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
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摘要
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.
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.
引文
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[13]中华医学会肝病学分会,中华医学会消化病学分会.常用肝脏生物化学试验的临床意义及评价共识[J].中华肝脏病杂志,2010,18(5):387-393.
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[15]AMERICAN GASTROENTEROLOGICAL ASSOCIATION.American Gastroenterological Association medical position statement:evaluation of liver chemistry tests[J].Gastroenterology,2002,123(4):1364-1366.
[2] ROSS SA,BOPPANA SB.Congenital cytomegalovirus infection:outcome and diagnosis[J].Semin Pediatr Infect Dis,2005,16(1):44-49.
[3]方峰,董永绥,魏晴,等.巨细胞病毒所致婴儿肝脏损害的前瞻性研究[J].中华儿科杂志,1995,33(6):350-351.
[4]董永绥.婴儿胆汁淤积性肝病研究进展及展望[J].中国实用儿科杂志,2013,28(4):241-245.
[5]罗灿,汤柳英,王雄虎,等.乙型肝炎病毒母婴垂直传播影响因素的研究进展[J].中国妇幼卫生杂志,2016,7(6):72-75.
[6]谢新宝,朱启镕,王晓红,等.儿童肝脏酶学异常382例病因分析[J].中国实用儿科杂志,2005,20(11):676-679.
[7]朱朝敏,刘作义.肝脏损害与小儿常见全身感染性疾病[J].实用儿科临床杂志,2005,20(9):837-839.
[8]刘燕琼,秦雪.人巨细胞病毒感染与婴儿肝炎综合征及肝功能损害的相关性研究[J].重庆医学,2014,43(36):4903-4905.
[9]王燕霞.先天性胆总管囊肿的病因、病理及诊断研究现状[J].中国实用儿科杂,1999,14(9):518-519.
[10]卢光全李儒贵谭华炳85例巨细胞病毒感染婴幼儿的临床特点[J].2017,11(3):282-286.
[11]徐新艳,赵艳丰.人巨细胞病毒感染的检测及临床表现分析[J].国际检验医学杂志,2013,21(34):2848-2849.
[12]郭丽丽.重庆地区2008年儿童巨细胞病毒血清流行病学调查与巨细胞病毒性肝炎临床分析[D].重庆:重庆医科大学,2010.
[13]中华医学会肝病学分会,中华医学会消化病学分会.常用肝脏生物化学试验的临床意义及评价共识[J].中华肝脏病杂志,2010,18(5):387-393.
[14]GIANNINI EG,TESTA R,SAVARINO V.Liver enzyme alteration:aguide for clinicians[J].CMAJ,2005,172(3):367-379.
[15]AMERICAN GASTROENTEROLOGICAL ASSOCIATION.American Gastroenterological Association medical position statement:evaluation of liver chemistry tests[J].Gastroenterology,2002,123(4):1364-1366.