围生期巨细胞病毒感染5年临床总结

A 5-year retrospective clinical study of perinatal cytomegalovirus infection

摘要:

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.