Zhao Yilin,Wu Xiaoxia,Xu Xiaodan,et al.Prognosis of biliary atresia associated with cytomegalovirus[J].Journal of Clinical Pediatric Surgery,2023,22(03):232-237.[doi:10.3760/cma.j.cn101785-202212017-006]
巨细胞病毒感染对胆道闭锁Kasai手术预后影响的研究
- Title:
- Prognosis of biliary atresia associated with cytomegalovirus
- Keywords:
- Biliary Atresia; Cytomegalovirus; Prognosis; Jaundice Clerance; Cholangitis
- 摘要:
- 目的 探究巨细胞病毒(cytomegalovirus,CMV)感染对胆道闭锁(biliary atresia,BA)患儿Kasai手术预后的影响。方法 本研究为回顾性研究,研究对象为2018年1月至2020年12月于天津市儿童医院和山西省儿童医院确诊为BA并行Kasai手术治疗的患儿。根据有无CMV感染,分为CMV阳性组和CMV阴性组;其中CMV阳性组患儿根据抗病毒治疗情况分为治疗组和未治疗组。随访截止日期为2021年10月10日,随访时间2~34个月。收集资料并分析CMV感染对BA患儿Kasai手术后黄疸清除、胆管炎发生情况及自体肝生存情况的影响。结果 共纳入91例BA患儿,其中CMV阳性组35例,CMV阴性组56例。CMV阳性组中治疗组26例,未治疗组9例。CMV阳性组较CMV阴性组手术日龄大,差异有统计学意义(P<0.05)。CMV阳性组与CMV阴性组白细胞比例不一致,CMV阳性组肝功能指标天冬氨酸转氨酶(aspartate amino transferase,AST)显著高于CMV阴性组[244.00(195.00,341.00)比185.00(126.25,281.00)],差异有统计学意义(P<0.05)。两组Kasai手术后预后指标黄疸清除率、胆管炎发生率及自体肝生存情况差异均无统计学意义(P>0.05)。CMV感染的BA患儿经抗病毒治疗后早期胆管炎发生率显著降低(11.54%比55.56%,P<0.05)。结论 CMV感染对BA患儿Kasai手术后预后无明显影响;CMV感染患儿经抗病毒治疗可减少早期胆管炎发病,这对改善CMV感染的BA患儿预后具有积极意义。
- Abstract:
- Objective To explore the impact of cytomegalovirus (CMV) infection on the prognosis of Kasai operation in children with biliary atresia (BA).Methods From January 2018 to December 2020,91 BA children undergoing Kasai operation at Tianjin Children’s Hospital and Shanxi Children’s Hospital were divided into two groups of CMV positive (n=35) and CMV negative (n=56).CMV positive children were divided into antiviral treatment and non-treated groups.Follow-ups were conducted for (2-34) months until October 10,2021.The impact of CMV infection on jaundice clearance,cholangitis and autologous liver survival after Kasai operation were examined.Results In CMV positive group,there were 26 cases in treatment group and 9 cases in non-treated group.Operative age was significantly older in positive group.Significant difference existed in proportion of white blood cell (WBC).In positive group,aspartate aminotransferase (AST) spiked sharply[244.00(195.00,341.00)vs.185.00(126.25,281.00),P＜0.05].No significant difference existed in jaundice clearance rate,incidence of cholangitis or survival of autologous liver after Kasai operation.The incidence rate of early cholangitis declined markedly after antiviral treatment(11.54%vs.55.56%,P＜0.05).Conclusion CMV infection has no significant impact on the prognosis of BA children.And antiviral therapy lowers the incidence of early cholangitis.It hints that antiviral therapy has a positive effect on BA children with CMV infection.
参考文献/References:
[1] Asai A,Miethke A,Bezerra JA.Pathogenesis of biliary atresia:defining biology to understand clinical phenotypes[J].Nat Rev Gastroenterol Hepatol,2015,12(6):342-352.DOI:10.1038/nrgastro.2015.74.
[2] Chiu HH,Chang MH,Chen CL,et al.Case report:paucity of interlobular bile ducts in Chinese children[J].J Gastroenterol Hepatol,1996,11(5):434-438.DOI:10.1111/j.1440-1746.1996.tb00287.x.
[3] Davenport M.Biliary atresia:clinical aspects[J].Semin Pediatr Surg,2012,21(3):175-184.DOI:10.1053/j.sempedsurg.2012.05.010.
[4] Murase N,Hinoki A,Shirota C,et al.Multicenter,retrospective,comparative study of laparoscopic and open Kasai portoenterostomy in children with biliary atresia from Japanese high-volume centers[J].J Hepatobiliary Pancreat Sci,2019,26(1):43-50.DOI:10.1002/jhbp.594.
[5] Lakshminarayanan B,Davenport M.Biliary atresia:a comprehensive review[J].J Autoimmun,2016,73:1-9.DOI:10.1016/j.jaut.2016.06.005.
