【作者】 刘红；

【导师】 杨波；

【作者基本信息】 山东大学 ， 儿科， 2007， 硕士

【摘要】 目的：探讨婴儿肝炎综合症(婴肝)病因、临床表现、并发症及针对病因的相关治疗及疗效评价。方法：对符合婴儿期起病、黄疸、肝脏肿大和肝功能障碍特征的44例病例，进行临床资料的回顾性分析，采用酶联免疫吸附试验法检测血清病毒抗原抗体，进行相关影像学检查及代谢病筛查等。对其中符合TORCH病毒感染的21例予以更昔洛韦进行治疗。结果：1．44例病例中24例明确为感染相关性，其中TORCH感染21例，占47.7％，包括单纯巨细胞病毒感染11例；巨细胞病毒合并其他病毒感染8例；单纯的疱疹病毒感染1例。乙肝病毒感染7例，占15.9％，其中4例合并TORCH感染，占9.1％。可疑先天性胆道病变5例，占11.4％，其中有2例通过剖腹探查证实，予以肝门空肠吻合术，术后效果较好。1例苯丙酮尿症。1例胆道结石。1例孕期有家犬咬伤史。病因不明12例，占27.3％。2．44例皆以黄疸不退或退而复现首诊；43例合并呼吸道感染，占97.7％；26例合并消化系统感染，占59.1％；5例并发颅内出血，5例合并心血管畸形，5例合并脐疝，各占11.4％。查体42例肝脏增大，占95.4％。44例均有不同程度肝功能损害。3．44例临床病例给予保肝利胆、利湿退黄、能量支持及祛除病因等治疗，14天一疗程，ALT、TBIL、DBIL及肝脏大小等指标显著降低(p＜0.001)，1～3疗程有效率为86.4％。4．临床治愈6例，占13.6％；显效15例，占34.1％；有效17例，占38.6％；无效6例(其中3例仅住院3天自动出院)，占13.6％。结论：1．婴肝常见病因有感染、先天性代谢缺陷及肝胆发育异常等，其中以TORCH感染比例最大，感染率47.7％；乙肝母婴传播不可忽视，感染率15.9％。2．婴肝患儿多以黄疸持续不退或退而复现首诊，肝脏增大占95.4％，实验室检查肝功能异常占100％，胆红素水平明显增高，直接胆红素与总胆比值多在40％～50％。3．婴肝合并多系统病变，常并发畸形、多系统继发感染、颅内出血、甲低及皮疹等。继发呼吸道感染率达97.7％。4．予以保肝利胆、利湿退黄、能量支持及病因祛除等治疗，明确病毒感染相关者，合理应用更昔洛韦，对于胆道闭锁、胆总管囊肿等病例，强调早期手术。5．44例治疗结果显示有效率为86.4％。更多还原

【Abstract】 Objective : To analyze the etiology .clinical features and therapy efficacy of infantile hepatitis syndrome .Methods : Retrospective analysis of the database was performed on patients present with the onset of infant . jaundice , hepatomegaly and liver function abnormalities . Detect TORCH-IgM and TORCH-IgG by the way of enzyme-linked immunosorbent assay , also adopt imageology and metabolic disease screening methods . 21 cases infected by TORCH were treated with Ganciclovir .Results :1. Of the 44 patients with infantile hepatitis syndrome , 24 of which were identified to be infected by pathogenic micro-organism , the infective rate was 54.5%; 21 cases were infected by TORCH (47.7%) . 11 only by CMV , and 8 by CMV compared with other viruses ;1 only by HSV ; 7 cases were caused by HBV infection , 4 of which were complicated with TORCH infection ; and 5 cases suffered from congenital liver and gall dysplasia , among which 2 cases were identified to be congenital cholangioclse and accepted operation named Kasai. 12 cases are still etiology-unknown(27.3%).2. Ail cases came for persisitent jaudance or delayed regression , and 43 combined with respiratory infection(97.7%) ;26 with alimentary system infection (59.1%) ; 5 with intracranial hemorrhage , 5 with cardiovascular system malformation , 5 with umbilical hernia , each takes 11.4% . Physical examination indicated that 42 occurred hepatomegaly (95.4%). 44 cases suffered Hepatic function damage . 3. 44 cases were offered ordinary therapy , 14 days were set as a course of treatment,indexes for evaluating curative effects such as ALT , TBIL , DBIL and liver size degraded markedly (p<0.001) . Effective power came to 86.4% after 1 to 3 courses of treatment.4. 6 cases were curinged , percentage was 13.6% ; 15 excellence , took 34.1% ; 17 utility ones , percentage was 38.6% ; and 6 were invalid ones (including 3 cases voluntarily discharge ), took 13.6% .Conclusion :1. Infection is still the chief cause of infant hepatitis syndrome, in which TORCH infection takes the main parts , infection rate is 47.7% ; and HBV infection can not be ignored , most cases are infected by the way of vertical transmission , infection rate is 15.9% .2. Most cases came for persisitent jaudance or delayed regression , Physical examination indicated that 42 occurred hepatomegaly (95.4%) . 44 cases suffered Hepatic function damage .and bilirubin lever increases , ratio of direct bilirubin in total fluctuates 40% to 50% .3. IFH usually combines with multisystem damages , such as malformation , secondary infections , intracranial hemorrhage , thyroid hypofunction and skin rash , et al. The respiratoy infection rate is 97.7% .4. Supplying ordinary therapy , curing cases infected by viruses with Ganciclouir and operating on infants with biliary atresia or choledochal cyst.5. Effective power came to 86.4% after 1 to 3 courses of treatment.更多还原