本文選題：巨細(xì)胞病毒　切入點(diǎn)：圍生期　出處：《上海交通大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：第一部分圍生期巨細(xì)胞病毒感染影響因素之多因素分析研究 目的通過回顧性隊(duì)列研究分析圍生期巨細(xì)胞病毒（Cytomegalovirus，CMV）感染的流行病學(xué)資料，探討我院圍生期CMV感染患兒的危險(xiǎn)因素，以期降低圍生期CMV感染的發(fā)生率。 方法回顧性分析上海交通大學(xué)醫(yī)學(xué)院附屬新華醫(yī)院兒內(nèi)科2011-2012年期間圍生期CMV感染住院患兒的臨床資料，通過比較圍生期CMV感染患兒（病例組）與同期非CMV感染患兒（對照組）之間各種相關(guān)因素的差異，先采用單因素檢驗(yàn)篩選出有統(tǒng)計(jì)學(xué)意義的變量，再對這些變量進(jìn)行向前逐步回歸Logistic回歸分析，最終得出有統(tǒng)計(jì)學(xué)意義的嬰兒圍生期CMV感染的危險(xiǎn)因素。 結(jié)果本研究有效病例即資料完整病例共325例，其中病例組109例（33.5%），對照組216例（66.5%）。兩組間單因素檢驗(yàn)發(fā)現(xiàn)患兒性別、出生體重百分位數(shù)、出生方式、胎膜早破、喂養(yǎng)方式、母親妊娠期糖尿病、母親妊娠期上呼吸道感染史、母親吸煙史及低人均年收入家庭之間的差異具有統(tǒng)計(jì)學(xué)意義。均納入向前逐步Logistic回歸分析中，得出多因素分析結(jié)果，即：患兒為小于胎齡兒、經(jīng)陰道分娩、胎膜早破及生后母乳喂養(yǎng)均可增加患兒感染CMV風(fēng)險(xiǎn)的獨(dú)立危險(xiǎn)因素。OR（95%CI）分別為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）。 結(jié)論母乳喂養(yǎng)、胎膜早破和陰道分娩是圍生期CMV感染的高危因素，尤其需加強(qiáng)小于胎齡兒的圍生期管理。 第二部分圍生期巨細(xì)胞病毒感染5年臨床總結(jié)及發(fā)育評估 目的研究圍生期巨細(xì)胞病毒（CMV）感染的的發(fā)病情況、臨床特征、治療、預(yù)后及影響更昔洛韋療效的危險(xiǎn)因素。 方法回顧性分析2008年至2012年臨床診斷為圍生期CMV感染的237例住院患兒的臨床資料。關(guān)于更昔洛韋療效的影響因素研究，先采用單因素檢驗(yàn)篩選出有統(tǒng)計(jì)學(xué)意義的變量，再對這些變量進(jìn)行向前逐步回歸Logistic回歸分析，最終得出有統(tǒng)計(jì)學(xué)意義的影響因素。以P≤0.05為差異具有統(tǒng)計(jì)學(xué)意義。對門診隨訪病人采集體格檢查和智力測試結(jié)果（MDI、PDI評分及Gesell發(fā)育量表），并作統(tǒng)計(jì)學(xué)分析。 結(jié)果5年間圍生期CMV感染患兒的基本特征及占同期總住院患兒的比例無明顯差異。其中，早產(chǎn)兒31例（13%），小于胎齡兒42例（17.7%）�；純憾酁�2個(gè)或2個(gè)以上系統(tǒng)受累，CMV肝炎合并CMV肺炎（43.1%）為最常見的臨床類型，先天畸形發(fā)生率為8.02%（19例）。病原學(xué)檢測結(jié)果提示血CMV-IgM及血/尿CMV-DNA均陽性為3.8%，僅血CMV-IgM陽性為90.3%，僅血/尿CMV-DNA陽性為5.9%。腦干聽覺誘發(fā)電位中至重度異常3例。197例圍生期CMV感染患兒接受了更昔洛韋治療，88.3%（174/197）患兒治療后臨床表現(xiàn)好轉(zhuǎn)。母孕史異常（OR=6.191，95%CI為1.597～24.002）和用藥前患兒肝臟受累（OR=3.705，95%CI為1.537～8.931）是影響更昔洛韋對圍生期CMV感染患兒療效的獨(dú)立危險(xiǎn)因素。