[6] 詹江华,陈亚军.Kasai手术与肝移植治疗胆道闭锁的利弊思考[J].临床小儿外科杂志,2021,20(2):101-106.DOI:10.12260/lcxewkzz.2021.02.001. Zhan JH,Chen YJ.Advantages and disadvantages of Kasai operation and liver transplantation for biliary atresia[J].J Clin Ped Sur,2021,20(2):101-106.DOI:10.12260/lcxewkzz.2021.02.001.
[7] Zani A,Quaglia A,Hadzic’N,et al.Cytomegalovirus-associated biliary atresia:an aetiological and prognostic subgroup[J].J Pediatr Surg,2015,50(10):1739-1745.DOI:10.1016/j.jpedsurg.2015.03.001.
[8] Ortiz-Perez A,Donnelly B,Temple H,et al.Innate immunity and pathogenesis of biliary atresia[J].Front Immunol,2020,11:329.DOI:10.3389/fimmu.2020.00329.
[9] 余钟声,郑季彦,陈黎勤,等.婴儿人巨细胞病毒感染病原学和临床分析[J].中华传染病杂志,2006,24(5):333-337.DOI:10.3760/j.issn:1000-6680.2006.05.011. Yu ZS,Zheng JY,Chen LQ,et al.Pathogen and spectrum of disease in infants with human cytomegalovirus infection[J].Chin J Infect Dis,2006,24(5):333-337.DOI:10.3760/j.issn:1000-6680.2006.05.011.
[10] Xu Y,Yu JK,Zhang RZ,et al.The perinatal infection of cytomegalovirus is an important etiology for biliary atresia in China[J].Clin Pediatr (Phila),2012,51(2):109-113.DOI:10.1177/0009922811406264.
[11] Hartley JL,Davenport M,Kelly DA.Biliary atresia[J].Lancet,2009,374(9702):1704-1713.DOI:10.1016/S0140-6736(09)60946-6.
[12] 葛亮,詹江华,高伟,等.胆道闭锁Kasai术后早期行肝移植手术的危险因素分析[J].天津医药,2019,47(4):351-355.DOI:10.11958/20190343. Ge L,Zhan JH,Gao W,et al.Risk factors of early liver transplantation after Kasai procedure for biliary atresia[J].Tianjin Med J,2019,47(4):351-355.DOI:10.11958/20190343.
[13] 赵方园,詹江华.胆道闭锁患儿Kasai手术年龄选择与预后关系的研究进展[J].中华肝胆外科杂志,2022,28(10):793-796.DOI:10.3760/cma.j.cn113884-20220426-00191. Zhao FY,Zhan JH.Research advances of relationship between age at Kasai portoenterostomy and prognosis for biliary atresia[J].Chin J Hepatobiliary Surg,2022,28(10):793-796.DOI:10.3760/cma.j.cn113884-20220426-00191.
[14] 董昆,杨体泉,董淳强,等.巨细胞病毒感染与胆道闭锁Kasai手术预后的关系[J].临床小儿外科杂志,2016,15(1):23-25,45.DOI:10.3969/j.issn.1671-6353.2016.01.007. Dong K,Yang TQ,Dong CQ,et al.Relationship between cytomegalovirus infection and prognosis of biliary atresia after Kasai operation[J].J Clin Ped Sur,2016,15(1):23-25,45.DOI:10.3969/j.issn.1671-6353.2016.01.007.
[15] Fischler B,Svensson JF,Nemeth A.Early cytomegalovirus infection and the long-term outcome of biliary atresia[J].Acta Paediatr,2009,98(10):1600-1602.DOI:10.1111/j.1651-2227.2009.01416.x.
[16] 施保华,汪海霞,范泽旭,等.实验室诊断婴幼儿感染人巨细胞病毒的方法学比较[J].广东医学,2014,35(20):3218-3220.DOI:10.13820/j.cnki.gdyx.2014.20.035. Shi BH,Wang HX,Fan ZX,et al.Comparison of laboratory diagnostic methods for infants infected with human cytomegalovirus[J].Guangdong Med J,2014,35(20):3218-3220.DOI:10.13820/j.cnki.gdyx.2014.20.035.
[17] Zhao YL,Xu XD,Liu GX,et al.Prognosis of biliary atresia associated with cytomegalovirus:a meta-analysis[J].Front Pediatr,2021,9:710450.DOI:10.3389/fped.2021.710450.
[18] Shen C,Zheng S,Wang W,et al.Relationship between prognosis of biliary atresia and infection of cytomegalovirus[J].World J Pediatr,2008,4(2):123-126.DOI:10.1007/s12519-008-0024-8.
