婴儿巨细胞病毒肝炎临床特点及中医治疗临床疗效观察

发布时间：2018-09-03 16:23

【摘要】：目的：通过前瞻性的中西药对照观察,总结婴儿巨细胞病毒肝炎中西医的临床特点,并探索中药治疗婴儿CMV肝炎的疗效及与病毒抑制、胆汁淤积的改善和肝功能恢复的关系,同时了解中药抑制CMV的远期效果,制定出婴儿CMV肝炎较为规范的诊断标准及中西医治疗方案,降低长时间胆汁淤积、肝细胞损害所引发肝硬变的风险,提高患儿的生存率。方法：通过前瞻性的中西药对照观察,将43例婴儿CMV肝炎患儿随机分为两组,即治疗组及对照组,根据辅助检查,收集入院时、治疗2周时及治疗4周时的临床资料进行对比总结。结果采用SAS8.0软件,对相关资料进行统计分析,计量资料符合正态分布的用方差分析,不符合正态分布的计量资料及计数资料行秩和检验。结果：1.婴儿巨细胞病毒肝炎约占86.1%的患儿以“皮肤巩膜黄染”而入院,少数患儿不表现出黄疸症状。2.婴儿巨细胞病毒肝炎具有呼吸系统、消化系统、循环系统、血液系统、神经系统等多系统损害的临床特点。3.治疗2周时,治疗组的总有效率为95.45%,明显高于对照组的有效率71.43%,而且在痊愈率上治疗组明显高于对照组,两组在统计学上通过卡方检验计算,F=0.0430,小于0.05,有统计学意义,说明治疗组与对照组在疗效上存在统计学差别。对两组病例各方面进行统计学比较,主要结果为：①在退黄率上,治疗组为57.89%,对照组为22.22%,经卡方检验,P=0.0448,小于0.05,有统计学意义。②在降胆红素方面,治疗组患儿胆红素值下降均值为85.78umol/L,而对照组为37.65umol/L,对两组患儿胆红素下降值之间进行秩和检验,Z=0.0062,小于0.05,有统计学意义。③治疗组在治疗2周时ALP下降均值为98,而对照组为54,二者进行秩和检验,Z=0.02514,小于0.05,有统计学意义；同时治疗组GGT下降均值为89,对照组为73,两组进行秩和检验,Z=0.04382,小于0.05,有统计学意义。4.治疗4周时,治疗组的总有效率为95.45%,明显高于对照组的有效率66.67%,两组在统计学上通过卡方检验计算,F=0.0343,小于0.05,有统计学意义,说明治疗组与对照组在疗效上存在统计学差别。对两组病例各方面进行统计学比较,主要结果为：①复查B超情况对比,治疗组在肝脏缩小治疗的有效率上高于对照组,且通过卡方检验,Z=0.0227,有统计学意义。②在降ALT方面,治疗组患儿ALT下降值均值为75.16U/L,而对照组为51.63/L,对两组患儿ALT下降值之间进行秩和检验,Z=0.0437,小于0.05,有统计学意义。③治疗组在治疗2周时ALP下降均值为105,而对照组为81,二者进行秩和检验,Z=0.0347,小于0.05,有统计学意义；同时治疗组GGT下降均值为97,对照组为83,两组进行秩和检验,Z=0.04519,小于0.05,有统计学意义。结论：1.通过对43例巨细胞病毒肝炎患儿进行总结,多数患儿以皮肤巩膜黄染而入院,少数患儿入院时不伴有黄疸症状。2.婴儿巨细胞病毒肝炎多表现为胆汁淤积性肝炎。3.婴儿巨细胞病毒肝炎具有病史长、并发症多等临床特点。4.通过治疗组与对照组的比较总结,治疗组在改善胆汁淤积和恢复肝功能方面优于对照组,可以看出本研究在治疗婴儿巨细胞病毒肝炎发挥很大作用,并证实了裴学义教授治疗婴儿巨细胞病毒肝炎的临床经验,即早期以黄疸为主,恢复期以肝酶升高为主,在治疗上分为两个阶段,即利胆退黄期与益肝降酶期。
[Abstract]:Objective: To summarize the clinical characteristics of infantile cytomegalovirus hepatitis (CMV) treated with traditional Chinese medicine and Western medicine, and to explore the relationship between the efficacy of traditional Chinese medicine and viral suppression, improvement of cholestasis and recovery of liver function in infantile CMV hepatitis. Diagnostic criteria and traditional Chinese and Western medicine treatment can reduce the risk of cirrhosis caused by prolonged cholestasis and liver cell damage, and improve the survival rate of children.
Methods:43 infants with CMV hepatitis were randomly divided into treatment group and control group by prospective comparison of traditional Chinese and Western medicine.According to the auxiliary examination,the clinical data of admission,treatment for 2 weeks and treatment for 4 weeks were collected and summarized.Results SAS 8.0 software was used to analyze the relevant data,and the measurement data accorded with each other. The normal distribution is analyzed by variance analysis, and the rank sum test is not used to measure the data of normal distribution and count data.
