目的 研究围生期巨细胞病毒(CMV)感染的的发病情况、临床特征、治疗及影响更昔洛韦疗效的因素。方法 回顾性分析2008~2012年237例临床诊断为围生期CMV感染的住院患儿的临床资料。结果 5年间围生期CMV感染患儿基本特征及占同期总住院患儿的比例无明显差异。患儿多为2个或2个以上系统受累,CMV肝炎合并CMV肺炎(43.1%)为最常见的临床类型。病原学检测结果提示血CMV-IgM及血/尿CMV-DNA均阳性为3.8%,仅血CMV-IgM阳性为90.3%,仅血/尿CMV-DNA阳性为5.9%。197例患儿接受了更昔洛韦治疗,治愈率为88.3%。母孕史异常(OR=6.191,95% CI:1.597~24.002)和用药前患儿肝脏受累(OR=3.705,95% CI:1.537~8.931)是影响更昔洛韦对围生期CMV感染患儿疗效的独立危险因素。结论 围生期CMV感染近5年的流行病学特征较为稳定。CMV常侵犯多个脏器或系统,以肝肺损害最常见。更昔洛韦治疗围生期CMV感染疗效明显;母孕史异常和用药前患儿肝脏受累会增加围生期CMV患儿对更昔洛韦耐药的风险。
Abstract
Objective To investigate the incidence, clinical features, and treatment of perinatal cytomegalovirus(CMV) infection, as well as the factors affecting the therapeutic effect of ganciclovir.Methods The clinical data of 237 infants who were hospitalized and diagnosed with perinatal CMV infection from 2008 to 2012 were retrospectively analyzed.Results The clinical features of infants with perinatal CMV infection and the proportion of such infants in all hospitalized infants showed no significant differences across the five years.In most infants, two or more systems were involved, and CMV hepatitis plus CMV pneumonia was most common(43.1%).The results of pathogen detection showed that the percentage of the infants with positive blood CMV-IgM and blood/urine CMV-DNA was 3.8%, while 90.3% of all infants had positive blood CMV-IgM alone and 5.9% had positive blood/urine CMV-DNA alone.A total of 197 infants were treated with ganciclovir, and the cure rate was 88.3%.An abnormal history of pregnancy(OR=6.191, 95% CI:1.597-24.002) and liver involvement before medication(OR=3.705, 95% CI:1.537-8.931) were the independent risk factors affecting the therapeutic effect of ganciclovir in infants with perinatal CMV infection.Conclusions The epidemiological characteristics of perinatal CMV infection have remained generally stable for the last 5 years.CMV often involves several organs or systems, especially the liver and lung.Ganciclovir has a significant efficacy in the treatment of perinatal CMV infection, and an abnormal history of pregnancy and liver involvement before medication can increase the risk of ganciclovir resistance in infants with perinatal CMV infection.
关键词
巨细胞病毒感染 /
更昔洛韦 /
婴儿
Key words
Cytomegalovirus infection /
Ganciclovir /
Infant
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 北京地区母婴巨细胞病毒感染调查协作组. 北京地区母婴巨细胞病毒感染状况调查[J]. 中华围产医学杂志, 2012, 15(8):459-461.
[2] 中华医学会儿科学分会感染学组; 全国儿科临床病毒感染协作组; 《中华儿科杂志》编辑委员会. 儿童巨细胞病毒性疾病诊断和防治的建议[J]. 中华儿科杂志, 2012, 50(4):290-292.
[3] 董永绥, 方峰. 巨细胞病毒感染[M]//胡亚美, 江载芳. 诸福棠实用儿科学(上册). 第7版. 北京:人民卫生出版社, 2002:816-821.
[4] 于四景, 李双杰, 肖耿吉, 等. 更昔洛韦治疗巨细胞病毒感染疗程的随机对照研究[J]. 实用预防医学, 2013, 20(4):467-470.
[5] 沈玲云, 蒋琼俏. 更昔洛韦治疗儿童巨细胞病毒感染两组方案的比较[J]. 现代医药卫生, 2007, 23(7):989.
