中华肝脏病杂志
中華肝髒病雜誌
중화간장병잡지
CHINESE JOURNAL OF HEPATOLOGY
2015年
6期
454-457
,共4页
黄疸%回顾性研究%诊断%婴儿
黃疸%迴顧性研究%診斷%嬰兒
황달%회고성연구%진단%영인
Jaundice%Retrospective studies%Diagnosis%Infants
目的 探讨近30年婴儿非溶血性黄疸的病因变化及其患儿性别、就诊年龄和胆红素等的变化. 方法 收集1982年1月至2011年12月我院感染消化科收治住院的3 113例1个月~1岁非溶血性黄疸患儿病例,按就诊时间分为A组(1982-1991年,n=537)、B组(1992-2001年,n=786)和C组(2002-2011年,n=1 790),就性别、年龄、病因、ALT和总胆红素(TBil)水平等方面进行回顾性研究.应用SPSS17.0统计软件,采用x2检验进行比较,P< 0.05为差异有统计学意义. 结果 3组患儿中,男性患儿分别为399例(74.3%)、524例(66.7%)和1 121例(62.6%),比例均高于女性患儿.A组就诊年龄以2~3个月为主(52.0%),B组和C组就诊年龄以1~2个月龄为主,分别占67.8%和61.0%,A组与B、C组比较,就诊年龄分布差异具有统计学意义(x2=560.766,P<0.001).A组有431例患儿(80.3%) TBil以轻度升高为主(17.1 ~ 171 μmol/L),B组和C组,患儿TBil以中度升高为主(171 ~ 342μmol/L),分别占53.4%和49.7%,A组与B、C组比较,差异具有统计学意义(x2=517.74,P<0.001).A组中,患儿主要病因诊断为巨细胞病毒(CMV)感染170例(31.%)、败血症98例(18.2%)、乙型肝炎7例(1.3%)、胆道畸形7例(1.3%),有250例(46.6%)患儿诊断不明确;B组中,患儿主要病因诊断为CMV感染283例(36.0%)、败血症169例(21.5%)、母乳性黄疸16例(2.0%)、乙型肝炎15例(1.9%)、胆道畸形7例(0.9%),有291例(37.9%)患儿诊断不明确;C组中,患儿主要病因诊断为CMV感染763例(42.6%)、母乳性黄疸316例(17.7%)、败血症134例(7.5%)、胆道畸形44例(2.46%),有521例(29.1%)患儿诊断不明确. 结论 感染性因素仍然是婴儿非溶血性黄疸的主要病因,尤其是CMV感染,细菌感染呈明显下降趋势.非感染因素如胆道畸形、遗传代谢性疾病日益受到临床的重视.虽然病因明确诊断比例有所增加,但仍有部分患儿病因诊断未能明确,还需进一步研究.
目的 探討近30年嬰兒非溶血性黃疸的病因變化及其患兒性彆、就診年齡和膽紅素等的變化. 方法 收集1982年1月至2011年12月我院感染消化科收治住院的3 113例1箇月~1歲非溶血性黃疸患兒病例,按就診時間分為A組(1982-1991年,n=537)、B組(1992-2001年,n=786)和C組(2002-2011年,n=1 790),就性彆、年齡、病因、ALT和總膽紅素(TBil)水平等方麵進行迴顧性研究.應用SPSS17.0統計軟件,採用x2檢驗進行比較,P< 0.05為差異有統計學意義. 結果 3組患兒中,男性患兒分彆為399例(74.3%)、524例(66.7%)和1 121例(62.6%),比例均高于女性患兒.A組就診年齡以2~3箇月為主(52.0%),B組和C組就診年齡以1~2箇月齡為主,分彆佔67.8%和61.0%,A組與B、C組比較,就診年齡分佈差異具有統計學意義(x2=560.766,P<0.001).A組有431例患兒(80.3%) TBil以輕度升高為主(17.1 ~ 171 μmol/L),B組和C組,患兒TBil以中度升高為主(171 ~ 342μmol/L),分彆佔53.4%和49.7%,A組與B、C組比較,差異具有統計學意義(x2=517.74,P<0.001).A組中,患兒主要病因診斷為巨細胞病毒(CMV)感染170例(31.%)、敗血癥98例(18.2%)、乙型肝炎7例(1.3%)、膽道畸形7例(1.3%),有250例(46.6%)患兒診斷不明確;B組中,患兒主要病因診斷為CMV感染283例(36.0%)、敗血癥169例(21.5%)、母乳性黃疸16例(2.0%)、乙型肝炎15例(1.9%)、膽道畸形7例(0.9%),有291例(37.9%)患兒診斷不明確;C組中,患兒主要病因診斷為CMV感染763例(42.6%)、母乳性黃疸316例(17.7%)、敗血癥134例(7.5%)、膽道畸形44例(2.46%),有521例(29.1%)患兒診斷不明確. 結論 感染性因素仍然是嬰兒非溶血性黃疸的主要病因,尤其是CMV感染,細菌感染呈明顯下降趨勢.非感染因素如膽道畸形、遺傳代謝性疾病日益受到臨床的重視.雖然病因明確診斷比例有所增加,但仍有部分患兒病因診斷未能明確,還需進一步研究.
