婴幼儿巨细胞病毒感染138例临床及治疗观察

目的：探讨婴幼儿巨细胞病毒（ CMV）感染的临床特点及治疗。方法：对在我院确诊、住院治疗的138例CMV感染患儿的临床资料进行回顾性分析。结果：138例患儿（男80例，女58例）血清CMV-IgM阳性和（或）血、尿CMV-DNA-PCR阳性，入院年龄9 d～3岁。临床表现为肺炎99例，伴有肺功能改变18例；婴儿肝炎62例，其中肝硬化1例，肝豆状核变性1例，高胆红素血症30例（2例合并核黄疸，3例胆道闭锁，1例胆总管囊肿，3例肝糖原累积症）；溶血性贫血10例，特发性血小板减少症6例；脑发育异常15例，其中脑积水1例、脑结节硬化2例、运动落后3例、智力低下3例、癫痫2例；脑干听觉诱发电位异常16例（双侧听力受损10例、青光眼1例）；先天性心脏病8例，多发畸形3例，迁延性肠炎5例，营养不良7例，喉软骨发育不良3例，选择性IgA缺乏症1例，遗传代谢性疾病1例，同时合并多重感染11例，合并呼吸衰竭、休克2例。治疗后好转114例，放弃治疗19例，死亡5例。结论：婴幼儿CMV感染临床表现多样化，以肺炎最多见；其次是肝胆系统受累。中枢神经系统受损可导致脑发育异常、听神经受损、运动落后等，少数病例可伴发其他畸形甚至多发畸形。绝大部分CMV感染病例预后良好，少数病例预后差甚至死亡。

Clinical characteristics and therapy of cytomegalovirus infection in 138 infant cases

Objective：To investigate the clinical characteristics and therapy of cytomegalovirus （ CMV） infection in infants.Methods：Clinical characteristics and outcome were retrospectively analyzied of in 138 infants infected CMV diagnosed in our hospital.Results：One hundred thirty-eight cases（male 80, female 58） were diagnosed by the positive of serum CMV-IgM and or blood/urine CMV-DNA-PCR.The admission age was 9 d to 3-year-old. Ninety-nine patients were diagnosed as pneumonia , 18 showed lung function detects .Sixty-two cases were diagnosed as infant hepatitis , 1 showed cirrhosis , 1 showed liver degeneration , 30 showed hyperbilirubin （ 2 cases as kernicterus , 3 as biliary atresia ,1 as choledochal cyst , 3 as glycogen accumulation disorder ） .Ten cases were diagnosed as hemolytic anemia .Six cases were diagnosed as ITP .Fivteen cases were diagnosed as abnormal brain development , including 1 case of hydrocephalus , 2 cases of cerebral tuberous sclerosis , 3 cases of backward movement , 3 cases of mental retardation , 2 cases of epilepsy .There were brainstem auditory evoked potential abnormalities in 16 cases,10 showed bilateral hearing impairment ,1 showed glaucoma.And 8 cases were diagn-osed as congenital heart disease .Three cases were diagnosed as multiple malformations .Five cases were diagnosed as persistent enteritis .Seven cases were diagnosed as malnutrition ,Three cases were diagnosed aslaryngeal cartilage dysplasia .One case were diagnosed as selective IgA deficiency , 1 case were diagnosed as hereditary metabolic disease.Eleven cases complicated with multiple infection complicated with respiratory failure and shock in 2 cases. After treatment,114 patients recovered,19 patients quitted therapy and 5 died.Conclusions：Clinical manifestations of CMV infection were diverse in infants and young children , the most common is pneumonia , and followed by the hepatobiliary system involvement .Central nervous system damage could cause abnormal brain development , auditory nerve damage , and backward movement and so on . Small number of cases may be associated with other malformations, and even multiple malformations .Most of the CMV infection in infants have the good prognosis , and just a few is poor prognosis , or even death .