圍生期CMV感染患兒在滿6月齡和1周歲時(shí)的體格生長水平及智力發(fā)育與正常嬰幼兒無明顯差別，但語言發(fā)育水平明顯落后正常同齡兒（P＜0.05）。 結(jié)論圍生期CMV感染患兒近5年的流行病學(xué)特征較為穩(wěn)定。CMV常侵犯患兒多個(gè)臟器或系統(tǒng)，以肝臟和肺損害最常見。更昔洛韋抗病毒療效明顯，副作用發(fā)生率較低。母孕史異常和用藥前患兒肝臟受累是影響更昔洛韋對圍生期CMV感染患兒療效的獨(dú)立危險(xiǎn)因素。除語言發(fā)育遲緩?fù)�，圍生期CMV感染對嬰兒的健康和發(fā)育無明顯影響。 第三部分圍生期巨細(xì)胞病毒感染與生后感染臨床特點(diǎn)比較 目的研究圍生期巨細(xì)胞病毒（CMV）感染和生后巨細(xì)胞病毒感染的的臨床特征、治療及預(yù)后。 方法回顧性分析并比較2008年至2012年臨床診斷為圍生期CMV感染和生后CMV感染的406例住院患兒的臨床資料，，包括一般情況、臨床表現(xiàn)、實(shí)驗(yàn)室檢查、靶器官損害情況及治療等。 結(jié)果5年間圍生期CMV感染和生后CMV感染患兒共406例，占同期全部入院患兒的1.88%，其中圍生期CMV感染患兒237例，占58.4%，生后CMV感染患兒169例，占41.6%，圍生期CMV感染患兒每年入院人數(shù)均高于生后CMV感染患兒入院人數(shù)，且NICU/PICU入住率明顯增高，住院時(shí)間延長、住院費(fèi)用高（P＜0.05）。圍生期CMV感染患兒臨床表現(xiàn)多為肝脾腫大和黃疸的，而生后CMV感染患臨床表現(xiàn)多為喘息及皮膚瘀點(diǎn)瘀斑�；純憾酁�2個(gè)或2個(gè)以上系統(tǒng)受累，圍生期CMV感染患兒常見的臨床類型有CMV肝炎合并CMV肺炎（43.1%），CMV肝炎合并心肌損害（16.7%），CMV肺炎合并嘔吐、納差、腹瀉等消化系統(tǒng)癥狀（8.7%）；而生后CMV感染患兒常見的臨床類型有CMV肺炎合并CMV肝炎（37.1%），CMV肺炎合并血液系統(tǒng)損害（28.3%），CMV肺炎合并心肌損害（12.1%），CMV腦炎合并CMV肝炎（3.3%）等。兩組間在CMV-IgM陽性率、更昔洛韋使用率及副作用發(fā)生率上的差異無明顯統(tǒng)計(jì)學(xué)意義，而生后CMV感染患兒的臨床好轉(zhuǎn)率明顯高于圍生期CMV感染患兒。 結(jié)論CMV常侵犯患兒多個(gè)臟器或系統(tǒng)，以肝臟和肺損害最常見。圍生期CMV感染主要累及肝膽系統(tǒng)及呼吸系統(tǒng)，而生后CMV感染主要累及呼吸系統(tǒng)及血液系統(tǒng)，但后者病情一般較輕，預(yù)后較好。圍生期CMV感染和生后CMV感染發(fā)病情況、臨床特點(diǎn)及嚴(yán)重程度的區(qū)別，主要是與感染途徑、感染發(fā)生的時(shí)間、CMV病毒毒力和患兒機(jī)體的免疫功能有關(guān)。無論何種類型CMV感染，更昔洛韋抗病毒療效明顯，副作用發(fā)生率均較低。
[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.

【學(xué)位授予單位】：上海交通大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R714.7

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相關(guān)期刊論文 前1條

1 胡勁濤;陳平洋;謝宗德;黨西強(qiáng);王濤;賀曉日;李雯;薄濤;;更昔洛韋治療先天性巨細(xì)胞病毒感染患兒的系統(tǒng)評價(jià)[J];中國當(dāng)代兒科雜志;2010年01期

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