中国实用儿科杂志

中国实用儿科杂志

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免疫功能正常儿童患巨细胞病毒胃肠炎系统评价

  

  1. 1.北京大学第三医院 a 八年制， b 儿科， 北京 100191；2.北京大学第一医院八年制， 北京 100034
  • 出版日期:2020-04-06 发布日期:2020-04-20

Cytomegalovirus gastroenteritis in immunocompetent children：A systematic review

  1. *Peking University Third Hospital，Beijing 100191，China
  • Online:2020-04-06 Published:2020-04-20

摘要： 目的　旨在分析免疫功能正常儿童巨细胞病毒（CMV）胃肠炎临床特征、 辅助检查和治疗， 为其临床诊治提供参考。方法　计算机检索中国知网等4个中文数据库和PubMed等6个英文数据库， 检索时间从建库至2019-01-01。按照纳入、 排除标准纳入文献并提取数据， 用SPSS统计软件进行分析。结果　纳入30篇病例报告， 共计33例患儿，男女比为2∶1，3月龄及以内（25例，75.8%）最多见，83.3%（10/12）的母亲在乳汁或血清中检测到CMV抗体或CMV-DNA阳性。患儿最常见症状是腹泻（29例，87.9%）， 其他症状可以见到。22例（66.7%）行消化道内镜检查， 其中6例（27.3%）内镜下肉眼观察无明显病变。HE染色病理检查和病毒核酸检查阳性率分别为70.0%（21例）和95.3%（20例）。20例（60.1%）进行抗病毒治疗。病程为1周至10个月（平均8.7周）， 存活率97.0%（32例）。结论　免疫正常的儿童CMV胃肠炎好发于3月龄以内婴儿， 母乳喂养可能是主要传播途径。临床主要表现为腹泻， 病理检查是诊断的金标准， 该疾病目前无统一治疗方案。

关键词: 巨细胞病毒, 免疫功能正常, 儿科, 胃肠炎, 腹泻

Abstract: Objective　To investigate the clinical characteristics，auxiliary examinations and treatment of immunocompetent children with CMV gastroenteritis，and to provide reference for the clinical diagnoises and treatment. Methods　A systematic literature search was conducted in 4 Chinese databases and 6 English databases. The searching time was from their inception to Jan.1，2019. The data was extracted according to inclusion and exclusion criteria，and SPSS was used to analyze the findings. Results　A total of 30 case reports met inclusion criteria and 33 patients were analyzed including 22 boys and 11 girls. About 75.8%（25 cases） patients were no more than 3 months. About 83.3%（10/12） of mothers were detected CMV antibody or DNA in their milk or serum. The most common gastrointestinal symptom was diarrhea（29，87.9%）. A total of 22（66.7%） patients underwent endoscopy， and no obvious lesion was observed under endoscope in 6 patients（27.3%）. HE staining and viral nuclear acid examination showed a positive rate of 70.0%（21 cases） and 95.3%（20 cases），respectively. Twenty patients（60.1%） received antiviral therapy. Clinical course ranged from 1 week to 10 months（at an average of 8.7 weeks） and the survival rate was 97.0%（32 cases）. Conclusion　Maternal breastfeeding may be the most probable way of CMV transmission in children. CMV infection should be considered in the differential diagnosis of unexplained intractable diarrhea in children. Gastrointestinal endoscopy and biopsy are recommended in case of misdiagnosis. Moreover，when and how to antiviral therapy need further study.

Key words: cytomegalovirus, immunocompetent, pediatrics, gastroenteritis, diarrhea