早产儿坏死性小肠结肠炎与人巨细胞病毒感染的相关性研究

摘要

目的 探讨早产儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)的发生、发展、预后与人巨细胞病毒(human cytomegalovirus,HCMV)感染的关系.方法 103例早产儿坏死性小肠结肠炎(NEC)分为:NECⅠ组(NECⅠ期,n=35)、NECⅡ组(NECⅡ期,n=38)、NECⅢ期组(NECⅢ期,n=30),选取同期健康的30例正常早产儿为对照组.检测所有研究对象的HCMV-PP65抗原及HCMV-IgG与HCMV-IgM抗体;根据NEC患儿的预后分为死亡组与存活组并进行分析.结果 4组中HCMV-PP65、HCMV-IgM与HCMV-IgM/IgG阳性率在NECⅢ组最高,在对照组最低(P<0.05);HCMV-IgM/IgG阴性率及HCMV-IgG阳性率在对照组最高,在NECⅢ组最低(P<0.05).HCMV-PP65阳性率与HCMV-IgM/IgG阳性率在对照组、NECⅠ组、NECⅡ组及NECⅢ组有升高的趋势,HCMV-IgM/IgG阴性率则有降低的趋势(P<0.05).4组 HCMV-PP65阳性率、HCMV-IgM/IgG阴性率、HCMV-IgM阳性率、HCMV-IgG阳性率与HCMV-IgM/IgG阳性率差异均有统计学意义(P<0.05).存活82例,死亡21例,单因素和多因素Logistic回归分析表明:HCMV-IgG阳性、HCMV-IgM/IgG阴性为NEC患儿预后的保护因素(P<0.05),HCMV-PP65阳性、HCMV-IgM阳性、HCMV-IgM/IgG阳性是NEC患儿预后的危险因素(P<0.05).结论 巨细胞病毒感染可能是早产儿坏死性小肠结肠炎发生、发展及不良预后重要因素.%Objective To investigate the correlation between pathogenesis,progression and prognosis of necrotizing enterocolitis (NEC) in preterm infants and human cytomegaloviru(HCMV)infection. Methods A total of 103 premature infants with NEC were divided into three groups;NEC stageⅠgroup(n=35),NEC stageⅡgroup(n=38) and NEC stageⅢ group (n=30),at the same time,the other 30 healthy preterm infants were served as control group.HCMV PP65 antigen and HCMV-IgG,HCMV-IgM antibody were detected.Moreover these premature infants with NEC were redivided into death group and survival group according to the prognosis of patients.Results The positive rates of HCMV-PP65,HCMV-IgM and HCMV-IgM/IgG in NEC stage Ⅲ group were the highest among the four groups,and which were the lowest in control group (P<0.05).However the negative rate of HCMV-IgM/IgG and the positive rate of HCMV-IgG were the highest in control group,which were the lowest in NEC stageⅢgroup(P<0.05). The positive rates of HCMV-PP65 and HCMV-IgM/IgG had an increase tendency in control group,NEC stageⅠgroup,NEC stageⅡgroup and NEC stageⅢ group,however,the negative rate of HCMV-IgM/IgG had a decrease tendency in the four groups (P <0.05). There were significant differences in the spositive rates of HCMV-PP65,HCMV-IgM,HCMV-IgG,HCMV-IgM/IgG and negative rate of HCMV-IgM/IgG among the four groups (P<0.05).Moreover 82 patients were survived and 21 patients died.The single factor and multiple factors Logistic regression analysis showed that positive HCMV IgG and negative HCMV IgM/IgG were protective factors of prognosis of premature infants with NEC (P<0.05). However positive HCMV-PP65,positive HCMV-IgM and HCMV-IgM/IgG were risk factors of premature infants with NEC(P<0.05).Conclusion HCMV infection may play an important role in pathogenesis, progression and poor prognosis of preterm infants with NEC.