[6] 王丽, 钱继红, 张拥军, 等. 人巨细胞病毒肝炎综合征婴儿外周血宿主microRNA表达的变化[J]. 中华实用儿科临床杂志, 2013, 28(10):737-740.
[7] Swanson EC, Schleiss MR. Congenital cytomegalovirus infection:new prospects for prevention and therapy[J]. Pediatr Clin North Am, 2013, 60(2):335-349.
[8] Ivanov IS, Popov NI, Moshe RI, et al. Prevalence of cytomegalovirus infection in hospitalized infants[J]. Folia Med(Plovdiv), 2012, 54(4):45-52.
[9] Narvaez-Arzate RV, Olguin-Mexquitic L, Lima-Rogel V, et al. Cytomegalovirus infection in infants admitted to a neonatal intensive care unit[J]. J Matern Fetal Neonatal Med, 2013, 26(11):1103-1106.
[10] Naing Z, Rayner B, Killikulangara A, et al. Prevalence of viruses in stool of premature neonates at a neonatal intensive care unit[J]. J Paediatr Child Health, 2013, 49(3):E221-E226.
[11] Pereira L, Petitt M, Fong A, et al. Intrauterine growth restriction caused by underlying congenital cytomegalovirus infection[J]. J Infect Dis, 2014, 209(10):1573-1584.
[12] Hasosah MY, Kutbi SY, Al-Amri AW, et al. Perinatal cytomegalovirus hepatitis in Saudi infants:a case series[J]. Saudi J Gastroenterol, 2012, 18(3):208-213.
[13] Cybulska P, Ni A, Jimenez-Rivera C. Viral hepatitis:retrospective review in a canadian pediatric hospital[J]. ISRN Pediatr, 2011, 2011:Article ID 182964, 4 pages.
[14] Bale JF Jr. Fetal infection and brain development[J]. Clin Perinatol, 2009, 36(3):639-653.
[15] Suzuki Y, Toribe Y, Mogami Y, et al. Epilepsy in patients with congenital cytomegalovirus infection[J]. Brain Dev, 2008, 30(6):420-424.
[16] White AL, Hedlund GL, Bale JF Jr. Congenital cytomegalovirus infection and brain clefting[J]. Pediatr Neurol, 2014, 50(3):218-223.
[17] Waters A, Jennings K, Fitzpatrick E, et al. Incidence of congenital cytomegalovirus infection in Ireland:implication for screening and diagnosis[J]. J Clin Virol, 2014, 59(3):156-160.
[18] Lazzarotto T, Guerra B, Lanari M, et al. New advances in the diagnosis of congenital cytomegalovirus infection[J]. J Clin Virol, 2008, 41(3):192-197.
[19] 杨长仪, 陈涵强, 石惠英, 等. 新生儿先天性巨细胞病毒感染的诊断及治疗探讨[J]. 中华围产医学杂志, 2009, 12(5):359-362.
[20] 王卫, 刘晓红. 更昔洛韦(丽科伟)在先天性巨细胞病毒感染的临床应用[J]. 小儿急救医学, 2002, 9(3):148-150.
[21] 胡劲涛, 陈平洋, 谢宗德, 等. 更昔洛韦治疗先天性巨细胞病毒感染患儿的系统评价[J]. 中国当代儿科杂志, 2010, 12(1):35-39.
[22] Choi KY, Sharon B, Balfour HH Jr, et al. Emergence of antiviral resistance during oral valganciclovir treatment of an infant with congenital cytomegalovirus(CMV) infection[J]. J Clin Virol, 2013, 57(4):356-360.
[23] Fischer L, Laib Sampaio K, Jahn G, et al. Generation and characterization of a GCV resistant HCMV UL97-mutation and a drug sensitive UL54-mutation[J]. Antiviral Res, 2013, 100(3):575-577.
基金
上海市教育委员会科研创新项目资助(14ZZ10B)。
PDF(928 KB)
