婴儿胆汁淤积性肝病综合征119例人巨细胞病毒检测的意义  

Significance of Human Cytomegalovirus Detection in 119 Infantile Cholestasis Syndrome

作　　者：王燕[1] 闫慧敏[2] 张辉[1] 么远[2] 胡燕[2] 闫静[1] 谢正德[1] 

机构地区：[1]首都医科大学附属北京儿童医院北京市儿科研究所病毒研究室,北京100045 [2]首都医科大学附属北京儿童医院内科综合病房,北京100045

出　　处：《实用儿科临床杂志》2009年第7期511-512,共2页Journal of Applied Clinical Pediatrics

基　　金：北京市中医药科技项目资助(JJ-2006-58)

摘　　要：目的探讨人巨细胞病毒感染(CMV)与婴儿胆汁淤积性肝病综合征的关系,以及血清学和分子生物学方法在诊断CMV感染中的作用。方法婴儿胆汁淤积性肝病综合征住院患儿119例。男71例,女48例;年龄1～7个月,平均2个月。分别在入院时采集急性期和出院时采集恢复期血清进行抗人CMV-IgM抗体和人CMV DNA检测。血清中抗人CMV-IgM抗体检测应用间接ELISA法;应用实时荧光定量PCR检测方法检测血清中人CMVDNA拷贝数。结果婴儿胆汁淤积性肝病综合征患儿119例中,人CMV感染63例,阳性率为52.9%(63/119例)。CMV感染阳性病例中,血清学方法共诊断52例,其中单份急性期血清抗人CMV-IgM抗体检测阳性47例;双份血清抗人CMV-IgM抗体由阴性转为阳性5例;通过荧光定量PCR检测诊断CMV感染11例(血清抗人CMV-IgM抗体检测阴性,血清CMVDNA检测阳性),占CMV感染病例的17.5%(11/63例)。119例患儿中,27例入院时荧光定量PCR检测CMVDNA阳性,其中16例患儿同时抗人CMV-IgM抗体检测阳性、11例血清抗人CMV-IgM抗体检测阴性;出院时15例患儿检测CMVDNA均为阴性。CMVDNA阳性患儿血清中CMVDNA平均拷贝数为1.96×106(6.15×105～8.76×106)拷贝/L。结论婴儿胆汁淤积性肝病中CMV感染较为常见,病毒感染诊断的确立要充分考虑血清学和分子生物学方法各自的局限性,二者可互为补充。Objective To investigate the relationship between human cytomegalovirus（CMV） and infantile cholestasis syndrome and the role that serological assay and molecular diagnostic methods play in diagnosis of CMV infection. Methods One hundred and nineteen cases of infantile cholestasis syndrome were enrolled in this study with 71 male and 48 female, whose average age was 2 months, ranging from 1 - 7 months. Both acute serum and convalescent serum were collected for detection of IgM anti - CMV and CMV DNA. Indirect enzyme linked immunosorbent assay was used to detect IgM anti - CMV in serum. Copies of CMV DNA in serum were detected by real - time fluorescent quantitative polymerase chain reaction （PCR）. Results Among 119 cases of infantile cholestasis syndrome,63 cases were positive of CMV, and the positive rate was 52.9% （63/119 ）. Among these positive cases ,52 were confirmed by detection of IgM anti - CMV in acute and convalescent se-rum,which including 47 cases with single serum masculine and 5 cases with paired serum negative. Eleven cases （ 11/63,17.5% ） were diagnosed by real - time fluorescent quantitative PCR with negative of IgM anti - CMV in acute and convalescent serum. Of all 119 cases,27 cases were positive of CMV DNA in serum when admitted and 16 cases were positive of IgM anti - CMV and 11 cases were negative of IgM anti - CMV at the same time. Convalescent serum from 15 cases were all negative of CMV DNA. Average copies of CMV DNA in serum were 1.96×10^6（6.15×10^5～8.76×10^6） copies/L. Conclusions Human CMV infection is common in infantile cholestasis syndrome. Both serum assay and molecular diagnostic method are limited to diagnose human CMV infection. Serum assay and molecular diagnostic method can complement each other.

关 键 词：胆汁淤积性肝病综合征 人巨细胞病毒 婴儿 

分 类 号：R725.7[医药卫生—儿科]