230例肝功能异常幼童病因和临床特征分析

Etiology and clinical feature in children with abnormal liver function tests: An analysis of 230 cases

目的 分析一组肝功能异常幼童病因和临床特征。方法 2020年10月~2022年10月我院收治的230例肝功能异常患儿,收集临床资料,分析病因和肝功能异常指标。结果 在230例肝功能异常患儿,婴儿占53.0%,幼儿占24.8%,学龄前儿童占12.6%和学龄儿童占9.6%;临床表现包括发热156例(67.8%),皮疹78例(33.9%),咳嗽66例(28.7%),腹泻33例(14.3%),食欲减退17例(7.4%),恶心呕吐13例(5.7%),皮肤黄染4例(1.7%),精神差4例(1.7%),无明显临床症状15例(6.5%);巨细胞病毒感染42例(53.2%),EB病毒感染22例(27.9%),轮状病毒感染7例(8.9%),肠道病毒感染4例(5.1%),呼吸道合胞病毒感染3例(3.8%),单纯疱疹病毒感染1例(1.3%);败血症4例,支气管炎4例,溶血性链球菌咽炎2例,脑膜炎双球菌脑膜炎1例,小儿肠炎3例;13例(5.7%)为上呼吸道支原体感染;43例(18.7%)为病毒、细菌和支原体混合感染;33例(14.3%)为药物性肝损伤;3例(1.3%)为自身免疫性肝炎;肝豆状核变性7例,糖原累积症3例;35例(15.2%)原因不明;22例学龄儿童血清ALT和AST水平分别为(140.5±37.2)U/L和(131.3±29.7)U/L,显著大于29例学龄前儿童[分别为(92.0±21.6)U/L和(88.6±25.3)U/L,P<0.05]或57例幼儿组[分别为(61.3±19.3)U/L和(60.4±18.1)U/L,P<0.05]或122例婴儿组[分别为(59.4±14.8)U/L和(57.1±14.5)U/L,P<0.05]。结论 婴幼儿肺部和肠道感染会引起短暂的肝功能异常,大多预后良好,应注意筛查和必要的管理。

Objective The aim of this study was to summarize the etiology and clinical feature in 230 children with abnormal liver function tests.Methods The clinical data of 230 children with abnormal liver function tests,who were encountered in our hospital between October 2020 and October 2022,were retrospectively analyzed.The clinical materials were retrieved and analyzed.Results Out of the 230 children with abnormal liver function tests,the infants accounted for 53.0%,the young children for 24.8%,the preschool children for 12.6%and the school-aged for 9.6%;the clinical manifestations included fever in 156 cases(67.8%),rash in 78 cases(33.9%),cough in 66 cases(28.7%),diarrhea in 33 cases(14.3%),anorexia in 17 cases(7.4%),nausea and vomiting in 13 cases(5.7%),jaundice in 4 cases(1.7%),fatigue in 4 cases(1.7%)and without symptoms in 15 cases(6.5%);the CMV infection in 42 cases(53.2%),the EB viral infection in 22 cases(27.9%),the rotavirus infection in 7 cases(8.9%),the enterovirus infection in 4 cases(5.1%),the respiratory syncytial virus infection in 3 cases(3.8%)and the herpes simplex virus infection in 1 case(1.3%);the septicemia in 4 case,the bronchitis in 4 cases,the pharyngitis caused by Hemolytic streptococcus in 2 cases,the Neissria meningitidis meningitis in 1 case,the enteritis in 3 case;the upper respiratory mycoplasma infection in 13 cases(5.7%);the mixed virus,bacteria and mycoplasma infection in 43 cases(18.7%);the drug-induced liver injury in 33 cases(14.3%);the autoimmune hepatitis in 3 cases(1.3%);the Wilson’s disease in 7 cases,the glycogen storage disease in 3 cases;the cryptogenic liver injury in 35 cases(15.2%);serum ALT and AST levels in 22 school-aged children were(140.5±37.2)U/L and(131.3±29.7)U/L,significantly higher than[(92.0±21.6)U/L and(88.6±25.3)U/L,respectively,P<0.05]in 29 preschool children or[(61.3±19.3)U/L and(60.4±18.1)U/L,P<0.05]in 57 young children or[(59.4±14.8)U/L and(57.1±14.5)U/L,P<0.05]in 122 infants.Conclusion The pulmonary and gut infections could lead to transient liver injuries,with good prognosis,and needs careful screening and management.