patients with congenital infection tended to have deformity and sometimes combine with chance directed infection,such as sepsis,respiratory infection and VK deficiency.Following 2 to 3 weeks of GCV (5mg/kg Q12h intravenous infusion)therapy,liver function improved,CMV DNA in urine decreased and enlarged liver and spleen diminished.No obvious adverse effect was observed during the therapy.Conclusion CMV hepatitis should be considered in infants with jaundice.GCV is a safe and effective agent in treating CMV infection and worth to be recommended.