儿童肝移植术后轮状病毒感染特点及临床分析

王永翠; 孙丽莹; 朱志军; 魏林; 曲伟; 刘颖; 曾志贵; 何恩辉; 张梁

doi:10.3969/j.issn.1674-7445.2016.02.006

儿童肝移植术后轮状病毒感染特点及临床分析

doi: 10.3969/j.issn.1674-7445.2016.02.006

300070 天津医科大学(王永翠)；首都医科大学附属北京友谊医院国家消化系统疾病临床医学研究中心移植耐受与器官保护北京市重点实验室(孙丽莹、朱志军、魏林、曲伟、刘颖、曾志贵、何恩辉、张梁)

基金项目:

北京市医院管理局临床技术创新项目 XMLX201302

详细信息

通讯作者:
孙丽莹, Email:sunxlx@outlook.com

中图分类号: R617;R725
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出版历程
- 收稿日期: 2015-12-15
- 网络出版日期: 2021-01-19
- 刊出日期: 2016-03-15

Clinical characteristics and analysis of rotavirus infection after liver transplantation in children

Tianjin Medical University, Tianjin 300070, China

More Information

Corresponding author: Sun Liying, Email:sunxlx@outlook.com

摘要

摘要: 目的总结儿童肝移植术后轮状病毒感染特点及治疗方法。方法回顾性分析2014年10月至12月在首都医科大学附属北京友谊医院的儿童肝移植术后患儿39例, 其中6例发生肝移植术后轮状病毒感染。分析6例患儿感染的症状、合并症、治疗和转归特点。结果 6例患儿中, 诊断轮状病毒感染时间为肝移植术后8~197 d (中位数22 d), 其中3例临床主要表现为高热、腹泻、呕吐, 余3例主要表现为腹泻。发生感染距离肝移植的时间越长, 轮状病毒感染的症状相对越轻。6例患儿中, 5例合并EB病毒、巨细胞病毒或呼吸道合胞病毒感染, 2例合并肝或心功能异常。治疗方法主要为减少FK506剂量, 部分患儿给予丙种球蛋白提高免疫力; 给予对症调节肠道菌群, 止泻治疗, 口服抗生素及补液支持治疗后均痊愈。2例合并严重心、肝功能异常的患儿给予对症处理后心、肝功能指标均恢复正常。结论儿童肝移植术后轮状病毒感染症状较重, 严重时合并心、肝等脏器功能损伤, 经合理治疗能逐步恢复正常。
- 肝移植 /
- 轮状病毒 /
- 他克莫司 /
- EB病毒 /
- 巨细胞病毒
Abstract: Objective To summarize the clinical characteristics and treatment of rotavirus infection after liver transplantation in children. Methods Thirty nine children undergoing liver transplantation in Beijing Friendship Hospital affiliated to Capital Medical University from October to December 2014 were retrospectively analyzed. And 6 cases were infected with rotavirus after liver transplantation. Characteristics of clinical symptoms, complications, treatments and prognosis in these six children were retrospectively analyzed. Results Six cases were diagnosed with rotavirus infection at 8-197 d after liver transplantation with a median time of 22 d, 3 cases of whom mainly manifested as high fever, diarrhea and vomiting and the remaining 3 presenting with diarrhea. The longer interval time between rotavirus infection and liver transplantation was, the slighter degree of rotavirus infection-related symptoms was. Among 6 cases, 5 cases were complicated with EB virus, cytomegalovirus or respiratory syncytial virus, and 2 cases were complicated with abnormal liver or heart function. The main treatment was decreasing the dose of FK506. Gamma globulin was administered in partial affected children to enhance immunity. Effective therapy was delivered to regulate intestinal tract bacterial colony and relieve diarrhea. All children recovered after oral use of antibiotics and supporting therapy using fluid infusion. Two cases complicated with severe cardiac and liver function abnormality were healed after expectant treatment. Conclusions Rotavirus infection-related symptoms are relatively severe after liver transplantation in children, occasionally complicated with cardiac and liver function injury, which can gradually return to normal after efficacious therapy.
- Liver transplantation /
- Rotavirus /
- Tacrolimus /
- Epstein-Barr virus /
- Cytomegalovirus

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表 1 6例肝移植患儿术后轮状病毒感染特点

Table 1. Characteristic of rotavirus infection in 6 children after liver transplantation

序号	性别	年龄(月)	体质量(kg)	感染与肝移植间隔时间(d)	免疫抑制剂方案	FK506血药浓度(ng/ml)	喂养方式	临床症状	合并症	预后
1	男	5	6.0	22	FK506+激素	7.4	奶粉+母乳	高热、呕吐、腹泻	CMV(+)	恢复
2	男	5	5.7	21	FK506+激素	18.5	奶粉	腹泻	心功能异常CMV(+)呼吸道合胞病毒(+)	延迟恢复
3	男	6	7.5	42	FK506+激素	10.1	奶粉	腹泻	无	恢复
4	女	10	5.0	20	FK506+激素	11.3	奶粉	高热、呕吐、腹泻	EB病毒(+)	恢复
5	女	11	6.4	197	FK506+激素	8.0	奶粉	腹泻	EB病毒(+)	恢复
6	女	13	10.5	8	FK506+激素	7.6	奶粉	高热、呕吐、腹泻	肝功能异常CMV(+)	延迟恢复
注：激素为肾上腺皮质激素

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