伴不同gH基因型人巨细胞病毒感染的免疫性血小板减少症患儿临床特征研究

Clinical characteristics of immune thrombocytopenia patients with human cytomegalovirus infection of different gH genotypes

目的探讨免疫性血小板减少症(ITP)伴不同gH基因型人巨细胞病毒(HCMV)感染的临床特征。方法留取2013年7月至2019年2月住院的新诊断ITP且HCMV DNA检测阳性的儿童尿液,作gH分型,根据gH分型将患儿分为gH1组和gH2组。收集临床资料和至少3个月的随访资料。采用χ^2检验、t检验、非参数检验分析gH基因型分布与ITP临床表现、预后的差异。结果共入组41例新诊断ITP伴HCMV感染患儿。其中gH1型26例(63.4%),gH2型15例(36.6%)。男女比例1.9:1,两组男性比例差异无统计学意义(15/26比12/15,P>0.05)。gH1组月龄3.5(0,15)个月,和gH2组[月龄4.0(0,15)个月]比较差异无统计学意义(P>0.05)。gH1比例在先天性感染组(5/6)、围生期感染组(7/10)和生后感染组(14/25)中均高于gH2型,但基因型分布差异无统计学意义(均P>0.05)。治疗后3个月内gH2组血小板完全恢复率(25/26)较gH1组(10/15)低(P<0.05)。结论ITP患儿伴HCMV感染的糖蛋白基因型以gH1型多见,ITP伴gH2型HCMV感染发展为持续性ITP可能性较大。

Objective To analyze the clinical characteristics of immune thrombocytopenia(ITP)patients with human cytomegalovirus(HCMV)infection of different gH genotypes.Methods Forty one newly diagnosed ITP children with HCMV infection admitted to the Children's Hospital Zhejiang University School of Medicine from July 2013 to February 2019 were recruited.HCMV-DNA gH typing was detected in urine samples,and patients were divided into gH1 group and gH2 group according to gH genotypes.The data of hospitalization and at least 3 months follow-up were collected.Chi-square test,T test and non-parametric test were used to analyze the differences of gH genotype distribution,ITP clinical manifestations and prognosis.Results There were 26 cases of gH1 type(63.4%)and 15 cases of gH2 type(36.6%).The overall ratio of males to females was 1.9:1,and there was no significant difference in the gender ratio between the gH1 group and gH2 group(15/11 vs 12/3,P>0.05).There was no significant difference in the age of patients between the gH1 group 3.5(0,15)months and gH2 group 4.0(0,15)months(P>0.05).The gH1 type were more common found in congenital infection,perinatal infection and postnatal infection,but there was no statistical difference in genotype distribution(P>0.05).The rate of complete platelet recovery within 3 months after treatment was lower in gH2(25/26)than in gH1(10/15)(P<0.05).Conclusion The gH1 type is more common in ITP children with HCMV infection,and patients with gH2 HCMV infection are more likely to develop persistent ITP.