婴儿巨细胞病毒肺炎40例临床分析

摘要：目的　探讨婴儿巨细胞病毒（CMV）肺炎的临床特点及诊治方法。方法　选取2005年5月至2006年7月于中国医科大学附属盛京医院小儿呼吸科住院的年龄1个月至1岁肺炎患儿60例,以血清CMV IgM抗体（CMV-IgM）阳性及尿CMV-DNA定量阳性的40例肺炎患儿为观察组;以CMV-IgM及尿CMV-DNA定量均阴性的20例肺炎患儿为对照组;将两组临床资料进行对比分析。结果　观察组较对照组在咳嗽、喘息、呼吸困难的临床表现方面差异无统计学意义（P > 0.05）;观察组肺部的喘鸣音和水泡音等体征少于对照组,差异有统计学意义（P < 0.05）。CMV肺炎的影像学诊断主要依靠肺CT,其敏感度为100％,而肺计算机X线摄影（CR）仅为29.4％。观察组中30例患儿予以更昔洛韦治疗,10例未用;更昔洛韦治疗组22例治愈,治愈率73.3％;未应用更昔洛韦组治愈率20.0％,两组比较有统计学意义（P < 0.05）。结论　婴儿CMV肺炎临床表现缺乏特异性,肺部体征不典型,普通胸片不易发现炎症,容易误诊。对疑诊患儿需及时检测血清CMV-IgM及尿CMV-DNA,及时做肺CT检查;确诊后首选更昔洛韦治疗。     

新生儿先天性巨细胞病毒感染的诊断及治疗探讨

目的 探讨新生儿先天性巨细胞病毒(CMV)感染的主要临床表现、诊断及治疗效果.方法采用酶联免疫吸附试验定量检测血清CMV抗体,用荧光实时定量PCR法检测尿CMV-DNA,2007年1月至2008年12月间共确诊新生儿先天性CMV感染145例,其中的101例症状性感染患儿采用更昔洛韦治疗,观察其疗效及副作用.各指标改善情况的比较采用卡方检验. 结果 症状性CMV感染主要临床表现及实验室指标异常为:病理性黄疸、肝脾肿大、间质性肺炎、皮肤瘀点、吸吮力差、血小板下降、血清谷丙转氨酶增高等.尿CMV-DNA阳性87例(60.0%),血清CMV-IgM阳性43例(29.7%),生后2周内血清IgG增高4倍21例(14.5%);13例(9.0%)患儿尿CMV-DNA阳性或血清CMV-IgM阳性,其血清IgG也比母亲高1倍以上.更昔洛韦治疗后,CMV感染的相关症状及体征和实验室指标得到明显改善.治疗期间副作用较少,主要有粒细胞减少、血小板下降,但未见肝肾功能损害. 结论 新生儿先天性CMV感染可造成多器官系统损害,临床表现多样;实验室依据包括尿CMV-DNA阳性,检测阳性率高;其他依次为血清CMV-IgM阳性及CMV-IgG4倍增高;患儿CMV-IgG比母亲增高1倍以上可能是诊断CMV感染实验室依据之一;更昔洛韦治疗症状性CMV感染效果较好.     

新生儿先天性巨细胞病毒感染的诊断及治疗探讨

目的 探讨新生儿先天性巨细胞病毒(CMV)感染的主要临床表现、诊断及治疗效果.方法采用酶联免疫吸附试验定量检测血清CMV抗体,用荧光实时定量PCR法检测尿CMV-DNA,2007年1月至2008年12月间共确诊新生儿先天性CMV感染145例,其中的101例症状性感染患儿采用更昔洛韦治疗,观察其疗效及副作用.各指标改善情况的比较采用卡方检验. 结果 症状性CMV感染主要临床表现及实验室指标异常为:病理性黄疸、肝脾肿大、间质性肺炎、皮肤瘀点、吸吮力差、血小板下降、血清谷丙转氨酶增高等.尿CMV-DNA阳性87例(60.0%),血清CMV-IgM阳性43例(29.7%),生后2周内血清IgG增高4倍21例(14.5%);13例(9.0%)患儿尿CMV-DNA阳性或血清CMV-IgM阳性,其血清IgG也比母亲高1倍以上.更昔洛韦治疗后,CMV感染的相关症状及体征和实验室指标得到明显改善.治疗期间副作用较少,主要有粒细胞减少、血小板下降,但未见肝肾功能损害. 结论 新生儿先天性CMV感染可造成多器官系统损害,临床表现多样;实验室依据包括尿CMV-DNA阳性,检测阳性率高;其他依次为血清CMV-IgM阳性及CMV-IgG4倍增高;患儿CMV-IgG比母亲增高1倍以上可能是诊断CMV感染实验室依据之一;更昔洛韦治疗症状性CMV感染效果较好.     

