Vig Ayushi, Elhence Poonam, Rathod Kirtikumar J, Nayak Shubhalaxmi, Jadhav Avinash Sukdev, Pathak Manish, Saxena Rahul, Sinha Arvind
Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
J Indian Assoc Pediatr Surg. 2023 Jan-Feb;28(1):5-8. doi: 10.4103/jiaps.jiaps_92_22. Epub 2023 Jan 10.
Biliary atresia is known to have a multifactorial etiology and perinatal infection with hepatotropic viruses such as cytomegalovirus (CMV) is a probable trigger in a subset of patients. The aim of the current study is to evaluate the effects of CMV association of biliary atresia on the initial presentation of patients and their response to Kasai portoenterostomy.
We conducted a retrospective, single-center study on 20 patients of biliary atresia and classified them into two groups based on their CMV immunoglobulin M (IgM) positivity. We compared the age of initial presentation, the liver biochemistry at presentation, immediate and delayed follow-up, rate of jaundice clearance following Kasai portoenterostomy, and histopathology of liver between the two groups. Data were reported in terms of means, and < 0.05 was considered significant.
Out of 20 cases of biliary atresia, 60% ( = 12) were CMV IgM positive. Infants with CMV-positive status were noted to be older at presentation (88.5 days [65-150 days] vs. 83 days [45-160 days] < 0.05) were more jaundiced at presentation (total bilirubin - 13.51 mg/dl [9.09-15.99 mg/dl] vs. 11.83 mg/dl [6.5-13.5 mg/dl] < 0.05), had higher alkaline phosphatase (751.2 IU/L [387-1951 IU/L] vs. 621.75 IU/L [172-857 IU/L] < 0.05), higher gamma-glutamyl transferase levels (505.58 IU/L [376-1127 IU/L] vs. 376.75 IU/L [186-624 IU/L] < 0.05), and had higher incidence of splenomegaly. The rate of resolution of jaundice postKasai portoenterostomy was also evidently less in CMV-positive patients. Four out of 12 patients have bilirubin >2 mg/dl at a 6-month follow-up.
CMV-associated biliary atresia patients have delayed initial presentation and impaired jaundice clearance postKasai portoenterostomy. The role of antiviral therapy should be studied in this subset of patients.
已知胆道闭锁病因是多因素的，围生期感染嗜肝病毒如巨细胞病毒（CMV）可能是部分患者的触发因素。本研究旨在评估CMV相关性胆道闭锁对患者初始表现及其对Kasai肝门空肠吻合术反应的影响。
我们对20例胆道闭锁患者进行了一项回顾性单中心研究，并根据其CMV免疫球蛋白M（IgM）阳性情况将他们分为两组。我们比较了两组患者的初始就诊年龄、就诊时的肝脏生化指标、即刻和延迟随访情况、Kasai肝门空肠吻合术后黄疸清除率以及肝脏组织病理学。数据以均值表示，P<0.05被认为具有统计学意义。
在20例胆道闭锁病例中，60%（n=12）为CMV IgM阳性。CMV阳性状态的婴儿就诊时年龄较大（88.5天[65 - 150天]对83天[45 - 160天]，P<0.05），就诊时黄疸更严重（总胆红素 - 13.51mg/dl[9.09 - 15.99mg/dl]对11.83mg/dl[6.5 - 13.5mg/dl]，P<0.05），碱性磷酸酶水平更高（751.2IU/L[387 - 1951IU/L]对621.75IU/L[172 - 857IU/L]，P<0.05），γ-谷氨酰转移酶水平更高（505.58IU/L[376 - 1127IU/L]对376.75IU/L[186 - 624IU/L]，P<0.05），脾肿大发生率更高。Kasai肝门空肠吻合术后CMV阳性患者的黄疸消退率也明显较低。12例患者中有4例在6个月随访时胆红素>2mg/dl。
CMV相关性胆道闭锁患者初始就诊延迟，Kasai肝门空肠吻合术后黄疸清除受损。应研究抗病毒治疗在这部分患者中的作用。
