巨细胞病毒感染对胆道闭锁Kasai手术预后影响的研究  

Prognosis of biliary atresia associated with cytomegalovirus

作　　者：赵一霖 吴晓霞[2] 徐晓丹 詹江华[1] Zhao Yilin;Wu Xiaoxia;Xu Xiaodan;Zhan Jianghua(Department of General Surgery,Municipal Children's Hospital,Tianjin 300134,China;Department of Surgery,Shanxi Children's Hospital,Taiyuan 030013,China)

机构地区：[1]天津市儿童医院普通外科,天津300134 [2]山西省儿童医院外科,太原030013

出　　处：《临床小儿外科杂志》2023年第3期232-237,共6页Journal of Clinical Pediatric Surgery

基　　金：天津市科技局重大专项(21ZXGWSY00070);新疆维吾尔自治区自然科学基金(2022D01A27、2021D01A38);天津大学儿童医院面上项目(Y2020002)

摘　　要：目的探究巨细胞病毒(cytomegalovirus,CMV)感染对胆道闭锁(biliary atresia,BA)患儿Kasai手术预后的影响。方法本研究为回顾性研究,研究对象为2018年1月至2020年12月于天津市儿童医院和山西省儿童医院确诊为BA并行Kasai手术治疗的患儿。根据有无CMV感染,分为CMV阳性组和CMV阴性组;其中CMV阳性组患儿根据抗病毒治疗情况分为治疗组和未治疗组。随访截止日期为2021年10月10日,随访时间2~34个月。收集资料并分析CMV感染对BA患儿Kasai手术后黄疸清除、胆管炎发生情况及自体肝生存情况的影响。结果共纳入91例BA患儿,其中CMV阳性组35例,CMV阴性组56例。CMV阳性组中治疗组26例,未治疗组9例。CMV阳性组较CMV阴性组手术日龄大,差异有统计学意义(P<0.05)。CMV阳性组与CMV阴性组白细胞比例不一致,CMV阳性组肝功能指标天冬氨酸转氨酶(aspartate amino transferase,AST)显著高于CMV阴性组[244.00(195.00,341.00)比185.00(126.25,281.00)],差异有统计学意义(P<0.05)。两组Kasai手术后预后指标黄疸清除率、胆管炎发生率及自体肝生存情况差异均无统计学意义(P>0.05)。CMV感染的BA患儿经抗病毒治疗后早期胆管炎发生率显著降低(11.54%比55.56%,P<0.05)。结论CMV感染对BA患儿Kasai手术后预后无明显影响;CMV感染患儿经抗病毒治疗可减少早期胆管炎发病,这对改善CMV感染的BA患儿预后具有积极意义。Objective To explore the impact of cytomegalovirus(CMV)infection on the prognosis of Kasai operation in children with biliary atresia(BA).Methods From January 2018 to December 2020,91 BA children undergoing Kasai operation at Tianjin Children's Hospital and Shanxi Children's Hospital were divided into two groups of CMV positive(n=35)and CMV negative(n=56).CMV positive children were divided into antiviral treatment and non-treated groups.Follow-ups were conducted for(2-34)months until October 10,2021.The impact of CMV infection on jaundice clearance,cholangitis and autologous liver survival after Kasai operation were examined.Results In CMV positive group,there were 26 cases in treatment group and 9 cases in non-treated group.Operative age was significantly older in positive group.Significant difference existed in proportion of white blood cell(WBC).In positive group,aspartate aminotransferase(AST)spiked sharply[244.00(195.00,341.00)vs.185.00(126.25,281.00),P<0.05].No significant difference existed in jaundice clearance rate,incidence of cholangitis or survival of autologous liver after Kasai operation.The incidence rate of early cholangitis declined markedly after antiviral treatment(11.54%vs.55.56%,P<0.05).Conclusion CMV infection has no significant impact on the prognosis of BA children.And antiviral therapy lowers the incidence of early cholangitis.It hints that antiviral therapy has a positive effect on BA children with CMV infection.

关 键 词：胆道闭锁 巨细胞病毒 预后 黄疸消除 胆管炎 

分 类 号：R726.5[医药卫生—儿科]