更昔洛韦联合丙种球蛋白治疗新生儿巨细胞病毒感染的疗效观察

目的:观察更昔洛韦(GCV)联合丙种球蛋白治疗新生儿巨细胞病毒(CMV)感染的临床效果。方法:选取我院自2007年3月至2010年12月收治的120例巨细胞病毒感染新生儿随机分为治疗组(更昔洛韦联合丙种球蛋白治疗组)和对照组(单纯更昔洛韦治疗组)各60例,比较两组患儿的治疗效果。结果:治疗组治愈48例,有效11例,总有效率为98.3%;对照组治愈32例,有效19例,总有效率为85.0%。两组患者总有效率比较差异显著(P<0.01),具有统计学意义。两组患儿均为出现明显不良反应症状。结论;更昔洛韦联合丙种球蛋白治疗新生儿巨细胞病毒感染效果理想,值得推广应用。     

更昔洛韦治疗不孕不育妇女巨细胞病毒感染的疗效观察

目的分析更昔洛韦治疗不孕不育妇女巨细胞病毒(CMV)感染的疗效。方法选取我院妇产科2010年1月~2015年1月收治的CMV感染的不孕不育妇女56例作为研究对象,将其随机分成试验组与对照组,各28例。试验组采用注射用更昔洛韦治疗,对照组采用抗巨细胞病毒的免疫球蛋白制剂治疗,对两组妇女的临床表现及疗效进行观察。结果采用更昔洛韦治疗后,CMV-DNA及CMV-Ig M转阴率明显升高,差异有统计学意义(P0.05);受孕率明显升高,差异有统计学意义(P0.05)。结论更昔洛韦治疗不孕不育妇女CMV感染的疗效显著,安全性较高,值得临床推广与应用。     

中西医结合治疗小婴儿巨细胞病毒性肝炎51例疗效观察

目的观察茵栀黄口服液联合更昔洛韦治疗小婴儿巨细胞病毒性(CMV)肝炎的临床疗效。方法 51例患儿按入院时间次序分为对照组19例和观察组32例,对照组给予更昔洛韦5mg/kg静脉滴注,每日2次,连用14d;观察组在此基础上加用茵栀黄口服液每次5mL,每日3次,连用14d。两组均给予常规保肝治疗。观察治疗前后黄疸、肝脾增大等临床表现;血巨细胞病毒抗体IgM、尿巨细胞病毒DNA拷贝数、肝功:血清谷丙转氨酶(ALT)、血清谷草转氨酶(AST)、血清总胆红素(TBIL)、血清直接胆红素(DBIL)的改变。结果观察组治疗后TBIL与DBIL、ALT与AST较对照组下降显著;尿CMV-DNA转阴率较对照组高;差异均有统计学意义(P0.05)。血CMV-IgM转阴率与对照组比较差异无统计学意义。结论茵栀黄口服液联合更昔洛韦治疗CMV肝炎在退黄、降酶、保肝、病毒转阴等方面均具有明显疗效,值得临床推广应用。     

