巨细胞病毒相关性胆道闭锁患儿临床特征分析

摘 要：目的:描述中国胆道闭锁（BA）患儿巨细胞病毒（CMV）感染的流行情况，分析CMV IgM阳性和CMV IgM阴性胆道闭锁的临床特点。方法: 纳入2007年3月至2021年12月，在上海交通大学医学院附属新华医院接受Kasai手术治疗的281例胆道闭锁患儿，收集BA患儿的基本资料和临床资料，包括年龄、性别、出生月份、CMV感染情况和肝脏生化指标等，回顾性分析BA患儿CMV感染的情况，比较CMV IgM阳性与CMV IgM阴性BA患者之间的临床差异。结果: 281例BA患儿中，CMV IgM阳性患儿106例占37.72%；CMV IgM阳性患儿的手术时年龄（72.5（63-86）天）显著大于CMV IgM阴性患儿（59（47-69）天；P < 0.0001）。11月份出生的CMV IgM阳性患儿例数显著多于CMV IgM阴性患儿（13.21% vs. 5.71% ; P = 0.0294）。CMV IgM阳性BA患儿出生于冬季（11月～1月）的发病率是夏季（6～8月）的1.6倍，但无统计学差异。单因素分析结果提示，CMV IgM阳性BA患儿的胆汁酸、天冬氨酸氨基转移酶、碱性磷酸酶、总胆红素和直接胆红素水平高于CMV IgM阴性BA患者，差异均有统计学意义（P < 0.05）。CMV IgM值与与各项生化指标无线性相关关系。结论: 中国BA患儿CMV IgM阳性率为37.72%，出生于11月最常见，但无季节性聚集；相比CMV IgM阴性BA，CMV IgM阳性BA患儿手术时年龄更大，胆汁酸、天冬氨酸氨基转移酶、碱性磷酸酶、总胆红素和直接胆红素水平更高。

Clinical characteristics of cytomegalovirus-related biliary atresia

Abstract: Objective: To describe the prevalence of cytomegalovirus (CMV) infection in Chinese children with biliary atresia (BA), and explore the clinical characteristics of CMV IgM-positive and CMV IgM-negative biliary atresia. Methods: From March 2007 to December 2021, 281 BA infants treated with Kasai surgery from Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine were recruited in this study. We collected the clinical data of BA patients, including age at surgery, gender, month of birth, CMV IgM results, and liver biochemical indicators. The prevalence of CMV infection in BA patients was retrospectively analyzed. We compared the clinical data collected between CMV IgM-positive and CMV IgM-negative BA patients. Results: Among the 281 infants with BA, 106 cases (37.72%) were CMV IgM positive at presentation. CMV IgM positive infants were older than CMV IgM-negative BA infants (72.5 (63-86) vs. 59 (47-69) days; P < 0.0001). 13.21% of CMV IgM-positive infants were born in November, which was significantly higher than that of CMV IgM-negative infants (5.71%; P = 0.0294). Although the birth prevalence rate from November through January was 1.6 times higher than that from June through August, there was no significant seasonal variation of CMV IgM-positive BA. Univariate analysis showed that the levels of bile acid, aspartate aminotransferase, alkaline phosphatase, total bilirubin, and direct bilirubin in CMV IgM-positive BA patients were higher than those in CMV IgM-negative BA patients, and the differences were statistically significant (P < 0.05). No significant correlation was found between the liver biochemical indicators and CMV IgM value. Conclusions: The incidence of CMV IgM-positive BA in our center is 37.72%. The birth prevalence rate of BA is highest in November, but no evidence for significant seasonal variation is found. Compared with CMV IgM-negative BA, CMV IgM-positive BA patients are older at the time of surgery and have higher levels of bile acid, aspartate aminotransferase, alkaline phosphatase, total bilirubin, and direct bilirubin.