婴幼儿和儿童中与巨细胞病毒感染相关的急性中耳炎

Yano Hisakazu, Okitsu Naohiro, Watanabe Oshi, Kisu Tomoko, Hori Toru, Hatagishi Etsuko, Okamoto Michiko, Ohmi Akira, Yamada Ken-ichiro, Sagai Shun, Suetake Mitsuko, Kobayashi Toshimitsu, Nishimura Hidekazu

Virus Research Center, Clinical Research Division, Sendai Medical Center, Miyagino-ku, Sendai 983-8520, Japan.

Int J Pediatr Otorhinolaryngol. 2007 Sep;71(9):1443-7. doi: 10.1016/j.ijporl.2007.05.025. Epub 2007 Jul 5.

OBJECTIVE

Acute otitis media (AOM) is one of the most common complications of viral respiratory tract infections in children, but the role of each virus is still to be elucidated. We analyzed AOM associated with infection by cytomegalovirus (CMV), which is known as one of the major causes of viral respiratory tract infection.

METHODS

Four hundred and ninety-five children (292 boys and 203 girls) diagnosed as having AOM in 2002 were studied. All of the children were under 6 years old, with the average age being 1.31+/-1.36 years. Bacterial and viral culture of both nasopharyngeal secretions (NPS) and middle ear fluid (MEF) was performed in all 495 children. The levels of glutamyl pyruvic transaminase (GPT) and the serum IgM antibody for CMV were measured. CMV infection was defined on the basis of isolation of this virus by culture and/or positive anti-CMV IgM antibody. NPS and MEF specimens of the subjects diagnosed as having CMV infection were tested for the virus by nested PCR.

RESULTS

Twelve of the 495 children were found to have CMV infection. They included 6 boys and 6 girls aged from 3 to 25 months, with the average age being 11+/-7 months. Among 10 children in whom CMV infection was diagnosed by viral culture, CMV was isolated from NPS alone in nine cases and from both NPS and MEF in one case. Nested PCR was performed in all 12 subjects diagnosed as having CMV infection, and all NPS samples were positive, as were 8 MEF samples. We obtained serum samples from 205 children under 2 years of age, including 9 with CMV infection. The mean serum GPT level of 124 children in whom no viruses were detected was 20.7+/-14.4 IU/L. While, the serum GPT levels of 9 children with CMV infection ranged from 10 to 280 IU/L with the average titer being 78.4+/-81.9 IU/L, and the GPT levels of the children with CMV infection were significantly higher than those of the children in whom no viruses were detected (p<0.05).

CONCLUSION

Our results suggested that CMV is a causative pathogen of AOM, and that CMV infection should be suspected in patients with AOM and liver dysfunction.

目的

急性中耳炎（AOM）是儿童病毒性呼吸道感染最常见的并发症之一，但每种病毒的作用仍有待阐明。我们分析了与巨细胞病毒（CMV）感染相关的AOM，CMV是病毒性呼吸道感染的主要病因之一。

方法

对2002年诊断为AOM的495名儿童（292名男孩和203名女孩）进行研究。所有儿童均未满6岁，平均年龄为1.31±1.36岁。对所有495名儿童的鼻咽分泌物（NPS）和中耳液（MEF）进行细菌和病毒培养。检测谷丙转氨酶（GPT）水平和CMV血清IgM抗体。CMV感染根据通过培养分离出该病毒和/或抗CMV IgM抗体阳性来定义。对诊断为CMV感染的受试者的NPS和MEF标本进行巢式PCR检测病毒。

结果

495名儿童中有12名被发现感染CMV。他们包括6名男孩和6名女孩，年龄在3至25个月之间，平均年龄为11±7个月。在通过病毒培养诊断为CMV感染的10名儿童中，9例仅从NPS中分离出CMV，1例从NPS和MEF中均分离出CMV。对所有12名诊断为CMV感染的受试者进行巢式PCR检测，所有NPS样本均为阳性，8份MEF样本也为阳性。我们从205名2岁以下儿童中获取血清样本，其中9名感染CMV。124名未检测到病毒的儿童的平均血清GPT水平为20.7±14.4 IU/L。而9名感染CMV的儿童的血清GPT水平在10至280 IU/L之间，平均滴度为78.4±81.9 IU/L，感染CMV的儿童的GPT水平显著高于未检测到病毒的儿童（p<0.05）。