新生儿黄疸中不同标本人巨细胞病毒检测及临床特征

Different specimens of human cytomegalovirus detection and clinical features for neonatal jaundice

目的:分析新生儿黄疸中不同类型标本人巨细胞病毒(HCMV)的检测结果;研究HCMV感染性新生儿黄疸的临床治疗情况。方法:选取2018年2月至2019年2月庆阳市人民医院住院的病理性黄疸新生儿300例,用实时荧光定量PCR(RT-FQ-PCR)方法检测患儿血浆、外周血单个核细胞(PBMC)、尿液HCMV-DNA及母乳HCMV-DNA,ELISA方法检测患儿血清HCMV-IgM和IgG,并用熊去氧胆酸片联合蓝光照射对症治疗,同时收集病理性黄疸患儿的临床数据和肝功能指标,对所有数据进行统计学分析。结果:300例黄疸患儿中,感染HCMV的为40例(13.33%),其中血浆HCMV-DNA阳性12例(4.00%),PBMC HCMV-DNA阳性20例(6.67%),尿液HCMV-DNA阳性30例(10.00%),母乳HCMV-DNA阳性138例(46.00%),血清HCMV-IgM阳性13例(4.33%),HCMV-IgG阳性228例(80.85%)。新生儿黄疸组血浆、PBMC、尿液、母乳HCMV-DNA及血清HCMV-IgM的阳性率显著高于正常对照组(P<0.05)。HCMV感染组治疗后TBil、DBil、TBA、γ-GGT、AST、CK、CK-MB均有不同程度的降低,与对照组比较差异均有统计学意义(P<0.05)。结论:新生儿病理性黄疸与HCMV感染密切相关;母乳HCMV-DNA阳性率最高,其次为尿液;熊去氧胆酸片联合蓝光照射对HCMV感染性新生儿黄疸有良好的治疗效果。

Objective:To analyze the different specimens results of human cytomegalovirus (HCMV) infection,and study the clinical treatment of HCMV positive infant in neonatal jaundice.Methods:Select in February 2018 to February 2019 of Qingyang City People′s Hospital of pathological jaundice infants,300 cases,with fluorescent quantitative polymerase chain reaction to detect the neonatal plasma,peripheral blood mononuclear cell (PBMC),urine HCMV-DNA and breast milk HCMV-DNA;ELISA method to detect neonatal serum HCMV-IgM and IgG.Ursodeoxycholic tablets and blue light symptomatic treated the neonatal,and collected the clinical data and pathological jaundice patients liver function indicators,and to all the data for statistical analysis.Results:Among the 300 children with jaundice,40(13.33%) were infected with HCMV,among which 12(4.00%) were positive for plasma HCMV-DNA,20(6.67%) were positive for PBMC HCMV-DNA,30(10.00%) were positive for urine HCMV-DNA,138(46.00%) were positive for breast milk HCMV-DNA,13(4.33%) were positive for serum HCMV-IgM,and 228(80.85%) were positive for HCMV-IgG.The positive rates of plasma,PBMC,urine,breast milk HCMV-DNA and serum HCMV-IgM in the neonatal jaundice group were significantly higher than those in the normal control group,with statistically significant differences (P<0.05).After treatment,TBil,DBil,TBA,gamma-GGT,AST,CK and CK-MB were all reduced in the HCMV infection group,and the differences were statistically significant compared with the control group (P<0.05).Conclusion:Neonatal pathological jaundice is closely related to HCMV infection.The positive rate of HCMV-DNA in breast milk was the highest,followed by urine.Ursodeoxycholic tablets combined with blue light irradiation have a good therapeutic effect on neonatal jaundice caused by HCMV infection.