小婴儿巨细胞病毒感染临床诊治分析

Clinical diagnosis and treatment of infants with CMV infection

目的观察小婴儿巨细胞病毒(CMV)感染的临床特点及诊治情况。方法 2014年10月至2016年10月郑州市儿童医院小婴儿科收治住院的CMV感染患儿72例。采用酶联免疫吸附试验法检测血清CMV-IgM阳性,进一步行PCR荧光探针法检测患儿血浆CMV-DNA-PCR量高于正常者。72例患儿均给予更昔洛韦治疗,治疗分为诱导治疗及维持治疗。进行血常规、肝肾功能、胸片、头颅CT、脑干听觉诱发电位、超声等检查,同时检测母亲乳汁CMV-DNA-PCR,并对其临床表现、诊治情况进行分析。结果 72例患儿中临床表现为婴儿肝炎45例,高胆红素血症35例,肺炎31例,脑损伤18例,脑干听觉诱发电位异常9例,营养不良6例,先天性心脏病5例,遗传性代谢病3例。60例纯母乳喂养患儿中母亲乳汁CMVDNA-PCR高于正常者45例。治疗后好转或治愈65例,放弃治疗7例。结论小婴儿易发生CMV感染,其临床表现多样,以肝胆系统异常最多见。对于确诊CMV感染的患儿,应同时检测患儿母亲乳汁CMVDNA-PCR并进行早期干预。经更昔洛韦抗病毒治疗大多数病例预后良好,及早进行诊断和治疗有利于改善预后。

Objective To observe the clinical characteristics,diagnosis and treatment of infantile cytomegalovirus（CMV）infection.Methods From Oct.2014 to Oct.2016,72 children with CMV infection were admitted to the Infant Department of Zhengzhou Children′s Hospital.Serum CMV-IgM was detected by enzyme-linked immunosorbent assay（ELISA）,and the children whose level of CMV-DNA-PCR was higher than that of normal group by PCR fluorescent probe were found.The 72 cases of children were given ganciclovir treatment,and the treatment was divided into induction therapy and maintenance therapy.The following examinations were performed：routine blood test,liver and kidney function,chest X-ray,cerebral CT,brainstem auditory evoked potential and ultrasonography.Meanwhile,the CMV-DNA-PCR of mothers were detected,and its clinical manifestations and diagnosis and treatment were analyzed.Results The clinical manifestations included infantile hepatitis in 45 cases,hyperbilirubinemia in 35 cases,pneumonia in 31cases,brain injury in 18 cases,brainstem auditory evoked potential abnormality in 9cases,malnutrition in 6cases,congenital heart disease in 5cases and hereditary metabolic diseases in 3cases.The milk CMV-DNAPCR of 45 mothers was higher in the 60 mothers of breast feeding.Totally 65 cases were improved or cured after treatment,and 7cases gave up treatment.Conclusion Small infants are prone to CMV infection,and the clinical manifestations are various,with hepatobiliary system abnormalities most common.For children diagnosed with CMV infection,CMV-DNA-PCR of mother＇s milk should be detected simultaneously and early intervention should be performed.Ganciclovir antiviral treatment produces good prognosis in most cases,and early diagnosis and treatment is helpful to improve the prognosis.