中医辨证论治配合更昔洛韦治疗婴儿巨细胞病毒肺炎疗效观察

目的观察中医辨证论治配合更昔洛韦治疗婴儿巨细胞病毒肺炎的临床疗效。方法将95例婴儿巨细胞病毒肺炎患儿随机分为观察组48例和对照组47例。对照组给予止咳、平喘、化痰等对症治疗,更昔洛韦5mg/kg,加入5%葡萄糖(1∶1)稀释后静脉滴注,每日2次,连用14d;观察组在对照组基础上辨证运用五虎汤合葶苈大枣泻肺汤加减。14d后观察患儿症状、体征变化。结果观察组治疗后血清谷丙转氨酶、谷草转氨酶、碱性磷酸酶、谷氨酸转氨酶、血清总胆红素与直接胆红素较对照组下降更为显著,差异有统计学意义(P0.05);观察组治愈率为91.7%(44/48),显著高于对照组61.7%(29/47),差异有统计学意义(P0.05)。结论五虎汤合葶苈大枣泻肺汤加减配合更昔洛韦治疗婴儿巨细胞病毒肺炎治疗作用强,无肝功能异常,疗效显著,可在临床推广应用。     

更昔洛韦与利巴韦林治疗小儿手足口病的疗效比较

目的:观察更昔洛韦治疗手足口病的效果。方法:将82例住院手足口病患儿按就诊顺序随机分为两组,观察组42例更昔洛韦静脉滴注;对照组40例利巴韦林静脉滴注,两组总有效率观察组为97.62%,对照组75%,两组比较差异有统计学意义(P<0.05)。结论:更昔洛韦治疗手足口病,临床症状消退时间,临床疗效较利巴韦林好,安全性较高,值得临床推广使用。     

小儿水痘的临床特点观察与治疗

目的:观察小儿水痘的临床特点观察与治疗方法。方法:将48例患儿分为两组,采用平行对照的方法,以伐昔洛韦治疗水痘24例为治疗组,以利巴韦林治疗水痘24例为对照组,对两组进行疗效比较。结果:经过观察,治疗组的退热时间及皮疹结痂时间明显少于对照组,差异有统计学意义(P<0.05)。治疗过程中伐昔洛韦组有1例出现呕吐,利巴韦林组未发现任何不良反应。两组不良反应情况对比无明显差异(P>0.05)。结论:伐昔洛韦分散片治疗水痘疗效好,临床症状改善快,值得推广应用。     

EB病毒感染所致传染性单核细胞增多症55例分析

目的总结小儿传染性单核细胞增多症的临床特征,以得到早期诊断及治疗。方法收集符合EBV感染的传染性单核细胞增多症55例,进行回顾性分析。结果本病的临床表现主要为:发热98.2%(54/55);咽峡炎100%(55/55);淋巴结肿大87.2%(48/55);肝脏肿大32.7%(18/55);脾脏肿大49.1%(27/55);双眼睑水肿54.5%(30/55);鼻塞29.0%(16/55);皮疹23.6%(13/55)。实验室检查:外周血常规白细胞数10×109/L者96%(53/55);EBV-DNA检测均阳性,可伴肝功能受损、心肌损害、肺炎等,更昔洛韦治疗有效。结论传染性单核细胞增多症临床表现复杂多样,可伴多器官多系统损害,大多预后良好。EBV-DNA检测具有特异性,可提高对本病的早期诊断。更昔洛韦治疗有效。     

High frequency oscillatory ventilation in children: experience of a medical center in Taiwan.

BACKGROUND/PURPOSE: Data about the effectiveness of high frequency oscillatory ventilation (HFOV) in children with respiratory failure are limited. This study investigated the efficacy and prognostic factors of this treatment. METHODS: Children between 2 months and 18 years of age who received HFOV between January 2000 and September 2006 in a tertiary care center were enrolled in this retrospective study. RESULTS: Thirty-six HFOV treatments were given to 33 patients (twice in one patient and three times in another patient) at a mean age of 5.4 +/- 5.0 years. HFOV was used as a rescue after conventional mechanical ventilation (CMV) for 4.4 +/- 4.2 days. The mean duration of HFOV was 7.6 +/- 7.9 days. The most common indication for HFOV was oxygenation failure, which was due to pneumonia with acute respiratory distress syndrome in 15 (45.5%), severe lobar pneumonia in nine (27.3%), pulmonary hemorrhage in eight (24.2%) and pneumothorax in one (3%). PaCO2 was significantly improved 4 hours after HFOV and the PaO2/FiO2 ratio increased significantly 12 hours later. The oxygenation index and alveolar-arterial oxygen difference P(A-a)O2, however, did not change markedly. Four (12%) patients needed further extracorporeal life support and two of these survived. The overall survival rate was 45.5%. Patients with heavier body weight (p less than 0.05) and of the male gender (p less than 0.05) had a higher risk of mortality. CONCLUSION: As a relatively late rescue therapy after failure of CMV, HFOV may improve PaCO2 and PaO2/FiO2 in children with respiratory failure. However, it carries an increased mortality rate in patients with heavier body weight and male gender.     

