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目的探讨巨细胞病毒(CMV)肝炎婴儿血浆生长抑素(SST)、肠血管活性多肽(VIP)水平与血清γ谷胺酰转肽酶(γ-GT)的相关性,了解其在CMV肝炎婴儿持续性胆汁瘀积的诊断和鉴别诊断中的意义。方法收集本院CMV肝炎婴儿60例。临床确诊依据CMV感染诊疗方案,即具备以下条件:(1)外周血或尿CMV-DNA和CMV-IgM呈阳性,甲型肝炎、乙型肝炎、丙型肝炎、丁型肝炎和戊型肝炎抗体检测均为阴性;(2)外周血ALT和结合胆红素(DB)高于正常值上限。根据最初的DB高低分组,≤136.8μmol.L-1(瘀胆型肝炎Ⅰ组)22例;>136.8μmol.L-1(瘀胆型肝炎Ⅱ组)20例,全部具备条件(1)和(2),影像学检查排除胆道闭锁(BA)。BA组18例全部具备条件(1)和(2),并有B超检测胆道不显影及锝99放射扫描显像法肠道不显影。健康对照组14例。血浆SST或VIP水平测定采用放射免疫法,而血清γ-GT水平测定采用常规生物化学法。结果健康对照组、瘀胆型肝炎Ⅰ组和瘀胆型肝炎Ⅱ组SST水平与γ-GT水平无相关性(r=0.180,P>0.05);3组VIP水平与γ-GT水平呈显著正相关性(r=0.383,P<0.05)。健康对照组和BA组SST、VIP水平分别与γ-GT水平均呈显著负相关(r=-0.743,P<0.01;r=-0.918,P<0.01)。结论 CMV肝炎患儿外周血VIP水平可作为反映肝内胆汁瘀积的良好指标。此外,外周血SST或VIP水平可作为瘀胆型肝炎和BA鉴别诊断的敏感指标之一。
Objective To investigate the correlation between plasma somatostatin (SST) and intestinal vasoactive peptide (VIP) levels and serum γ-glutamyl transpeptidase (γ-GT) in infants with cytomegalovirus (CMV) hepatitis, Significance of diagnosis and differential diagnosis of persistent cholestasis. Methods Sixty infants with CMV hepatitis were collected in our hospital. Clinical diagnosis based on CMV infection treatment programs, that is, have the following conditions: (1) peripheral blood or urine CMV-DNA and CMV-IgM was positive, hepatitis A, hepatitis B, hepatitis C, hepatitis D and hepatitis E antibody Test were negative; (2) peripheral blood ALT and conjugated bilirubin (DB) higher than the upper limit of normal. According to the original DB high and low group, there were 22 cases of ≤136.8μmol.L-1 (stasis-biliary hepatitis group Ⅰ) and> 136.8μmol.L-1 (stasis-biliary hepatitis group Ⅱ) (2), imaging examination to exclude biliary atresia (BA). BA group 18 cases all have the conditions (1) and (2), and B ultrasound detection of biliary non-imaging and technetium 99 radiation imaging of intestinal development. Healthy control group of 14 cases. Plasma SST or VIP levels were measured by radioimmunoassay, while serum γ-GT levels were measured by conventional biochemical methods. Results There was no correlation between the level of SST and the level of γ-GT (r = 0.180, P> 0.05) in healthy control group, stasis-biliary hepatitis group Ⅰ and stasis-biliary hepatitis group Ⅱ. The levels of VIP and γ-GT were significantly positive Correlation (r = 0.383, P <0.05). The levels of SST and VIP in healthy control group and BA group were significantly negatively correlated with γ-GT level (r = -0.743, P <0.01; r = -0.918, P <0.01). Conclusion The level of VIP in children with CMV hepatitis can be used as a good indicator of intrahepatic cholestasis. In addition, peripheral blood SST or VIP levels can be used as a sensitive indicator of the differential diagnosis of bruising hepatitis and BA.