The Evaluation Of Liver Function Indices And Prognosis In Infantile Cholestatic Hepatopathy

ObjectiveThis paper is aim to study the incidence rate and outcome of infant cytomegalovirus hepatitis, analyse the diagnostic value of changing in liver function indices before and after treatment,and explores the high risk factors and the prognosis in infantile cholestatic hepatopathy.Methods The conditions of 86 infants with cholestatic hepatopathy were reviewed and analysed from pediatric department of internal medicine and pediatric surgery in Second Hospital of Hebei Medical University from Feb.2007 to Apr.2012,including the names, sexss, ages, hospitalizing days, feeding history, chief complaints, jaundice in neonatal period, family history, enlargement of the liver and spleen, liver functions indices, HCMV DNA,TORCH, second liver five, abdominal altrasound, hepatobiliary dynamic scanning, hereditary metabolic diseases and genes.Results1 The morbidities between boys and girls with infant cytomegalovirus hepatitis were 1.6:1. The incidence rates of the fraternal twins were 2.3%. The ages of the onset were from one to three months and the incidence rates were 68.6%. 2 89.5% of the baby patients were hospitalised for jaundice in skin or sclera, 10.5% of the patients just for abnormal liver function indices.Among them about 26.7% of the children’s bowel were pottery clay like stools..3 ICH complication incidence were 15.2%, Among the complications, umbilical hernia was the most common(4.65%), followed by congenital heart disease and secondary epilepsy(3.48%).4 The logistic regression analyse was been used to explore the high risk factors of incidence of ICH,86 infants with cholestatic hepatopathy and 100 infants at randomly were reviewed. 5The positive rate of ICH infected by Cytomegalovirus was 40.7%, 94.28% of patients turned to negative through the treatment by using ganciclovir, While the side effects incidence rate was 11.4%. 6 The differences in levels of ALT、AST、TBIL、DBIL、IBIL、GGT、TBA、ALP、ALB、TP、CHE before and after therapy were statistically significant,the p value were 0.019, 0.0015, 0.014, 0.047, 0.021,0.45, 0.085, 0.02, 0.006, 0.051, 0.126.7while the level of GGT and CHE have no statistically significant. The ALT level in HCMV infected group was as this as in biliary atresia group, while the GGT and TBA levels were statistically significant(P<0. 05).ConclusionsFirstly, as the disease causes of ICH, female gender、artificial feeding and the age exceed three month are protective factors, while breast feeding、pathological jaundice in neonatal period、the history of jaundice in skin or sclera and higher level of ALT are the high risk factors. Second, clay-colored stool、the higher level of TBA and GGT and hepatobiliary dynamic scanning can raise the diagnostic rate, but the other indices have no specific value. Once again, The majoritise of the patients improve after the treatment of Ganciclovir, it’s safe and effective to be applied in clinic. Similarly, the infant with biliary atresia except conservative treatment or surgery may improve the survival rate, while giving- up therapy may be in bad ending. last but not the least, ICH combined with congenital monstrosity don’t affect the prognosis, but the history of jaundice in neonatal period, white stool,higher level of TBA often has little improvement in ICH.