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目的探讨人巨细胞病毒(HCMV)感染与婴幼儿贫血的关系及其治疗策略。方法选择2004年1月-2009年2月本科住院的130例贫血患儿。患儿住院后均进行血清呼吸道合胞病毒(RSV)、流感病毒(IFV)、腺病毒(ADV)、副流感病毒(PIV)及HCMV 5种病毒特异性抗体检查。全部患儿CRP<8 mg.L-1。根据HCMV检测结果分为HCMV感染组和非HCMV感染组,根据出生14 d内HCMV感染的筛查结果,将HCMV感染组分为先天性HCMV感染组和后天性HCMV感染组,按治疗方法分为常规治疗组和更昔洛韦(GCV)治疗组。对GCV治疗效果进行对照观察。结果 1.HCMV感染组较非HCMV感染组贫血程度重,贫血发生率高,差异有统计学意义(P<0.01)。2.先天性HCMV感染组较后天性HCMV感染组贫血发生率高,贫血程度重,差异有统计学意义(P<0.01)。3.HCMV感染组HCMV-DNA载量和贫血程度无相关性。4.经GCV治疗后,HCMV-DNA载量显著降低(P<0.01),Hb水平显著升高(P<0.01)。5.随诊1个月后,GCV治疗组Hb水平显著高于常规治疗组,持续贫血病例明显减少(P<0.01)。结论婴幼儿HCMV感染可引起红系造血功能紊乱,导致贫血。先天性HCMV感染导致贫血的发生率高,程度重,持续时间长。GCV治疗能明显缩短HCMV感染婴幼儿贫血病程,降低病毒载量。
Objective To investigate the relationship between human cytomegalovirus (HCMV) infection and infant anemia and its therapeutic strategy. Methods From January 2004 to February 2009, 130 under-hospital children with anemia were selected. After hospitalization, all the patients were tested for RSV, IFV, ADV, parainfluenza virus (PIV) and HCMV virus-specific antibodies. All children with CRP <8 mg.L-1. HCMV infection was divided into HCMV infection group and non-HCMV infection group according to HCMV test results. HCMV infection was divided into congenital HCMV infection group and acquired HCMV infection group according to the screening results of HCMV infection within 14 days of birth, and were divided into treatment group Conventional treatment group and ganciclovir (GCV) treatment group. The control effect of GCV was observed. HCMV infection than non-HCMV infection group anemia, anemia, the difference was statistically significant (P <0.01). In congenital HCMV infection group, the incidence of anemia was higher than that of HCMV infection group, the degree of anemia was heavier, the difference was statistically significant (P <0.01). HCMV infection group HCMV-DNA load and anemia no correlation. After treatment with GCV, HCMV-DNA load was significantly decreased (P <0.01), Hb level was significantly increased (P <0.01). After 1 months of follow-up, Hb level in GCV treatment group was significantly higher than that in conventional treatment group, and persistent anemia was significantly reduced (P <0.01). Conclusion Infant HCMV infection can cause erythrocyte hematopoietic disorders, leading to anemia. Congenital HCMV infection causes a high incidence of anemia, to a large extent, for a long time. GCV treatment can significantly shorten the course of anemia in children with HCMV infection and reduce the viral load.