新生儿巨细胞病毒感染与肝炎综合征的临床特点及预后比较

Comparison of clinical features and prognosis between neonatal cytomegalovirus infection and hepatitis syndrome

目的对比分析新生儿巨细胞病毒(CMV)感染与肝炎综合征(IHS)的临床特征及临床预后。方法收集2018年1月至2020年12月期间滨州市第二人民医院收治的单纯CMV感染患儿58例,IHS患儿58例(含17例非CMV感染IHS患儿,41例CMV感染IHS患儿),另选健康新生儿58名。比较各组的一般临床资料、临床表现、血清CMV-IgM及尿CMV DNA、TBil、γ-GT、ALT、AST和Alb水平。结果IHS组的黄疸、淋巴结肿大及肝、脾肿大分别为54例(93.10%)、15例(25.86%)、47例(81.03%)、41例(70.69%),高于CMV组的29例(50.00%)、3例(5.17%)、12.07%、7例(10.34%)(P<0.05),且CMV-IHS组的黄疸及脾肿大率高于NCMV-IHS组(P<0.05)。IHS组的CMV-IgM和CMV DNA阳性率分别为21例(36.21%)、41例(70.69%),CMV组为26例(44.83%)、49例(84.48%),均显著高于NC组的1例(1.72%)和1例(1.72%)(P<0.05)。CMV组和IHS组的TBil、γ-GT、ALT及AST均高于NC组,且IHS组高于CMV组(P<0.05);IHS组的Alb低于CMV组及NC组(P<0.05)。CMV-IHS组的ALT为(127.85±36.79)U/L,显著高于NCMV-IHS组的(106.01±31.03)U/L,而Alb为(34.93±3.02)g/L,低于NCMV-IHS组的(39.19±3.59)g/L(P<0.05)。CMV组和IHS组分别58例(100.00%)、57例(98.28%)治愈出院。随访6个月,CMV-IHS组5例(12.50%)IHS复发,而NCMV-IHS组无复发,两组间差异有统计学意义(P<0.05)。结论单纯CMV感染缺乏典型症状,IHS主要临床表现为黄疸、肝脾肿大等,且CMV感染可诱发IHS,患儿的整体预后较好,但CMV感染可能增加IHS复发风险。

Objective To compare and analyze the clinical features and prognosis of neonatal cytomegalovirus(CMV)infection and infant hepatitis syndrome(IHS).Methods From January 2018 to December 2020,58 newborns with simple CMV infection(CMV group),58 with IHS(IHS group)were enrolled.Among the newborns with IHS,17 IHS newborns with non-CMV infection were collected as NCMV-IHS group,41 IHS newborns with CMV infection were selected as the CMV-IHS group,and 58 healthy newborns were selected as the normal control group(NC group).The general clinical data,clinical manifestations,serum CMV-IgM and urine CMV-DNA test results of each group were compared,the serum total bilirubin(TBIL),γ-glutamyl transpeptidase(γ-GT),alanine aminotransferase(ALT),aspartate aminotransferase(AST)and albumin(Alb)levels of each group were detected and compared.Results The ratios of jaundice,lymphadenopathy,hepatomegaly and splenomegaly in the IHS group were 93.10%,25.86%,81.03%,and 70.69%,respectively,which were higher than 50.00%,5.17%,12.07%,and 10.34%in the CMV group(P<0.05),and the ratios of jaundice and splenomegaly in the CMV-IHS group were higher than those in the NCMV-IHS group(P<0.05).The positive rates of CMV-IgM and CMV-DNA in the IHS group were 36.21%and 70.69%,respectively,and those in the CMV group were 44.83%and 84.48%,which were significantly higher than the 1.72%and 1.72%in the NC group(P<0.05).The serum levels of TBIL,γ-GT,ALT and AST in CMV group and IHS group were higher than those in the NC group,and these in IHS group were higher than those in CMV group(P<0.05);serum level of Alb in IHS group was lower than that in the CMV group and NC group(P<0.05).The ALT of the CMV-IHS group was(127.85±36.79)U/L,significantly higher than(106.01±31.03)of the NCMV-IHS group,while the Alb was(34.93±3.02)g/L in the CMV-IHS group,which was lower than(39.19±3.59)g/L of the NCMV-IHS group(P<0.05).58 cases(100.00%)and 57 cases(98.28%)in the CMV group and IHS group were cured and discharged.After 6 months of follow-up,5 cases(12.50%)in the CMV-IHS group had IHS recurrence,there was no recurrence in the NCMV-IHS group,the difference between the two groups was statistically significant(P<0.05).Conclusion Simple CMV infection lacks typical symptoms,while IHS infants have the main clinical manifestations including jaundice,hepatosplenomegaly,and CMV infection can induce IHS.The overall prognosis of neonatal CMV and IHS is good,but CMV infection may increase the risk of IHS recurrence.