婴儿巨细胞病毒感染与胆道闭锁的关系

目的　探讨巨细胞病毒 (CMV)感染与胆道闭锁的关系 ,了解婴儿CMV肝炎并胆道闭锁的临床特点。方法　对确诊为CMV感染并胆道闭锁 1 6例患儿的临床资料进行回顾性分析 ,并与同期诊断为单纯CMV肝炎 2 9例患儿进行比较。结果　CMV感染并胆道闭锁患儿血清CMV IgM抗体和外周血多形核白细胞中CMV pp65抗原均阳性 9例 ,IgM阳性 1例 ,仅pp65阳性3例 ,IgM和pp65均阴性 3例 (但其肝组织CMV pp65阳性 )。 1 5例肝组织标本中CMV pp65阳性 1 4例。CMV感染并胆道闭锁患儿各项指标明显重于有黄疸的单纯CMV肝炎 (P均 <0 .0 5) ,肝组织病理检查 1 5例显示胆小管增生伴肝纤维化 ,继发性胆汁性肝硬化 2例。结论　CMV感染可同时累及肝细胞和胆管上皮细胞 ,导致胆管闭锁。对以胆汁淤积为主要表现且已明确为CMV感染患儿应警惕是否并胆道闭锁 ,避免丧失手术治疗机会。

Clinical Study on Infantile Cytomegalovirus Infection and Biliary Atresia

Objective To investigate the relationship between cytomegalovirus infection and biliary atresia.Methods Sixteen infants with CMV infection and biliary atresia were retrospectively reviewed and compared with clinical manifestations with 29 infants with CMV hepatitis.Results Both serum CMV-IgM antibody and CMV-pp65 in polymophnuclear leukocytes were found positive in 9 cases,only CMV IgM antibody was found positive in 1 case and only CMV-pp65 were found positive in 3 cases,both CMV-IgM and CMV-pp65 were found negative in 3 cases.14 of 15 cases of CMV-pp65 were detected in liver tissues including 3 cases with negative CMV-IgM antibody and CMV-pp65 in blood.The clinical indexes in these 16 cases were much more severe than which in 29 infants with CMV hepatitis (P< 0.01).The pathological changes of liver in 15 cases showed ductal and ductular proliferation accompanied by variable degrees of fibrosis.Conclusions Cytomegalovirus infection may cause biliary atresia.Infants with CMV infection and cholestasis should take the investigation to differentiate biliary atresia from CMV hepatitis.