胆道闭锁婴儿嗜肝病毒和非嗜肝病毒感染情况

摘要

目的 探讨胆道闭锁(BA)婴儿嗜肝病毒和非嗜肝病毒感染情况,分析各种病毒感染与BA发生发展的关系.方法 收集2010年1月1日至2014年12月31日广州市妇女儿童医疗中心收治的184例BA婴儿的病历资料和病原学检测结果,分析3类嗜肝病毒即甲肝病毒(HAV)、乙肝病毒(HBV)、戊肝病毒(HEV)和5类非嗜肝病毒即巨细胞病毒(CMV)、EB病毒(EBV)、单纯疱疹病毒(HSV)、肠道病毒(EV)、柯萨奇病毒(Cox)感染情况;选用同期门诊和住院非BA的无免疫缺陷患儿结果作对照.结果 BA患儿3种嗜肝病毒(HAV、HBV、HEV)和5种非嗜肝病毒(CMV、EBV、HSV、EV、Cox)中,以CMV检出率最高(40.21%,39/97例),HBV、HEV、EBV、HSV、EV、Cox检出率均较低,9例存在病毒混合感染;BA患儿检出的主要感染病原体CMV IgM 阳性率[34.94%(29/83例)]显著高于对照组患儿[15.69%(8/51例)],差异有统计学意义(x2=5.86,P<0.05);CMV DNA定量检出率[28.57%(20/70例)]显著高于对照组患儿[3.70%(1/27例)],差异有统计学意义(x2=7.10,P<0.05);≤60 d组与>60 d组BA患儿CMV DNA检出率比较差异有统计学意义[45.45%(15/33例)比25.48%(5/37例),x2=8.72,P<0.01],但CMV IgM阳性率在≤60 d组、60～90 d组及≥90 d组比较差异无统计学意义[47.22%(17/36例)比20.00%(6/30 例)比35.29%(6/17 例),x2=5.62,P>0.05];CMV DNA检出组与未检出组BA患儿检测龄差异无统计学意义(P>0.05).CMV DNA和CMV IgM 2种方法检测一致性较差(Kappa值<0.4).结论 BA患儿CMV感染率高,≤60 d的小婴儿CMV DNA检出率最高,各年龄段患儿CMV IgM阳性率无明显差异,不支持CMV是BA的继发感染,CMV可能参与BA的发生发展.%Objective To explore the infection rate of hepadnaviruses and non-hepatotropic virus in infants with biliary atresia(BA)and their relationship between the onset and development of BA.Methods The data and pathogen test records from 184 BA infants who were hospitalized at Guangzhou Women and Children's Medical Center from January 1,2010 to December 31,2014 were reviewed,and the infection rates caused by 3 hepadnaviruses including hepatitis A virus(HAV),hepatitis B virus(HBV),hepatitis E virus(HEV)as well as 5 non-hepatotropic viruses including cytomegalovirus(CMV),Epstein-Barr virus(EBV),herpes simplex virus(HSV),enterovirus(EV),Coxsackie-virus were analyzed.The outpatients or inpatients without BA and immunodeficiency were selected as controls.Results In BA patients,the infection rates of CMV were highest(40.21％,39/97 cases)caused by 3 hepadnaviruses(HAV,HBV,HEV)and 5 non-hepatotropic viruses(CMV,EBV,HSV,EV,Cox),while the infection rates of HAV,HEV,HBV,EBV,HSV,EV or Coxsackievirus were all low,and mixed virus infection was found in 9 patients.The positive rate of CMV IgM in BA group[34.94％(29/83 cases)] was significantly higher than that in the control group[15.69％(8/51 cases)],and the difference was statistically significant(x2=5.86,P<0.05);and the positive rate of CMV DNA in BA group[28.57％(20/70 cases)] was significantly higher than that in the control group[3.70％(1/27 cases)],and the difference was statistically significant(x2=7.10,P<0.05).In BA infants under 60 days,the detection rate of CMV DNA was 45.45％(15/33 cases),which was higher than that in the ones over 60 days[25.48％(5/37 cases)],and the difference was statistically significant(x2=8.72,P<0.01);while the positive rate of CMV IgM had no significant difference among≤60 d group,60-90 d group and ≥90 d group[47.22％(17/36 cases),20.00％(6/30 cases),35.29％(6/17 cases)](x2=5.62,P>0.05).No statistical difference in age was found in BA patients on detection between the positive and the negative group,and the consistency of CMV DNA and CMV IgM was not ideal(Kappa value<0.4).Conclusions Infection of CMV is quite common in BA patients,BA infants under 60 days old show higher detection rate of CMV DNA than the older ones,but there is no difference in detection rate of CMV IgM among different ages,CMV is not supported as a secondary infection and may play a role in the occurrence and development of BA.