Clinical Study On Infant Human Cytomegalovirus Hepatitis

Hepatitis and pneumonia are the clinical manifestes of infant cytomegalovirus infection. There are no obvious symptoms in children of cytomegalovirus infection. The rate of cytomegalovirus infection was 48.1%～78.3% in the infantile hepatitis syndrome. And the mortality rate of congenital cytomegalovirus hepatitis reached 20%. So, cytomegalovirus hepatitis is one of the common diseases in the period of infant. The further study of early diagnosis and the treatment of infantile cytomegalovirus hepatitis can help to the clinical work. There were four parts of the study below:Part OneClinical Study on Infantile Human Cytomegalovirus Hepatitis Detected by Human Cytomegalovirus pp65 AntigenemiaObjective: To know the value and foreground of human cytomegalovirus pp65 antigenemia assay for infantile cytomegalovirus hepatitis in the diagnosis, monitoring and prognosis. Method: We detected cytomegalovirus pp65 antigenemia of 76 infants who suffered with infantile hepatitis syndrome and were admitted in our hospital from Nov. 2001 to Oct. 2002 with IFA method. At the same time we detected cytomegalovirus IgM in the serum samples of these infants. 47 infants who were diagnosed cytomegalovirus hepatitis were treated by gancilovir. Then, we detected the level of pp65 antigenemia of these infants before and after the treatment. After the treatment we followed the infants as outpatients. Results: Cytomegalovirus antigenemia was detected in PMNLs in 59 (77.8%) of the 76 patients who had infantile hepatitis syndrome. Cytomegalovirus IgM was detected in serum of in 41 (53.9%) of the 76 patients who had infantile hepatitis syndrome. 64 patients were diagnosed infantile cytomegalovirus hepatitis of the 76 patients who had infantile hepatitis syndrome. The sensitivity of cytomegalovirus IgM was only 61.0%according to the standard of cytomegalovirus pp65 antigenemia. High level of antigenemia was detected in PMNLs in 48 (81.4%)of the 59 patients and middling level of antigenemia was detected in 11 (18.6%)of the 59 patients. No low level of antigenemia was detected in 59 patients. 47 patients of infantile cytomegalovirus hepatitis were treated by gancilovir for two weeks on the basis of the protective liver therapy. Before the treatment high level of antigenemia was detected in PMNLs in 42 of the 47 patients. After the treatment high level of antigenemia was detected in PMNLs in 26 of the 47 patients. There was significant difference in the level of antigenemia of patients before and after the treatment, p<0.01. 39 patients of infantile cytomegalovirus hepatitis were followed more than three months after the treatment. In those patients the hepatic function was normal in 20 patients and abnormal in 19 patients after 3 months. High level of antigenemia was detected in PMNLs in 5 of the 20 patients. But high level of antigenemia was detected in PMNLs in 17 of the 19 patients. There was significant difference in the level of antigenemia of patients with and without abnormal hepatic function, p<0.01. Conclusion: Cytomegalovirus pp65 antigenemia was more sensitive than cytomegalovirus IgM for detecting infantile cytomegalovirus infection. The level of cytomegalovirus pp65 antigenemia can be momitored the variety of the infantile cytomegalovirus hepatitis, guided the treatment and evaluated the prognosis. Part TwoStudy on Liver Samples of Infantile Hepatitis Syndrome Detected by Monoclonal Antibody of Cytomegalovirus pp65 Antigen Objective: To understand cytomegalovirus active infection in the liver samples of infantile hepatitis syndrome detected by special monoclone antibody of cytomegalovirus pp65 antigen and compare with the assay and other assays detected cytomegalovirus infection in blood. Methods: We detected liver samples from the 29 patients of infantile hepatitis syndrome by special monoclone antibody of cytomegalovirus pp65 with IFA who were admitted from Nov. 2001 to Apr. 2003. The liver samples were from operations or liver punctures. In the 29 patients of infantile hepatitis syndrome...