围生期巨细胞病毒感染的影响因素及回顾性临床研究

发布时间：2018-03-08 16:02

本文选题：巨细胞病毒　切入点：围生期　出处：《上海交通大学》2014年硕士论文　论文类型：学位论文

【摘要】：第一部分围生期巨细胞病毒感染影响因素之多因素分析研究目的通过回顾性队列研究分析围生期巨细胞病毒（Cytomegalovirus，CMV）感染的流行病学资料，探讨我院围生期CMV感染患儿的危险因素，以期降低围生期CMV感染的发生率。方法回顾性分析上海交通大学医学院附属新华医院儿内科2011-2012年期间围生期CMV感染住院患儿的临床资料，通过比较围生期CMV感染患儿（病例组）与同期非CMV感染患儿（对照组）之间各种相关因素的差异，先采用单因素检验筛选出有统计学意义的变量，再对这些变量进行向前逐步回归Logistic回归分析，最终得出有统计学意义的婴儿围生期CMV感染的危险因素。结果本研究有效病例即资料完整病例共325例，其中病例组109例（33.5%），对照组216例（66.5%）。两组间单因素检验发现患儿性别、出生体重百分位数、出生方式、胎膜早破、喂养方式、母亲妊娠期糖尿病、母亲妊娠期上呼吸道感染史、母亲吸烟史及低人均年收入家庭之间的差异具有统计学意义。均纳入向前逐步Logistic回归分析中，得出多因素分析结果，即：患儿为小于胎龄儿、经阴道分娩、胎膜早破及生后母乳喂养均可增加患儿感染CMV风险的独立危险因素。OR（95%CI）分别为3.630（1.520，8.665），1.845（1.107，3.075），1.851（1.020，3.359）和1.992（1.155，3.569）。结论母乳喂养、胎膜早破和阴道分娩是围生期CMV感染的高危因素，尤其需加强小于胎龄儿的围生期管理。第二部分围生期巨细胞病毒感染5年临床总结及发育评估目的研究围生期巨细胞病毒（CMV）感染的的发病情况、临床特征、治疗、预后及影响更昔洛韦疗效的危险因素。方法回顾性分析2008年至2012年临床诊断为围生期CMV感染的237例住院患儿的临床资料。关于更昔洛韦疗效的影响因素研究，先采用单因素检验筛选出有统计学意义的变量，再对这些变量进行向前逐步回归Logistic回归分析，最终得出有统计学意义的影响因素。以P≤0.05为差异具有统计学意义。对门诊随访病人采集体格检查和智力测试结果（MDI、PDI评分及Gesell发育量表），并作统计学分析。结果5年间围生期CMV感染患儿的基本特征及占同期总住院患儿的比例无明显差异。其中，早产儿31例（13%），小于胎龄儿42例（17.7%）。患儿多为2个或2个以上系统受累，CMV肝炎合并CMV肺炎（43.1%）为最常见的临床类型，先天畸形发生率为8.02%（19例）。病原学检测结果提示血CMV-IgM及血/尿CMV-DNA均阳性为3.8%，仅血CMV-IgM阳性为90.3%，仅血/尿CMV-DNA阳性为5.9%。脑干听觉诱发电位中至重度异常3例。197例围生期CMV感染患儿接受了更昔洛韦治疗，88.3%（174/197）患儿治疗后临床表现好转。母孕史异常（OR=6.191，95%CI为1.597～24.002）和用药前患儿肝脏受累（OR=3.705，95%CI为1.537～8.931）是影响更昔洛韦对围生期CMV感染患儿疗效的独立危险因素。围生期CMV感染患儿在满6月龄和1周岁时的体格生长水平及智力发育与正常婴幼儿无明显差别，但语言发育水平明显落后正常同龄儿（P＜0.05）。结论围生期CMV感染患儿近5年的流行病学特征较为稳定。CMV常侵犯患儿多个脏器或系统，以肝脏和肺损害最常见。更昔洛韦抗病毒疗效明显，副作用发生率较低。母孕史异常和用药前患儿肝脏受累是影响更昔洛韦对围生期CMV感染患儿疗效的独立危险因素。除语言发育迟缓外，围生期CMV感染对婴儿的健康和发育无明显影响。第三部分围生期巨细胞病毒感染与生后感染临床特点比较目的研究围生期巨细胞病毒（CMV）感染和生后巨细胞病毒感染的的临床特征、治疗及预后。方法回顾性分析并比较2008年至2012年临床诊断为围生期CMV感染和生后CMV感染的406例住院患儿的临床资料，，包括一般情况、临床表现、实验室检查、靶器官损害情况及治疗等。结果5年间围生期CMV感染和生后CMV感染患儿共406例，占同期全部入院患儿的1.88%，其中围生期CMV感染患儿237例，占58.4%，生后CMV感染患儿169例，占41.6%，围生期CMV感染患儿每年入院人数均高于生后CMV感染患儿入院人数，且NICU/PICU入住率明显增高，住院时间延长、住院费用高（P＜0.05）。围生期CMV感染患儿临床表现多为肝脾肿大和黄疸的，而生后CMV感染患临床表现多为喘息及皮肤瘀点瘀斑。患儿多为2个或2个以上系统受累，围生期CMV感染患儿常见的临床类型有CMV肝炎合并CMV肺炎（43.1%），CMV肝炎合并心肌损害（16.7%），CMV肺炎合并呕吐、纳差、腹泻等消化系统症状（8.7%）；而生后CMV感染患儿常见的临床类型有CMV肺炎合并CMV肝炎（37.1%），CMV肺炎合并血液系统损害（28.3%），CMV肺炎合并心肌损害（12.1%），CMV脑炎合并CMV肝炎（3.3%）等。两组间在CMV-IgM阳性率、更昔洛韦使用率及副作用发生率上的差异无明显统计学意义，而生后CMV感染患儿的临床好转率明显高于围生期CMV感染患儿。结论CMV常侵犯患儿多个脏器或系统，以肝脏和肺损害最常见。围生期CMV感染主要累及肝胆系统及呼吸系统，而生后CMV感染主要累及呼吸系统及血液系统，但后者病情一般较轻，预后较好。围生期CMV感染和生后CMV感染发病情况、临床特点及严重程度的区别，主要是与感染途径、感染发生的时间、CMV病毒毒力和患儿机体的免疫功能有关。无论何种类型CMV感染，更昔洛韦抗病毒疗效明显，副作用发生率均较低。
[Abstract]:Analysis of factors affecting perinatal cytomegalovirus infection
Objective to analyze the epidemiological data of Cytomegalovirus (CMV) infection in perinatal period through retrospective cohort study, and explore the risk factors of perinatal CMV infection in our hospital, so as to reduce the incidence of CMV infection in perinatal period.
Methods a retrospective analysis of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine during 2011-2012 years in the clinical data of hospitalized children born during CMV infection, by comparing the perinatal CMV infection (case group) compared with non CMV infection group (control group) between the various relevant factors of the differences, first by single factor test were statistically significant the variable, then the variable forward stepwise Logistic regression analysis, finally obtains the statistically significant risk factors of perinatal infant CMV infection.
