婴儿人巨细胞病毒肝炎肝功能分析

An analysis of hepatic function of infants with human cytomegalovirus hepatitis

[目的]探讨婴儿人巨细胞病毒(HCMV)肝炎的肝功能变化规律。[方法]选取2012年5月~2016年5月我院儿科收治的35例婴儿HCMV肝炎(HCMV肝炎组),45例婴儿嗜肝病毒肝炎(嗜肝病毒肝炎组)作为研究对象。检测所有研究对象的血清丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、γ-谷氨酰转肽酶(GGT)、总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)、总胆汁酸(TBA)、白蛋白(ALB)、前白蛋白(PA)、拟胆碱酯酶(PCHE)以及血浆凝血酶原时间(PT)、国际标准化比值(INR)等指标。[结果]HCMV肝炎组患儿血清ALT为(89.5±53.1)U/L,显著低于嗜肝病毒肝炎组[(154.8±60.7)U/L,P<0.05],AST为(105.2±66.0)U/L,显著低于嗜肝病毒肝炎组[(214.5±97.9)U/L,P<0.05],GGT为(201.2±61.4)U/L,显著低于嗜肝病毒肝炎组[(362.8±73.7)U/L,P<0.05],TBIL为(54.5±11.3)μmol/L,显著低于嗜肝病毒肝炎组[(87.3±20.8)μmol/L,P<0.05],IBIL为(29.1±9.4)μmol/L,显著低于嗜肝病毒肝炎组[(46.0±13.7)μmol/L,P<0.05],TBA为(60.5±29.9)μmol/L,显著低于嗜肝病毒肝炎组[(93.6±38.5)μmol/L,P<0.05],ALB为(28.0±1.8)g/L,显著高于嗜肝病毒肝炎组[(25.1±1.5)g/L,P<0.05],PA为(139.2±56.9)mg/L,显著高于嗜肝病毒肝炎组[(95.3±34.5)mg/L,P<0.05],PCHE为(5025.0±543.7)U/L,显著高于嗜肝病毒肝炎组[(4162.5±369.4)U/L,P<0.05],血浆PT为(17.5±2.1)s,显著低于嗜肝病毒肝炎组[(23.4±2.8)s,P<0.05],INR为(1.64±0.28),显著低于嗜肝病毒肝炎组[(1.92±0.33),P<0.05]。[结论]与婴儿嗜肝病毒肝炎相比,婴儿HCMV肝炎的肝损伤程度更轻,因此上述指标可以用于婴儿HCMV肝炎与婴儿嗜肝病毒肝炎的鉴别诊断。

[Objective]To investigate the change of liver function in infants with human cytomegalovirus（HCMV）hepatitis.[Methods]35 infants with HCMV hepatitis in our department from May 2012 to May2016 were enrolled as HCMV Hepatitis Group.45 infants with hepatotropic virus hepatitis were selected as hepatotropic virus hepatitis group.The Indicators of all subjects were detected including serum alanine amino transferase（ALT）,aspartate aminotransferase（AST）,γ-glutamyl transferase（GGT）,total bilirubin（TBIL）,direct bilirubin（DBIL）,indirect bilirubin（IBIL）,total bile acid（TBA）,albumin（ALB）,prealbumin（PA）,cholinesterase（PCHE）,the plasma prothrombin time（PT）and international normalized ratio（INR）.[Results]The level of serum ALT in the HCMV Hepatitis group was（89.5±53.1）U/L,which was significantly lower than that in the hepatotropic virus hepatitis group[（154.8±60.7）U/L,P〈0.05）].The levels of AST in the HCMV Hepatitis group was（105.2±66.0）U/L,which was significantly lower than that of hepatotropic virus hepatitis group[（214.5±97.9）U/L,P〈0.05）].The levels of GGT in the HCMV Hep-atitis group was（201.2±61.4）U/L,which was significantly lower than that of hepatotropic virus hepatitis group[（362.8±72.7）U/L,P〈0.05）].TIBIL in the HCMV Hepatitis group was（54.5±11.3）μmol/L,which was significantly lower than that of hepatotropic virus hepatitis group[（87.3±20.8）μmol/L,P〈0.05）].IBIL in the HCMV Hepatitis group was（29.1±9.4）μmol,which was significantly lower than that of hepatotropic virus hepatitis group[（31.5±11.3）μmol/L,（P〈0.05）].TBA in the HCMV Hepatitis group was（60.5±29.9）μmol/L,which was significantly lower than that of hepatotropic virus hepatitis group[（93.6±38.5）,P〈0.05）].ALP in the HCMV Hepatitis group was（28.0±1.8）g/L,which was significantly higher than that of hepatotropic virus group[（25.1±1.5）g/L,P〈0.05）].PA in the HCMV Hepatitis group was（139.2±56.9）mg/L,which was significantly higher than that of hepatotropic virus hepatitis group[（95.3±34.5）mg/L,P〈0.05）],PCHE in the HCMV Hepatitis group was（5025.0±543.7）U/L,which was significantly higher than that of hepatotropic virus hepatitis group[（4162.5±360.4）U/L,P〈0.05）.The plasma PT in the HCMV Hepatitis group was（17.5±2.1）s,which was significantly lower than that of hepatotropic virus hepatitis group[（23.4±2.8）s,P〈0.05].The INR in the HCMV Hepatitis group was（1.64±0.28）,which was significantly lower than that of hepatotropic virus hepatitis group[（1.92±0.33）,P〈0.05].[Conclusion]Compared with infants with hepatotropic virus hepatitis,the infants with HCMV hepatitis have lower degree of liver damage,so the above indicators can be used for differential diagnosis of HCMV hepatitis and hepatotropic virus hepatitis in infants.