Colon perforation with peritonitis in an acquired immunodeficiency syndrome patient due to cytomegalovirus and amoebic colitis.

Invasive amoebiasis is rarely seen in human immunodeficiency virus (HIV)-infected individuals, even in endemic areas. By contrast, cytomegalovirus (CMV) disease is recognized as a major clinical problem in acquired immunodeficiency syndrome patients. A 34-year-old HIV-infected man with amoeba colitis, disseminated Mycobacterium avian complex and CMV infection with cecum perforation, presented with the initial symptoms of fever, shortness of breath and painful sensation when swallowing. He was treated with fluconazole, trimethoprim-sulfamethoxazole and hydrocortisone under the impression of esophageal candidiasis and Pneumocystis jiroveci pneumonia. However, diarrhea and abdominal pain developed on day 6 of hospitalization. Invasive amoebiasis and CMV colitis was diagnosed after examination of colon pathological specimens. Emergent laparotomy was performed. Right hemicolectomy with double barrel ileostomy and colostomy was done due to perforation of the cecum. Iodoquinol was given, followed by metronidazole 14 days afterwards. He underwent closure of double barrel ileostomy and colostomy 5 months later. This case illustrates the diagnostic challenge of caring for acquired immunodeficiency syndrome persons with multiple illnesses and medication use. CMV infection, amoebic colitis and possibly corticosteroid may have played a role in colon perforation in our patient.     

Fatal cytomegalovirus gastrointestinal disease in an infant with Wiskott-Aldrich syndrome.

Although most cytomegalovirus (CMV) infections are asymptomatic or cause only mild disease, the virus can cause serious disease and even mortality in immunocompromised children. In patients with Wiskott-Aldrich syndrome (WAS), recurrent CMV infection is infrequently seen. A 3-month-old male infant was referred to Chang Gung Children's Hospital due to persistent thrombocytopenia and intermittent tachypnea. WAS complicated with CMV pneumonitis was diagnosed subsequently. He was discharged at the age of 7 months after a complete course of antiviral treatment. Unfortunately, refractory hemorrhagic gastritis developed later and recurred in spite of antiviral treatment and intravenous immunoglobulin. The patient died of recurrent gastrointestinal bleeding at the age of 23 months. This observation indicates that a case of WAS complicated with CMV gastrointestinal disease may need more vigorous treatment.     

住院新生儿弓形虫与巨细胞病毒感染发生率调查

目的　探讨住院新生儿弓形虫 (TOX)与巨细胞病毒 (CMV)感染发生率与危害性。　方法　用酶联免疫吸符试验 (EL ISA)方法检测新生儿血清 CMV- Ig G/Ig M抗体与 TOX- Ig G/Ig M抗体。　结果　住院新生儿 CMV- Ig G阳性率 86 .7% ,CMV- Ig M阳性率 5 .2 % ,TOX- Ig G阳性率13.9% ,TOX- Ig M阳性率 0 .4%。CMV/TOX- Ig G(Ig M)阳性患儿临床以早产儿、小于胎龄儿、新生儿肺炎、败血症、脑病、肝炎综合征等为主要表现 ,且患儿母亲妊娠期间有不同程度发热、异常饮食史、宠物接触史。　结论　住院新生儿 TOX与 CMV感染发生率较高 ,新生儿 TOX和 CMV感染可引起多种临床表现。     