The results of this study were as effective data of 325 cases, 109 cases (33.5%), 216 cases in the control group (66.5%). Among the two groups of single factor test showed that children with gender, birth weight percentile, birth, premature rupture of membranes, feeding, mother gestational diabetes, pregnancy the history of upper respiratory tract infection, the difference was statistically significant between mother smoking and low per capita income of the family. Are included in the forward stepwise Logistic regression analysis, the results of multivariate analysis, namely: children for gestational age, vaginal delivery, and postnatal breastfeeding can increase the independent risk factors for.OR infection in children with CMV risk the premature rupture of membranes (95%CI) were 3.630 (1.520,8.665), 1.845 (1.107,3.075), 1.851 (1.020,3.359) and 1.992 (1.155,3.569).
Conclusion breastfeeding, premature rupture of membranes and vaginal delivery are the high risk factors for perinatal CMV infection, especially to strengthen the perinatal management of children less than gestational age.
The clinical summary and development evaluation of the second part perinatal cytomegalovirus infection for 5 years
Objective to investigate the incidence of perinatal cytomegalovirus (CMV) infection, clinical features, treatment, prognosis and risk factors for the effect of ganciclovir.
Methods Retrospective analysis of clinical diagnosis from 2008 to 2012 for perinatal CMV infection in 237 cases of hospitalized children with the clinical data. Research on the influencing factors of the curative effect of ganciclovir, first by single factor test were statistically significant variables, then the variable forward stepwise Logistic regression analysis, finally obtains the influencing factors with statistical significance the statistically significant difference in P is less than or equal to 0.05. The collection outpatient physical and mental patient follow-up test results (MDI, PDI score and Gesell developmental scale), and statistical analysis.
No significant difference between the results and the proportion accounted for 5 years the basic characteristics of perinatal CMV infection in children with total hospitalized children. Among them, 31 cases of premature infants (gestational age 13%), 42 cases (17.7%). Many children for 2 or more than 2 systems involved, CMV hepatitis with CMV pneumonia (43.1%) for the most common clinical type, congenital malformation rate was 8.02% (19 cases). The pathogen detection results suggest that blood CMV-IgM and blood / urine CMV-DNA positive was 3.8%, only 90.3% CMV-IgM positive blood, only blood / urine CMV-DNA positive for 5.9%. brainstem auditory evoked potential in 3 cases of abnormal.197 to severe cases of perinatal period CMV infected children received ganciclovir treatment, 88.3% (174/197) after treatment. Clinical improvement history of pregnancy anomalies (OR=6.191,95%CI = 1.597 ~ 24.002) and medication in children before liver involvement (OR=3.705,95%CI = 1.537 ~ 8.931) is the effect of ganciclovir on perinatal CMV infection curative effect Independent risk factors. There was no significant difference in physical growth level and intelligence development among children with CMV infection at the age of 6 month old and 1 years old, but the level of language development was significantly lagged behind the normal children of the same age (P < 0.05).
