分析探讨胆道闭锁(BA)患儿巨细胞病毒(CMV)感染对发病和预后的影响。

对36例胆道闭锁患儿进行CMV检测，29例进行Kasai手术，将其分为CMV阴性组（6例）、CMV-IgM阳性组（12例）和CMV-pp65阳性组（11例）三组，分析各组术后3个月患儿黄疸消退率和术后6个月内反流性胆管炎的发生率，检测肝门纤维块CMV-pp65抗原免疫组化染色，比较各组肝脏炎症和肝纤维化分级的病理改变。

CMV阴性组和CMV-IgM阳性组术后3个月内黄疸消退率显著高于CMV-pp65阳性组(P<0.05);两者术后反流性胆管炎的发生率亦显著低于后者（P<0. 05）。CMV-pp65阳性组肝门纤维块CMV-pp65抗原免疫组化染色的阳性率较高（72. 7%），肝组织炎症程度和纤维化程度均较其他两组严重。

围生期CMV正在复制可能加重胆道闭锁肝组织炎症和肝纤维化程度，影响患儿术后黄疸消退及反流性胆管炎的发生。

To investigate the relationship between the infection of cytomegalovirus (CMV) and the prognosis of biliary atresia (BA).

Thirty-six newborns of BA from Jan 2002 to March 2004 were selected. All of them and their mothers were measured for serum CMV-IgG, CMV-IgM and CMV-pp65. Twenty-nine of them underwent Kasai procedure and were divided into three groups : CMV negative group, CMV-IgM positive group, and CMV-pp65 infected group. The rate of jaundice disappearance and the incidence of reflux cholangitis were analyzed statistically. The histopathological changes of liver were examined.

Positive expression of CMV-IgM and CMV-pp65 was more in patients than in their mothers. Compared to the other two groups, the rate of jaundice disappearance in CMV-pp65 infected group (36%) was significantly lower (P<0. 05) and the incidence of reflux cholangitis was higher (P<0.05). The liver histopathologic examination showed that the degree of liver fibrosis and inflammation was more serious (P <0. 05).

BA patients with CMV-pp65 infection are strongly correlated with a lower rate of jaundice disappearance, a higher incidence of post-operational reflux cholangitis, and more severe liver fibrosis.