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目的:探讨免疫正常婴儿支气管肺泡灌洗液(BALF)中检测到巨细胞病毒(CMV)-DNA,临床是否有必要行抗病毒治疗。方法:回顾性分析2010年4月至2014年4月,通过BALF检测CMV-DNA方法诊断CMV肺炎的病例,按是否给予更昔洛韦抗病毒治疗分为治疗组和对照组,比较两组临床特点和转归。结果:43例患儿纳入研究,治疗组28例,对照组15例。两组患儿病程、喘息、外周血白细胞及淋巴细胞计数、肝功能及听力损害、血CMV-DNA阳性率、合并其他病原感染比例以及治疗后影像学和临床症状恢复情况等比较差异均无统计学意义,治疗组BALF、外周血中CMV-DNA拷贝数较高。两组共19例(44.2%)合并感染,肺炎支原体感染9例,呼吸道合胞病毒感染6例,其它感染4例。治疗组临床好转率85.7%,对照组临床好转率93.3%,两组比较差异无统计学意义(P>0.05)。结论:免疫功能正常婴儿的BALF中检测到CMV-DNA有可能为潜伏感染,不一定需要抗病毒治疗,临床应避免过度治疗。CMV-DNA拷贝数高低与是否进行治疗的关系有待进一步探讨。
Objective: To investigate the detection of cytomegalovirus (CMV) -DNA in bronchoalveolar lavage fluid (BALF) of immunocompetent infants and whether it is necessary for antiviral therapy in clinic. Methods: The cases of CMV pneumonia diagnosed by CMV-DNA by BALF were analyzed retrospectively from April 2010 to April 2014. The patients were divided into treatment group and control group according to whether or not ganciclovir was given antiviral therapy. Features and outcomes. RESULTS: Forty-three children were included in the study, 28 in the treatment group and 15 in the control group. There was no statistical difference in the course of disease, wheezing, peripheral blood leucocyte and lymphocyte count, liver function and hearing impairment, the positive rate of CMV-DNA in blood, the proportion of other pathogen infection, and the recovery of imaging and clinical symptoms after treatment Significance, the treatment group of BALF, the higher the copy number of CMV-DNA in peripheral blood. In both groups, 19 cases (44.2%) had combined infection, 9 cases were Mycoplasma pneumoniae infection, 6 were respiratory syncytial virus infection and 4 were other infections. The clinical improvement rate was 85.7% in the treatment group and 93.3% in the control group, with no significant difference between the two groups (P> 0.05). CONCLUSIONS: CMV-DNA detected in BALF of normal immunocompetent infants may be latent infection and may not require antiviral therapy. Overtreatment should be avoided clinically. The relationship between CMV-DNA copy number and whether or not to be treated remains to be further explored.