[19] 詹江华,李梦迪.胆道闭锁Kasai术后胆管炎的发病机制探讨[J].天津医药,2022,50(1):1-4.DOI:10.11958/20211092. Zhan JH,Li MD.The study on pathogenesis of cholangitis after Kasai procedure in children with biliary atresia[J].Tianjin Med J,2022,50(1):1-4.DOI:10.11958/20211092.
[20] Yu P,Li MD,Sun RJ,et al.Primary exploring the value of metagenomic next-generation sequencing in detecting pathogenic bacteria of cholangitis with biliary atresia after Kasai operation[J].Pediatr Surg Int,2022,38(12):1931-1937.DOI:10.1007/s00383-022-05254-4.
[21] 吉耿锋.胆道闭锁Kasai手术预后相关因素的分析[D].沈阳:中国医科大学,2020.DOI:10.27652/d.cnki.gzyku.2020.000633. Ji GF.Analysis of prognostic factors in Kasai operation for biliary atresia[D].Shenyang:China Medical University,2020.DOI:10.27652/d.cnki.gzyku.2020.000633.
[22] Fischler B,Czubkowski P,Dezsofi A,et al.Incidence,impact and treatment of ongoing CMV infection in patients with biliary atresia in four European centres[J].J Clin Med,2022,11(4):945.DOI:10.3390/jcm11040945.
[23] 詹江华,徐晓丹.胆道闭锁伴发巨细胞病毒感染的诊治现状[J].临床外科杂志,2021,29(6):504-507.DOI:10.3969/j.issn.1005-6483.2021.06.002. Zhan JH,Xu XD.Diagnosis and treatment of biliary atresia with cytomegalovirus infection[J].J Clin Surg,2021,29(6):504-507.DOI:10.3969/j.issn.1005-6483.2021.06.002.
[24] 徐志伟,汪洪娇,陈均亚,等.巨细胞病毒肝炎患儿的听力损伤及更昔洛韦的疗效研究[J].中国临床药理学与治疗学,2008,13(8):926-929.DOI:10.3969/j.issn.1009-2501.2008.08.019. Xu ZW,Wang HJ,Chen JY,et al.Clinical investigation of hearing impairment in children with cytomegalovirus hepatitis and curative effect of ganciclovir[J].Chin J Clin Pharmacol Ther,2008,13(8):926-929.DOI:10.3969/j.issn.1009-2501.2008.08.019.
[25] Mareri A,Lasorella S,Iapadre G,et al.Anti-viral therapy for congenital cytomegalovirus infection:pharmacokinetics,efficacy and side effects[J].J Matern Fetal Neonatal Med,2016,29(10):1657-1664.DOI:10.3109/14767058.2015.1058774.
相似文献/References:
[1]毛永忠,汤绍涛,阮庆兰,等.胆道闭锁肝组织MMP-1、MMP-2、TIMP-1的表达与预后研究[J].临床小儿外科杂志,2007,6(01):5.
[2]毛永忠,汤绍涛,阮庆兰,等.胆道闭锁肝脏组织MMP-2、TGF-β_1的表达及意义[J].临床小儿外科杂志,2007,6(03):5.
[3]余梦楠 刘钢 黄柳明 王伟. 胆道闭锁术后反复发作性胆管炎的细菌谱分析及抗生素选择[J].临床小儿外科杂志,2012,11(03):187.
[J].Journal of Clinical Pediatric Surgery,2012,11(03):187.
[4]董淳强 杨体泉 董昆. 胆道闭锁术后早期胆管炎风险因素分析[J].临床小儿外科杂志,2013,12(05):348.
[5]陈功 郑珊 孙松. 不同年龄胆道闭锁患儿手术效果分析[J].临床小儿外科杂志,2014,13(01):22.
[6]谭梅军 陶强 黄金狮. IL-17在胆道闭锁患儿肝组织中的表达及意义[J].临床小儿外科杂志,2014,13(04):302.
[7]杨文萍 吴艳 张守华. 胆道闭锁患者肝脏组织病理改变的综合评价[J].临床小儿外科杂志,2015,14(01):10.
[8]李康 阳历 汤绍涛. 胆道闭锁患者肝内胆管γδT 细胞和调节性T细胞浸润及意义[J].临床小儿外科杂志,2015,14(01):16.
[9]刘丹丹 詹江华 高伟. 胆道闭锁患者肝门的病理解剖学研究[J].临床小儿外科杂志,2015,14(01):20.
[10]张震 李龙 乔国梁. 胆道闭锁Kasai术后生存率及条件生存率分析[J].临床小儿外科杂志,2015,14(01):25.
备注/Memo
收稿日期:2022-12-7。
基金项目:天津市科技局重大专项(21ZXGWSY00070);新疆维吾尔自治区自然科学基金(2022D01A27、2021D01A38);天津大学儿童医院面上项目(Y2020002)
通讯作者:詹江华,Email:zhanjianghuatj@163.com