Severe postnatal cytomegalovirus infection in a very premature infant

Several studies have reported that postnatally acquired cytomegalovirus (CMV) infection can cause sepsis-like syndrome in premature infants. We here report a 622-gram birth weight male infant of 23 weeks' gestation who had sepsis-like syndrome and pneumonia. Substantial CMV loads were detected in peripheral blood cells, plasma, and urine when the patient was in crisis, but was decreased in parallel to clinical improvement without using ganciclovir. CMV DNA was not detected from his umbilical cord or Guthrie card, even by highly sensitive real-time PCR. Molecular profiles were indistinguishable between the CMV strain isolated from his urine and that from maternal breast milk, indicating postnatal acquisition of CMV through breast milk. Although he had transient hearing impairment, his neurodevelopmental outcome of 30 months of corrected age was normal. Further accumulation of clinical and virological data in postnatal CMV infection is necessary for evaluating the severity and selecting patients requiring antiviral therapy.     

小儿肺炎继发腹泻相关因素分析及微生态制剂的预防作用

目的探讨小儿肺炎继发腹泻的危险因素及应用微生态制剂(培菲康)预防的效果。 方法调查2002年1月至2004年5月在福建医科大学附属第一医院住院治疗的小儿肺炎314例，以住院期间抗生素治疗同时应用微生态制剂(培菲康)的患儿为病例组，仅使用抗生素治疗或住院72h后因出现继发腹泻才开始应用微生态制剂(培菲康)的患儿为对照组，对肺炎患儿的临床特征、微生态制剂的应用情况与继发腹泻的关系进行单因素卡方分析和非条件Logistic回归模型多因素分析。 结果病例组114例，住院治疗期间继发腹泻病21例，发生率为184%；对照组200例，继发腹泻79例，发生率395%。单因素卡方分析显示：患儿发病年龄、住院天数、住院后有无侵入性操作、微生态制剂的应用、居住地、病情严重程度、血中性粒细胞、血红蛋白数量、激素应用与小儿肺炎继发腹泻有关联。非条件Logistic多因素回归分析筛选出3个危险因素，即患儿年龄(χ2=14120,P=0000)、住院天数(χ2=11532,P=0001)、入院后接受侵入性操作(χ2=6827,P=0009)和1个保护因素：微生态制剂应用(χ2=12943,P=0000)。 结论肺炎患儿年龄越小、住院时间越长或进行侵入性操作可增加继发腹泻的发生率；微生态制剂能够降低小儿肺炎继发腹泻的发生率，提示具有预防作用。     

儿童支原体肺炎70例临床诊治分析

目的:探讨儿童支原体肺炎的临床表现度诊断治疗方法。方法:回顾性分析70例肺炎支原体肺炎患儿的临床资料。结果:发热、咳嗽是肺炎支原体肺炎患儿主要症状;婴幼儿伴发喘息的较多;影像学检查以肺内单侧斑片状阴影为多见;阿奇霉素及红霉素治疗有效。结论:支原体肺炎发病率较高,早期症状较重,体征较轻,胸部X线阴影明显。大环内酯类抗生素治疗有效,尤其是阿奇霉素,安全、效好。     

Congenital and maternal cytomegalovirus infections in a London population.

OBJECTIVE--To determine if women at risk of having babies infected with cytomegalovirus (CMV) can be identified antenatally. DESIGN--Prospective serological and demographic study of pregnant women and virological study of their newborn infants. SETTING--Teaching hospital in London. SUBJECTS--3315 pregnant women and 2737 of their babies. MAIN OUTCOME MEASURES--Quantitative detection of CMV IgG antibodies; qualitative detection of CMV IgM antibodies; demographic characteristics of mothers; qualitative and quantitative titration of CMV viruria in newborn. RESULTS--Congenital CMV infection was found in nine newborn babies (0.33%) two of whom had symptoms. Serological testing of the nine mothers showed four primary and five recurrent infections; both of the symptomatic children were born in the latter group. Testing for CMV specific IgM antibodies or quantitation of IgG antibodies in early pregnancy sera could not differentiate those women at risk of giving birth to babies infected or damaged by CMV from the rest of the population. Quantitation of viruria confirmed that those babies most at risk of CMV disease have the highest titres of CMV. CONCLUSIONS--(i) Since laboratory tests in pregnant women cannot reliably identify fetuses at risk of disease, screening for asymptomatic maternal infection coupled with termination of pregnancy cannot be recommended. (ii) Since 'immune' women can still give birth to babies affected by CMV, we propose that future CMV vaccines should be used to immunize children with the aim of eradicating CMV infection in preference to selective immunization of sero-susceptible females.     

