与巨细胞病毒感染和胆道闭锁相关的问题。

Problems related to CMV infection and biliary atresia.

机构信息

University of Stellenbosch, South Africa.

出版信息

S Afr Med J. 2012 Sep 11;102(11 Pt 2):890-2. doi: 10.7196/samj.6163.

DOI:10.7196/samj.6163

PMID:23116753

Abstract

BACKGROUND

Human cytomegalovirus (CMV) infection is related to biliary disease, being cholestatic in its own right. It has also been associated with intrahepatic bile duct destruction and duct paucity, indicating a possible role in extrahepatic biliary atresia pathogenesis and progression. When related to biliary atresia CMV IGM positive patients appear to have more liver damage thus affecting outcome. Methods We carried out a retrospective chart review on 74 patients diagnosed with hepatobiliary disease (2000-2011).

METHODS

included clinical and outcome review as well as evaluation of potential risk factors. Patients were divided into 2 groups those with biliary atresia and those without Biliary atresia (BA). The 2 groups were compared in terms of CMV infection.

RESULTS

Of the 74 patients with hepatobiliary disease investigated, 39 (52%) were shown to have Biliary atresia and 35 other cases. 12 of the BA group and 4 of the non-BA were excluded due to lack of data Twenty-seven (69%) of the biliary atresia group had sufficient available data for review. Of these, 21 (78% of the 27) had CMV positivity (IgM/IgG) on testing, with 20 of these being IgM positive versus 8 in the non-biliary atresia group. (p<0.01) Two (7.5%) of 27 BA infants were HIV exposed being born to HIV positive mothers whereas HIV positivity was observed in 7 (35%) of the non-biliary atresia group (p<0.01). Both of these biliary atresia infants were CMV IgM positive. Long- term outcome of the 21 with CMV positivity showed 3 deaths (non-HIV exposed) and a higher rate of severe early liver damage suggesting a poorer outcome in CMV affected patients.

CONCLUSIONS

This study suggests a correlation between CMV exposure, infection and surgical hepatobiliary disease including biliary atresia affecting outcome.HIV positivity does not preclude Biliary atresia and should be further investigated.

摘要

背景

人巨细胞病毒（CMV）感染与胆道疾病有关，本身就是胆汁淤积性的。它也与肝内胆管破坏和胆管稀少有关，表明其在肝外胆道闭锁的发病机制和进展中可能起作用。当与胆道闭锁相关时，CMV IgM 阳性患者似乎有更多的肝脏损伤，从而影响结果。

方法

我们对 74 例（2000-2011 年）诊断为肝胆疾病的患者进行了回顾性图表回顾。

方法

包括临床和结局评估以及潜在危险因素的评估。患者分为两组，一组为胆道闭锁组，另一组为非胆道闭锁组（BA）。两组比较 CMV 感染情况。

结果

在所研究的 74 例肝胆疾病患者中，有 39 例（52%）为胆道闭锁，另有 35 例。BA 组中有 12 例和非 BA 组中有 4 例因缺乏数据而被排除在外。27 例（BA 组的 69%）胆道闭锁患者有足够的数据进行回顾。其中，21 例（27 例的 78%）检测到 CMV 阳性（IgM/IgG），其中 20 例为 IgM 阳性，而非胆道闭锁组为 8 例。（p<0.01）27 例 BA 婴儿中有 2 例（7.5%）为 HIV 暴露，出生于 HIV 阳性母亲，而非胆道闭锁组有 7 例（35%）为 HIV 阳性（p<0.01）。这两个胆道闭锁婴儿均为 CMV IgM 阳性。21 例 CMV 阳性患者的长期预后显示 3 例死亡（非 HIV 暴露），且早期严重肝损伤发生率较高，表明 CMV 感染患者预后较差。