人巨细胞病毒活动性感染与婴儿不明原因肝炎的相关性研究

The correlation analysis of human cytomegalovirus active infection and infantile unknown hepatitis

目的研究人巨细胞病毒(HCMV)活动性感染[HCMV(+)]与婴儿不明原因肝炎的相关性。方法选取不明原因肝功能损伤患儿236例(不明原因肝炎组)及肝功能正常的母乳性黄疸患儿116例(对照组),记录其一般情况、临床表现、诊断、尿人巨细胞病毒DNA(HCMV-DNA)、人巨细胞病毒特异性抗体IgM(HCMV-IgM)、谷丙转氨酶(ALT)、谷草转氨酶(AST)和总胆红素(TB)水平,对其进行回顾性分析。结果不明原因肝炎组与对照组患儿HCMV-IgM阳性率分别为74.2%和19.7%,差异有统计学意义(P<0.05)。HCMV(+)组与HCMV(-)组均以黄疸、肝脏增大、发热、腹泻等为主要表现,且HCMV(-)组发生肝脏增大的可能性更大,差异有统计学意义(P<0.05)。HCMV(+)组与HCMV(-)组的ALT、AST和TB水平比较,差异均无统计学意义(P>0.05)。HCMV(+)组和HCMV(-)组ALT水平小于或等于正常值2倍、正常值大于2～5倍、正常值大于5～10倍,正常值的10倍以上占比比较,差异均有统计学意义(P<0.05)。结论婴儿不明原因肝炎与HCMV感染具有显著相关性,其以黄疸、肝脏增大、发热、腹泻等为主要临床表现,但肝损伤的严重程度与HCMV活动性感染不具有相关性,ALT值为正常值大于5～10倍时,其为HCMV感染的可能性更大,更适合提前给予其抗HCMV治疗。

Objective To study the association between human cytomegalovirus (HCMV) active infection [HCMV(+)] and unexplained hepatitis in infants. Methods A total of 236 children with unexplained liver function impairment (unexplained hepatitis group) and 116 children with normal liver function of breast milk jaundice (control group) were selected.The general condition and clinical manifestations of the two groups of children were recorded,and the levels of HCMV-DNA,HCMV-IgM,ALT,AST and TB were measured.And it was retrospectively analyzed. Results The positive rates of HCMV-IgM in the unexplained hepatitis group and the control group were 74.2% and 19.7%,respectively,and the difference was statistically significant ( P < 0.05 ).HCMV(+) group and HCMV(-) group were mainly caused by jaundice,liver enlargement,fever,diarrhea,etc.,and HCMV(-) group was more likely to have hepatic enlargement,the difference was statistically significant ( P <0.05).There were no significant differences in ALT,AST and TB levels between HCMV(+) and HCMV(-) groups ( P >0.05).The ALT levels in HCMV(+) group and HCMV(-) group were equal or less than 2 times,>2-5 times,>5-10 times,and the ratios were more than 10 times.The differences were statistically significant ( P <0.05). Conclusion Unexplained hepatitis in infants has a significant correlation with HCMV infection.The main clinical manifestations of jaundice,liver enlargement,fever,diarrhea,etc.,but the severity of liver injury is not associated with HCMV active infection.When the ALT value is >5-10 times normal,it is more likely to be infected with HCMV,and it is more suitable for anti-HCMV treatment in advance.