非淤胆型婴儿巨细胞病毒性肝炎治疗68例

目的:探讨非淤胆型婴儿巨细胞病毒性肝炎的治疗方法.方法:选择2008-01/2010-07本院儿科住院的68例非淤胆型婴儿巨细胞病毒性肝炎患儿,随机分为治疗组34例和对照组34例,均予复方甘草酸苷2 mL/(kg.次),1次/d,共3 wk.治疗组加用更昔洛韦5 mg/(kg.次),2次/d,2 wk;1次/d,1 wk.结果:治疗组和对照组总有效率分别为94.1%和91.1%,治疗3 wk复查肝功能指标结果提示丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(total bilirubin,T B I L)、谷氨酰转肽酶(g a m m a g l u t a m y ltranspeptidase,GGT)和碱性磷酸酶(alkalinephosphatase,ALP)指标较治疗前均明显下降,差异有显著意义(P<0.05);直接胆红素(directbilirubin,DBIL)、总胆汁酸(total bile acid,TBA)指标较治疗前均无明显变化,差异无显著意义(P>0.05).治疗前或治疗后2组间比较上述指标差异无显著意义(P>0.05).随访1年,失访5人,余患儿肝功能均正常;尿CMV-DNA,治疗组18人(54.5%)阳性,对照组15人(50.0%)阳性,差异无显著意义(P>0.05).结论:非淤胆型婴儿巨细胞病毒性肝炎不建议常规予更昔洛韦抗病毒治疗.

Treatment of non-cholestatic cytomegalovirus hepatitis in infants:An analysis of 68 cases

AIM: To investigate treatment options for infants with non-cholestatic cytomegalovirus(CMV) hepatitis.METHODS: Sixty-eight infants with non-cholestatic CMV hepatitis who were treated at our hospital between December 2008 and July 2010 were divided into two groups: treatment group(n = 34) and control group(n = 34).All infants were given compound glycyrrhizin at a dose of 2 mg/(kg d) for 3 weeks.The therapy group was additionally treated with ganciclovir at a dose of 10 mg/(kg d) for 2 weeks and 5 mg/(kg d) for one more week.RESULTS: The response rate was 94.1% in the treatment group and 91.1% in the control group.Serum levels of aminotransferases(ALT,AST),total bilirubin(TBIL),gamma-glutamyl transpeptidase(GGT),and alkaline phosphatase(ALP) had a significant decrease after treatmentin the two groups(all P < 0.05),while direct bilirubin(DBIL) and total bile acid(TBA) showed no significant changes(both P > 0.05).All these parameters had no significant differences between the two groups either before or after therapy(all P > 0.05).During one-year follow-up period,5 infants were lost to follow-up,and hepatic function parameters were normal in the remaining infants.The positive rate of urine CMVDNA was 54.5% in the treatment group and 50% in the control group(P > 0.05).CONCLUSION: Routine antiviral therapy with ganciclovir is not recommended in infants with non-cholestatic CMV hepatitis.