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目的观察不同疗程更昔洛韦(GCV)治疗婴儿巨细胞病毒性肝炎(CMV肝炎)的效果及不良反应。方法选取2009年1月-2010年12月在本科住院的1~4月龄CMV肝炎患儿48例,随机分为治疗1组(n=25)和治疗2组(n=23)。二组均予保肝、退黄治疗,治疗1组给予GCV5 mg.kg-1,每日2次,连用2周。治疗2组诱导期给予GCV5 mg.kg-1,每日2次,连用2周;维持期给予GCV5 mg.kg-1,每日1次,连用7 d。治疗前后常规检查肝、肾功能及心肌酶谱,所有患儿出院后随访2个月,监测其血CMV-IgM水平。结果二组患儿治疗后血清ALT、总胆红素、结合胆红素水平均显著下降,与治疗前比较差异均有统计学意义(Pa<0.05);治疗后二组ALT、总胆红素及结合胆红素水平比较差异亦有统计学意义(Pa<0.05)。治疗后随访2个月,血CMV-IgM转阴率治疗2组高于治疗1组。血常规、肾功能及心肌酶谱二组比较无统计学差异(Pa>0.05)。结论 GCV治疗婴儿CMV肝炎的疗效肯定,且3周二期治疗方案优于2周一期治疗方案,前者能够获得高病毒转阴率和较低复发率,同时较长程疗法更少引起不良反应,较经济且易于被小婴儿耐受,易于推广。
Objective To observe the effects and adverse reactions of ganciclovir (GCV) in treating infantile cytomegalovirus hepatitis (CMV hepatitis). Methods Forty-eight children aged 1 to 4 months with CMV hepatitis admitted from January 2009 to December 2010 were randomly divided into treatment group 1 (n = 25) and treatment group 2 (n = 23). The two groups were given liver protection, Huang treatment, treatment group 1 given GCV5 mg.kg-1, 2 times a day, once every 2 weeks. Two groups were treated with GCV5 mg.kg-1 twice a day for 2 weeks during the induction period. GCV5 mg.kg-1 was given once a day for 7 days. Before and after treatment routine examination of liver and kidney function and myocardial zymogram, all children were followed up for 2 months after discharge to monitor their blood CMV-IgM levels. Results After treatment, serum ALT, total bilirubin and conjugated bilirubin were significantly decreased in both groups (P <0.05), and the levels of ALT, total bilirubin And bilirubin levels were also significantly different (Pa <0.05). Followed up for 2 months after treatment, blood CMV-IgM negative rate of treatment two groups higher than the treatment of a group. Blood routine, renal function and myocardial enzymes in the two groups showed no significant difference (Pa> 0.05). Conclusion The curative effect of GCV on infants with CMV hepatitis is certain. The 3-week treatment is better than the 2-week treatment. The former can achieve a high viral negative rate and a low recurrence rate, while the less long-range therapy causes fewer adverse reactions, which is more economical And easy to be tolerated by small infants, easy to promote.