Prevention and treatment of fetal cytomegalovirus infection with cytomegalovirus hyperimmune globulin: a multicenter study in Madrid

Introduction: Cytomegalovirus (CMV) is the leading cause of congenital infection worldwide. Data about the management of CMV infection in pregnant women are scarce, and treatment options are very limited. The aim of the study is to investigate the effectiveness of cytomegalovirus hyperimmune globulin (CMV-HIG) for the prevention and treatment of congenital CMV (cCMV) infection.

Materials and methods: A retrospective observational study was conducted in three tertiary hospitals in Madrid. In the period 2009–2015, CMV-HIG (Cytotect^® CP Biotest, Biotest) treatment was offered to all pregnant women with primary CMV infection and/or detection of CMV-DNA in amniotic fluid in participating centers. Women were divided into prevention and treatment groups (PG and TG, respectively). Those with primary CMV infection who had not undergone amniocentesis comprised the PG and received monthly CMV-HIG (100 UI/kg). If CMV-DNA was subsequently detected in amniotic fluid, one extra dose of CMV-HIG (200 UI/kg) was given 4 weeks after the last dose. Those women were considered to be part of the PG group despite detection of CMV-DNA in amniotic fluid. In the case of a negative result in CMV-DNA detection in amniotic fluid or if amniocentesis was not performed, monthly HIG was given up to the end of the pregnancy.

Results: Thirty-six pregnant women were included. Median gestational age at birth was 39 weeks (interquartile range: 38–40) and two children (5.5%) were premature (born at 28 and 34 weeks’ gestation). Amniocentesis was performed in 30/36 (83.4%) pregnancies and CMV PCR was positive in 21 of them (70%). One fetus with a positive PCR in amniotic fluid that received one dose of HIG after amniocentesis presented a negative CMV-PCR in urine at birth, and was asymptomatic at 12 months of age. Twenty-four children were infected at birth, and 16/21 (76.2%) presented no sequelae at 12 months, while two (9.5%) had a mild unilateral hearing loss and three (14.3%) severe hearing loss or neurological sequelae. Seventeen women were included in the PG and 19 in the TG. In the PG 7/17 (41%) fetuses were infected, one pregnancy was terminated due to abnormalities in cordocentesis and one showed a mild hearing loss at 12 months of age. In the TG, 18/19 children (95%) were diagnosed with cCMV, while the remaining neonate had negative urine CMV at birth. Eight out of the 19 fetuses (42.1%) showed CMV related abnormalities in the fetal US before HIG treatment. Complete clinical assessment in the neonatal period and at 12 months of age was available in 16 and 15 children, respectively. At birth 50% were symptomatic and at 12 months of age, 4/15 (26.7%) showed a hearing loss and 3/15 (20%) neurologic impairment. Fetuses with abnormalities in ultrasonography before HIG presented a high risk of sequelae (odds ratios: 60; 95%CI: 3–1185; p?=?.007).

Discussion: Prophylactic HIG administration in pregnant women after CMV primary infection seems not to reduce significantly the rate of congenital infection, but is safe and it could have a favorable effect on the symptoms and sequelae of infected fetuses. The risk of long-term sequelae in fetuses without US abnormalities before HIG is low, so it could be an option in infected fetuses with normal imaging. On the other hand, the risk of sequelae among infected fetuses with abnormalities in fetal ultrasonography before HIG despite treatment is high.