【作者】 李弢； 周俪姗； 熊小丽； 邱娅莉； 向强； 袁凯； 江治霞； 鄢素琪；

【Author】 Li Tao;Zhou Lishan;Xiong Xiaoli;Qiu Yali;Xiang Qiang;Yuan Kai;Jiang Zhixia;Yan Suqi;Department of Nephrology,Wuhan Children’s Hospital;

【机构】 武汉市儿童医院肾内科； 武汉市儿童医院中西医结合科； 武汉市儿童医院麻醉科；

【摘要】 [目的]探讨早期血浆置换(PE)治疗对重症婴儿巨细胞病毒(CMV)感染胆汁淤积性肝病(ICH)的近期疗效及其影响因素。[方法]采用回顾性统计方法,调取本院2013年1月-2014年12月在武汉市儿童医院中西医结合科住院,并接受早期PE治疗的8例重症CMV感染ICH患儿住院病历,记录患儿一般情况(性别、家庭生活环境、接受PE治疗时的年龄和体重)、PE治疗信息(置换次数、置换总量)、治疗前后临床资料(肝脾肿大体征,TBIL、DBIL、TBA、γ-GT、ALP、ALT、AST、CMV-IgG/IgM抗体水平等实验室检查结果),对患儿的近期疗效进行评估,并进一步通过"单因素方差"的方法分析了疗效的影响因素。[结果]8例患儿的男女比例为3:5,城市与农村生活环境比例为2:6,入院平均年龄为(53.63±23.37)天,接受PE治疗时平均年龄为(67.38±21.27)天,接受PE治疗时平均体重为(4.91±0.86)kg;PE治疗平均置换次数为2.75次/人,平均每次置换血浆量为295.45ml,平均置换总量为812.5ml/人。8例患儿在PE治疗过程中均耐受良好,无严重不良反应发生;经PE治疗后,评估疗效显示:4例患儿显效,4例患儿有效,总有效率达100%。与PE治疗前比较,肝脏肿大体征有改善(p<0.05)、脾脏肿大体征无差异(p<0.05);淤胆相关生化指标,如TBIL、DBIL、TBA、γ-GT、ALP均有降低(p<0.01,p<0.05),其中TBIL、DBIL.、ALP显著降低(p<0.01);肝细胞损伤相关生化指标,如ALT、AST亦有降低(p<0.05);CMV病毒毒力,IgM抗体滴度下降(p<0.05),但IgG抗体滴度水平无明显变化(p>0.05)。单因素方差分析显示:TBA及ALP两项因素与患儿疗效之间有相关关系(p<0.05);其余因素,如性别、家庭生活环境、接受PE治疗时的年龄和体重、PE治疗置换次数和置换总量、反应胆汁淤积程度的生化指标(TBIL、DBIL、TBA、γ-GT、ALP)、反应肝细胞损伤的生化指标(ALT、AST)、CMV病毒毒力(CMV-IgM/I8G的抗体滴度)等等,虽在数据上呈现出了一些趋势,但无明显相关关系(p>0.05)。[结论]在内科综合治疗的同时早期采用PE治疗,近期疗效明显;TBA和ALP水平对于PE近期治疗效果有预测价值。更多还原

【Abstract】 Objective To investigate the nearby curative effect and influence factors of sever infantile cholestatic hepatopathy(ICH) induced by cytomegalovirus(CMV) infection patients treated with plasma exchange(PE) in early period.Methods Based on the database of patients’ files in Wuhan Children’s Hospital,eight cases were received PE treatment in early period and discharged between 2013 Jan and 2014 Dec.According to the general information,PE treatment related data,physical signs and biochemical items at the time of hospital admission and after procedure of those 8 patients,the nearby curative effect were estimated.The influence factors of clinical effect were also analyzed by one-way ANOVA.Results None of those 8 cases had serious said effect.The total effective rate reached to 100%,with 4 cases were remarkably effective.Physical signs,biochemical indicators and CMV-IgM antibody titer were attenuated(p<0.01,p<0.05),while TBIL,DBIL and ALP got a significant decrees(p<0.01).TBA and ALP are influence factors of clinical effect(p<0.05).Conclusion Medical treatment integrated with PE theYapy in early period had evident nearby clinical effect.TBA and ALP have a predictive value on nearby clinical effect of PE therapy.更多还原