慢性重型乙型肝炎患者人巨细胞病毒感染及特性分析  

Human cytomegalovirus infection in patients with chronic severe hepatitis B and clinical characterization analysis

作　　者：陈茂[1] 但芸婕[1] 周依[1] 何韦韦 谭文婷[1] 郭衍志 邓国宏[1] 

机构地区：[1]第三军医大学西南医院全军感染病研究所,感染病研究重庆市重点实验室,重庆400038

出　　处：《第三军医大学学报》2014年第4期386-390,共5页Journal of Third Military Medical University

基　　金：“十二五”国家科技重大专项(2012ZX10002007-002-005);全军后勤科研“十二五”计划重大项目(AWS11C001);第三军医大学临床科研重大专项(2012XLC05)~~

摘　　要：目的研究慢性重型乙型肝炎(chronic severe hepatitis B,CSH)患者人巨细胞病毒(human cytomegalovirus,HCMV)感染特征及基因型分布情况。方法对2011年4月至2012年12月西南医院感染科住院并诊断为慢性重型乙型肝炎患者132例进行血清HCMV抗体检测,巢式PCR法扩增外周血HCMV DNA(gB基因片段)。HCMV IgM或DNA任一阳性定义为HCMV活化,依据结果分为无HCMV活化组(122例)和HCMV活化组(10例),分析2组患者临床特征、gB基因型并构建序列进化树。结果①患者HCMV IgG及IgM阳性率分别为100%与3.78%。2组AFP中位值分别为101.75和27.19,差异有统计学意义(P=0.024),其余实验室检查指标差异无统计学意义。无HCMV活化组,男女比例为7.7∶1,死亡2例,前者死于严重的并发症和多种病原体混合感染,后者死于多种并发症和心力衰竭;HCMV活化组(10例),男女比例为4∶1,无死亡病例,其自发性腹膜炎、腹水、肝性脑病、肝肾综合征比率均比无HCMV活化组高;②2组患者MELD评分无显著性差异(P=0.783),无HCMV活化组AFP水平显著高于HCMV活化组(P<0.05);③HCMV DNA阳性率5.3%(7/132),其中gB1型占85.71%(6/7),gB3型占14.29%(1/7),未检测到gB2型和gB4型。HCMV IgM和DNA均阳性2例。结论 CSH患者HCMV DNA检出率高于血清IgM检出率,HCMV基因型以gB1型为主,存在较低比例的HCMV活化,CSH患者发生HCMV活化可能会影响疾病的转归。Objective To study the clinical characteristics of the patients with chronic severe hepatitis B （CSH） and human cytomegalovirus （HCMV） infection, and the distribution of HCMV genotypes.Methods We examined the serum HCMV of 132 patients with CSH diagnosed by our hospital among March, 2011 and December, 2012, and used nested PCR to amplify the DNA of the peripheral blood mononucleated cell （PBMC） of these patients. Either anti-HCMV IgM positive or HCMV DNA positive was determined as HCMV reactive infection and the patients were then classified into the group of CSH without HCMV activation （n=122） and the group of CSH with HCMV activation （n=10）. We analyzed the clinical characteristics of the two groups and their HCMV gB genotypes and constructed a phylogenetic tree accordingly.Results （1） In the 132 CSH patients, the positive rate of anti-HCMV IgG and anti-HCMV IgM were 100% and 3.78% （5/132）, respectively. The group of CSH without HCMV activation had the ratio of male to female of 7.7∶1 and two deaths （one case of severe complications and a variety of mixed infection of pathogens and the other case of multiple complications and heart failure）. The group of CSH with HCMV activation had a male to female ratio of 4∶1 and no death, with higher incidence rates of spontaneous bacterial peritonitis, ascites, hepatic encephalopathy, and hepatorenal syndrome than the group of CSH without HCMV activation. （2） The MELD scores of the two groups were not significantly different （P=0.783）. The AFP level of the group of CSH without HCMV activation was significantly higher than that of the group of CSH with HCMV activation （median value 101.75 vs 27.19, P=0.024）. （3） HCMV DNA positive rate was 5.3% （7/132）, in which gB1 accounted for 85.71% （6/7） and gB3 14.29% （1/7）, with no detection of gB2 or gB4. Both anti-HCMV IgM and HCMV DNA were positive in two cases.Conclusion There is a lower proportion of active HCMV infection in the patients with CSH. HCMV DNA detect

关 键 词：人巨细胞病毒 慢性重型乙型肝炎 糖蛋白B 

分 类 号：R195.4[医药卫生—卫生统计学] R512.62[医药卫生—卫生事业管理]