목적 탐토근30년영인비용혈성황달적병인변화급기환인성별、취진년령화담홍소등적변화. 방법 수집1982년1월지2011년12월아원감염소화과수치주원적3 113례1개월~1세비용혈성황달환인병례,안취진시간분위A조(1982-1991년,n=537)、B조(1992-2001년,n=786)화C조(2002-2011년,n=1 790),취성별、년령、병인、ALT화총담홍소(TBil)수평등방면진행회고성연구.응용SPSS17.0통계연건,채용x2검험진행비교,P< 0.05위차이유통계학의의. 결과 3조환인중,남성환인분별위399례(74.3%)、524례(66.7%)화1 121례(62.6%),비례균고우녀성환인.A조취진년령이2~3개월위주(52.0%),B조화C조취진년령이1~2개월령위주,분별점67.8%화61.0%,A조여B、C조비교,취진년령분포차이구유통계학의의(x2=560.766,P<0.001).A조유431례환인(80.3%) TBil이경도승고위주(17.1 ~ 171 μmol/L),B조화C조,환인TBil이중도승고위주(171 ~ 342μmol/L),분별점53.4%화49.7%,A조여B、C조비교,차이구유통계학의의(x2=517.74,P<0.001).A조중,환인주요병인진단위거세포병독(CMV)감염170례(31.%)、패혈증98례(18.2%)、을형간염7례(1.3%)、담도기형7례(1.3%),유250례(46.6%)환인진단불명학;B조중,환인주요병인진단위CMV감염283례(36.0%)、패혈증169례(21.5%)、모유성황달16례(2.0%)、을형간염15례(1.9%)、담도기형7례(0.9%),유291례(37.9%)환인진단불명학;C조중,환인주요병인진단위CMV감염763례(42.6%)、모유성황달316례(17.7%)、패혈증134례(7.5%)、담도기형44례(2.46%),유521례(29.1%)환인진단불명학. 결론 감염성인소잉연시영인비용혈성황달적주요병인,우기시CMV감염,세균감염정명현하강추세.비감염인소여담도기형、유전대사성질병일익수도림상적중시.수연병인명학진단비례유소증가,단잉유부분환인병인진단미능명학,환수진일보연구.
Objective To investigate the causes of non-hemolytic jaundice among infants in Chongqing,China from the period of 1982 to 2011 and to determine whether the etiologies have changed over the past 30 years.Methods The medical records of 3 113 infants,aged 1 month to 1 year,admitted to our hospital with non-hemolytic jaundice were collected and stratified according to decade-long time periods:group A (1982-1991),n =537; group B (1992-2001),n =786; group C (2002-2011),n =1 790.Data on sex,age,etiology and bilirubin level were retrospectively assessed using the chi-square test.Results In the three groups,boys consistently accounted for the majority of cases (group A:74.3%,group B:66.7%,group C:62.6%).In group A,52% of the patients were 1-2 months of age; the peak age of patients in both group B and C was 2-3 months (group B:67.8%,group C:61.0%).Group A showed the highest level of patients with mildly elevated total bilirubin level (80.3%); however,moderately elevated total bilirubin level was most frequent in group B (53.4%) and group C (49.7%).The main etiologic diagnoses of the patients in group A were cytomegalovirus (CMV) infection (31.7%),sepsis (18.2%),hepatitis B virus (HBV) (1.3%),and biliary tract anomalies (1.3%); 46.6% of the cases had unclear cause.The main etiologic diagnoses of the cases in group B were CMV infection (36.0%),sepsis (21.5%),breast milk jaundice (2.0%),and HBV (1.9%); 37.9% of the cases had unclear cause.The main etiologic diagnoses of the cases in group C were CMV infection (42.6%),sepsis (7.5%),breast milk jaundice (17.7%),and biliary tract anomalies (2.46%); 29.1% of the cases had unclear cause.Conclusion In Chongqing,infective factors,especially CMV,remain the main cause of nonhemolytic jaundice in infants,but bacterial etiologies have declined over the past 30 years.Non-infective factors,such as biliary tract anomalies and inherited metabolic diseases,have trended upwards.Although there has been great progress in the clinical management of non-hemolytic jaundice in infants,etiological diagnosis remains a challenge and further study is needed to eliminate this condition.