应用聚合酶链反应检测新生儿胆汁淤积症婴儿肝组织中的巨细胞病毒。

Detection of Cytomegalovirus in Liver Tissue by Polymerase Chain Reaction in Infants With Neonatal Cholestasis.

机构信息

From the Department of Pediatric Infectious Diseases and Pediatric Hepatology.

Department of Biochemistry, National Institute for Research in Reproductive Health (ICMR), Mumbai, India.

出版信息

Pediatr Infect Dis J. 2018 Jul;37(7):632-636. doi: 10.1097/INF.0000000000001889.

DOI:10.1097/INF.0000000000001889

PMID:29389827

Abstract

AIM

Cytomegalovirus (CMV) is associated with neonatal cholestasis (NC). Diagnosis of CMV infection is most often based on either positive blood CMV IgM or CMV blood polymerase chain reaction (PCR). Isolation of CMV in liver tissues in patients with NC has rarely been reported. This study was undertaken to see if CMV is present in liver tissues of patients with NC and evaluate the correlation between positive CMV PCR in liver tissue with the serology and blood PCR.

METHODS

This study was conducted in 31 infants with NC from June 2015 to December 2016. All patients underwent blood CMV IgM, blood CMV PCR and liver CMV PCR. Prevalence of CMV in NC based on positive liver CMV PCR was calculated. Sensitivity and specificity of the serologic markers and blood CMV PCR to identify CMV infection in the liver was determined.

RESULTS

CMV IgM was positive in 13 (42%) patients, CMV IgG was positive in 26 (84%) patients and blood CMV PCR was positive in 23 (74%) patients. Liver CMV PCR was positive in 16 (52%) patients. Fifteen (48%) patients had biliary atresia (BA), 10 (32%) patients had neonatal hepatitis, 5 (16%) had paucity of bile ducts and 1 (3%) had ascending cholangitis. Of the 16 patients with positive liver CMV PCR, 8 (50%) had BA, 4 (25%) had neonatal hepatitis, 3 (19%) had paucity of bile ducts and 1 (6%) had ascending cholangitis. Sensitivity of blood CMV IgM in relation to liver CMV PCR was 69% and specificity was 61%. Sensitivity of blood CMV PCR was 61% and specificity was 71% when compared with liver CMV PCR.

CONCLUSION

CMV is present in the liver tissues of more than half the patients with NC. Serology or blood CMV PCR is apparently not an accurate marker of CMV in the liver tissue. Also, CMV infection in children seems to be associated equally with BA or non-BA neonatal hepatitis.

摘要

目的

巨细胞病毒（CMV）与新生儿胆汁淤积症（NC）有关。CMV 感染的诊断最常基于血液 CMV IgM 阳性或 CMV 血液聚合酶链反应（PCR）。在 NC 患者的肝组织中分离出 CMV 的情况很少见。本研究旨在观察 CMV 是否存在于 NC 患者的肝组织中，并评估肝组织中 CMV PCR 阳性与血清学和血液 PCR 的相关性。

方法

本研究于 2015 年 6 月至 2016 年 12 月对 31 例 NC 婴儿进行，所有患者均行血 CMV IgM、血 CMV PCR 和肝 CMV PCR。根据肝 CMV PCR 阳性计算 NC 中 CMV 的患病率。确定血清学标志物和血液 CMV PCR 对识别肝 CMV 感染的敏感性和特异性。

结果

13 例（42%）患者 CMV IgM 阳性，26 例（84%）患者 CMV IgG 阳性，23 例（74%）患者血液 CMV PCR 阳性，16 例（52%）患者肝 CMV PCR 阳性。15 例（48%）患者为胆道闭锁（BA），10 例（32%）患者为新生儿肝炎，5 例（16%）患者为胆管稀少，1 例（3%）患者为上行性胆管炎。16 例肝 CMV PCR 阳性患者中，8 例（50%）为 BA，4 例（25%）为新生儿肝炎，3 例（19%）为胆管稀少，1 例（6%）为上行性胆管炎。血液 CMV IgM 与肝 CMV PCR 相关的敏感性为 69%，特异性为 61%。与肝 CMV PCR 相比，血液 CMV PCR 的敏感性为 61%，特异性为 71%。