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目的探讨婴儿巨细胞病毒(CMV)感染的临床特点、治疗及预防。方法 146例CMV患儿,男86例,女60例;年龄1～12月;母乳喂养94例,混合喂养52例。经血清学CMV-IgM定性检测或尿CMV-DNA定量检测确诊为CMV感染;母乳CMV-DNA检测100%阳性。临床表现为高胆红素血症48例(32.9%),腹泻病40例(27.4%),婴儿肝炎28例(19.2%),急性支气管肺炎24例(16.4%),中枢神经系统损害6例(4.1%)。所有病例静脉给予更昔洛韦(GCV,5mg/kg,每12h1次,疗程7～10d)诱导治疗;中枢神经系统损害者其后增加维持治疗。结果高胆红素血症48例治愈26例,好转22例;婴儿肝炎28例治愈20例,好转8例;腹泻病40例、支气管肺炎24例及中枢神经系统损害6例均治愈。除个别患儿ALT增高停药后很快恢复外,未见其他GCV治疗的不良反应。结论婴儿CMV感染临床表现多样,严重者可致中枢神经系统损害;血清特异性CMV-IgM抗体、尿CMV-DNA定量检测是实验室诊断依据,GCV是治疗首选药物,早期母乳CMV-DNA筛查是其预防的有效手段。
Objective To investigate the clinical characteristics, treatment and prevention of infant cytomegalovirus (CMV) infection. Methods 146 cases of CMV children, 86 males and 60 females; aged 1 to 12 months; 94 breastfeeding, mixed feeding 52 cases. Serum CMV-IgM qualitative detection or urine CMV-DNA quantitative detection of CMV infection; breast milk CMV-DNA test was 100% positive. Clinical manifestations of hyperbilirubinemia in 48 cases (32.9%), 40 cases of diarrhea (27.4%), infantile hepatitis in 28 cases (19.2%), acute bronchopneumonia in 24 cases (16.4%), central nervous system damage in 6 cases (4.1%). All cases were given ganciclovir intravenously (GCV, 5 mg / kg, once every 12h for 7 ~ 10 days). Patients with central nervous system injury were followed by maintenance therapy. Results In 48 cases of hyperbilirubinemia, 26 cases were cured and 22 cases were improved. Infantile hepatitis was cured in 28 cases and improved in 8 cases. Diarrhea in 40 cases, bronchopneumonia in 24 cases and central nervous system damage in 6 cases were cured. In addition to some children with ALT increased fast withdrawal after withdrawal, no other side effects of GCV treatment. Conclusions The clinical manifestations of CMV infection in infants are diverse and may lead to central nervous system damage. Serum-specific CMV-IgM antibodies and CMV-DNA in urine are the basis of laboratory diagnosis. GCV is the drug of choice for treatment. CMV-DNA screening of early stage breast milk It is an effective means of prevention.