摘要
目的探讨巨细胞病毒(CMV)感染对胆道闭锁(BA)患儿行葛西手术(KPE)预后的影响及可能的机制。方法纳入2015年至2018年76例因胆道闭锁在广州市妇女儿童医疗中心新生儿外科行KPE的患儿,并于术后6月内进行随访。收集并保存其KPE术前一周内及术后随访时间点的外周血标本,分析其各阶段的肝功能指标、CMV感染情况、肝脏纤维化指标、术后胆管炎发病情况等,分析术前各种因素对KPE术后的预后影响。结果总共60名BA患者(男女比为31∶29)接受KPE,并完成6个月的随访。手术年龄的中位数是61.5 d。术后6个月内预后良好与预后不良的比例为34∶26。单因素和多因素分析表明手术年龄,术前肝功能及并发胆管炎并不对早期预后产生影响,而术前CMV病毒感染是预后不良的独立预测因子(OR=4.67,95%CI:1.36~16.03)。CMV感染组和非感染组在纤维粘连蛋白(FN)、层粘连蛋白(LN)和结合珠蛋白(HP)3个肝纤维化指标的差异有统计学意义(P<0.05)。结论 CMV病毒感染是影响BA患者KPE术后预后的独立因素,这可能和CMV病毒感染引起肝脏纤维化程度加重有关。
Objective Investigate the influence of Cytomegalovirus(CMV)infection on the prognosis in biliary atresia(BA)patients after Kasai.s portoenterostomy(KPE),and explore the possible mechanism.Methods 76 BA patients treated withKPE from the Department of Neonatal Surgery,Guangzhou Women and Children.s Medical Center in 2015-2018 wererecruited in this study.Follow-up was performed within 6 months after surgery.Peripheral blood samples from one weekbefore and after the KPE were collected and preserved.Liver function indicators at various stages,CMV infection,liverfibrosis index and incidence of postoperative cholangitis were analyzed.The prognostic effects of preoperative factors on KPEwere analyzed.Results A total of 60 BA patients(31∶29 male to female)received KPE and completed 6 months of follow-up.The median age of surgery was 61.5 days.The ratio of good prognosis to poor prognosis within 6 months after surgery was34∶26.Univariate and multivariate analysis showed that the age of surgery,preoperative liver function and concurrentcholangitis did not affect early prognosis,and preoperative CMV virus infection was an independent predictor of poorprognosis(OR=4.67,95%CI:1.36~16.03).There was significant difference in liver fibrosis indexes between CMV infectiongroup and non-infection group in fibronectin(FN),laminin(LN),haptoglobin(HP)(P<0.05).Conclusion CMV infectioncould independently predict the poor prognosis of BA patients after KPE,which was closely related with liver fibrosis.
作者
吕俊健
王哲
钟微
LüJun-jian;WANG Zhe;ZHONG Wei(Surgical Neonatal Intensive Care Unit,Women and Children??s Medical Center of Guangzhou,Guangzhou,Guangdong 510623,China)
出处
《热带医学杂志》
CAS
2019年第8期1024-1027,共4页
Journal of Tropical Medicine