Results: 1. About 86.1% of the infants with cytomegalovirus hepatitis were hospitalized with "skin and sclera yellow stain" and a few of them did not show jaundice symptoms. 2. Infant cytomegalovirus hepatitis has the clinical characteristics of respiratory system, digestive system, circulatory system, blood system, nervous system and other system damage. 3. In the treatment group, the total has two weeks. Efficiency was 95.45%, significantly higher than the control group 71.43%, and the cure rate in the treatment group was significantly higher than the control group, the two groups were statistically calculated by Chi-square test, F = 0.0430, less than 0.05, statistically significant, indicating that the treatment group and the control group in the curative effect of statistical differences. The main results were as follows: (1) In the yellowing rate, the treatment group was 57.89% and the control group was 22.22%. Chi-square test showed that P = 0.0448, less than 0.05, had statistical significance. 2) In the aspect of reducing bilirubin, the mean decrease of bilirubin value in the treatment group was 85.78 umol/L, while that in the control group was 37.65 umol/L. Rank sum test was conducted between the two groups, Z = 0.65 umol/L. The mean value of ALP in the treatment group was 98 at 2 weeks, while that in the control group was 54. The mean value of GGT in the treatment group was 89 and that in the control group was 73. The total effective rate of the treatment group was 95.45%, which was significantly higher than that of the control group (66.67%). The two groups were statistically calculated by Chi-square test, F = 0.0343, less than 0.05. There was statistical significance, indicating that the treatment group and the control group had statistical differences in curative effect. Compared with the control group, the effective rate of liver shrinkage treatment in the treatment group was higher than that in the control group, and through the chi-square test, Z = 0.0227, with statistical significance. Significance. 3) The mean value of ALP decrease was 105 in the treatment group and 81 in the control group at 2 weeks of treatment. The two groups were tested by rank sum test, Z = 0.0347, less than 0.05, and the mean value of GGT decrease was 97 in the treatment group and 83 in the control group. The two groups were tested by rank sum test, Z = 0.04519, less than 0.05, with statistical significance.
Conclusion: 1. Through summarizing 43 cases of cytomegalovirus hepatitis, most of them were hospitalized with skin and sclera yellow staining, a few of them were not accompanied with jaundice symptoms. 2. Infant cytomegalovirus hepatitis mostly manifested as cholestatic hepatitis. 3. Infant cytomegalovirus hepatitis has a long history and many complications. 4. Through treatment. Compared with the control group, the treatment group was superior to the control group in improving cholestasis and restoring liver function. It can be seen that this study played a great role in the treatment of infantile cytomegalovirus hepatitis, and confirmed Professor Pei Xueyi's clinical experience in treating infantile cytomegalovirus hepatitis, that is, jaundice was the main treatment in the early stage and hepatic enzyme was the main treatment in the recovery stage. The treatment is mainly divided into two stages, namely, the gallbladder and the yellow and the liver.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R272

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