Conclusion the epidemiological characteristics of perinatal CMV infection in children with nearly 5 years of relatively stable.CMV children with multiple organ involvement or system to liver and lung damage. The most common ganciclovir antiviral curative effect, lower incidence of side effects. The history of pregnancy and abnormal before treatment in children with liver involvement is the effect of ganciclovir on perinatal risk CMV infection factors of treatment. In addition to language retardation, perinatal CMV infection on the health and development of infants had no obvious effect.
Comparison of the clinical characteristics of perinatal cytomegalovirus infection and postnatal infection in the third part
Objective to study the clinical features, treatment and prognosis of cytomegalovirus (CMV) infection and postnatal cytomegalovirus infection in perinatal period.
Methods the clinical data of 406 hospitalized children with perinatal CMV infection and postnatal CMV infection from 2008 to 2012 were retrospectively analyzed, including general situation, clinical manifestation, laboratory examination, target organ damage and treatment.
The results of 5 years of perinatal CMV infection and CMV infection in children after birth were 406 cases, accounted for 1.88% of all hospitalized children, including perinatal CMV infection in 237 cases, accounting for 58.4%, after CMV infection in 169 cases, accounted for 41.6% of perinatal CMV infection in children was higher than the number of children per year in hospital admission CMV infection after birth, and the NICU/PICU occupancy rate increased significantly, prolonged hospitalization, hospitalization costs (P < 0.05). The clinical manifestations of perinatal CMV infection in children with jaundice and hepatosplenomegaly were born after CMV infection, the clinical manifestations of wheezing and skin petechia. Many children for 2 or 2 the above system involvement, clinical types of perinatal CMV infection in children with common CMV hepatitis with CMV pneumonia (43.1%), CMV (16.7%) hepatitis complicated with myocardial damage, CMV pneumonia and vomiting, anorexia, diarrhea and other symptoms of digestive system (8.7%); clinical types common in children with CMV infection after birth CMV pneumonia with CMV hepatitis (37.1%), CMV pneumonia and blood system damage (28.3%), CMV pneumonia combined with myocardial damage (12.1%), CMV (3.3%) CMV encephalitis and hepatitis. Among the two groups in the positive rate of CMV-IgM, and the side effect of ganciclovir usage differences in incidence of children with no statistical significance, CMV infection and postnatal clinical improvement rate was higher than that of perinatal CMV infection in children.
Conclusion CMV patients often invades multiple organs or systems in the liver and lung lesions. The most common perinatal CMV infection mainly involving the hepatobiliary system and respiratory system, mainly involving the respiratory CMV infection after birth and blood system, but the latter was generally mild, the prognosis is good. Perinatal CMV infection and CMV after birth the incidence of infection, clinical characteristics and severity, mainly with infection, infection time, virulence and immune function of CMV children body. No matter what type of CMV infection, ganciclovir efficacy and side effect incidence rate was low.

【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.7

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