巨细胞病毒感染与胆道闭锁Kasai手术预后的关系

目的探讨巨细胞病毒感染与胆道闭锁预后的关系。方法回顾性分析2013年1月至2014年8月我们收治的87例胆道闭锁病例,根据巨细胞病毒IgM抗体的测定结果分为阴性组55例和阳性组32例,分析术中肝活检组织的病理结果,AST与血小板比值指数(APRI),术后黄疸清除率和生存时间,比较其差异。结果术前两组年龄、总胆红素、ALT、AST和GCT比较,差异无统计学意义(P值均0.05)。术中肝活检病理结果根据Ohkuma Y分级,阴性组肝纤维化程度低于阳性组(P=0.002);两组APRI比较,术前差异无统计学意义(P=0.615),术后阳性组活动性肝纤维化占40.6%(13例),高于阴性组(11例,占20.0%),P=0.048;术后6个月阳性组黄疸清除率62.5%,阴性组78.2%,差异无统计学意义(P=0.139);两组累计生存率经log-rank检验比较,阴性组高于阳性组(P=0.034)。结论巨细胞病毒感染可能加重肝纤维化程度,影响胆道闭锁患儿的预后。

Relationship between cytomegalovirus infection and prognosis of biliary atresia after kasai operation

Objetive To investigate the relationship between cytomegalovirus infection and prognosis of biliary atresia.Methods A retrospective analysis was made on 87 cases of biliary atresia from Aug.2014 to Jan.2013.According to the test results of cytomegalovirus-IgMantibody,all the cases were divided into negative group (55 cases)and positive group (32 cases).Results Comparing the two groups,there was no significant difference in age (99.75 ±31.71 d ,101.34 ±33.70 d,P =0.830);or in TBILs (180.42 ±89.94 μmol/L, 191.81 ±91.48 μmol/L,P =0.58).According to Ohkuma Y the pathological results of liver biopsies were gra-ded from Ⅰ to Ⅳ.In negative group :22cases were classified into Grade Ⅰ,18 cases into GradeⅡ,11 cases into Grade Ⅲ,4 cases into Grade Ⅳ;in positive group :4 cases were classified into GradeⅠ,11 cases into GradeⅡ,10 cases into GradeⅢ,7 cases into GradeⅣ.The degree of liver fibrosis in the negative group was lower than that in the positive group,P =0.002 .In the negative group,the serum TBIL after operation was 28.3 (1 1 .2 ,55 .7 )μmol /L,vs.positive group 17 .3 (12 .2 ,46 .7 )μmol /L.There was no significant difference between the two groups,P =0.785 .The cumulative survival rate of the two groups was compared with the log-rank test,and the negative group was higher than that of the positive group,P =0.034. Conclusions The infection of CMV may aggravate the degree of liver fibrosis,and be a prognostic factor of bili-ary atresia.