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人细小病毒B19感染致婴儿爆发性肝炎误诊一例

刘薇1,赵津生2   

  1. 1. 天津市卫生局医政处
    2. 天津市儿童医院
  • 收稿日期:2010-04-02 修回日期:2010-05-28 出版日期:2011-03-15 发布日期:2011-03-15
  • 通讯作者: 刘薇

Human parvovirus B19 infection in infants caused by the outbreak of misdiagnosis of one case of hepatitis

  • Received:2010-04-02 Revised:2010-05-28 Published:2011-03-15 Online:2011-03-15

摘要: 我院接诊的一例患儿以咳喘3天至当地医院就诊,因查体发现肝脏异常肿大而怀疑存在急性充血性心力衰竭,但在给予相应治疗后效差,又怀疑其为血液系统疾病故而转入我院。该患儿入院后,根据其症状、体征考虑肝脾肿大应与肺部感染无关,故急查肝功能,提示存在肝酶的明显异常,腹部B-us示肝实质弥漫性病变,肝脾增大,骨髓穿刺涂片回报为三系均增生骨髓象,余未见明显异常,结合患儿HPVB19-PCR(+),故考虑为人微小病毒B19感染致婴儿爆发性肝炎,即予抗病毒、保肝、营养支持、加强呼吸道管理等治疗护理措施。患儿诊断明确、治疗有效,肝脾回缩较快,肝功能恢复良好,好转出院。在此提请广大临床医师注意,对于婴幼儿肝脏肿大者应特别注意脾脏查体的情况,凡肝脾肿大的患儿应考虑到感染和非感染感染两方面因素,并及时取血化验肝功能,以免发生误诊、延误治疗。

关键词: 人微小病毒B19, 婴儿爆发性肝炎, 误诊

Abstract: Example of hospital admissions in children with cough 3 days to a local hospital because of abnormal physical examination of liver enlargement and the suspected presence of acute congestive heart failure, but given the appropriate treatment in the after-effects worse, they suspected the blood system disease Guer into our hospital. The patient is hospitalized, according to their symptoms and signs should be considered hepatosplenomegaly and pulmonary infection and, therefore Jicha liver function, suggesting that there is significantly abnormal liver enzymes, abdominal B-us show diffuse liver disease, liver and spleen increased bone marrow punctures were reported as hyperplasia of bone marrow of three lines, I no obvious abnormalities, combined with children HPVB19-PCR (+), it is considered man parvovirus B19 infection in infants caused by the outbreak of hepatitis as fast anti-virus, Liver, nutrition support, strengthen management and treatment of respiratory nursing. Children diagnosed, treatment is effective, rapid retraction of the liver and spleen, the liver function recovered well, better hospital. This drew the majority of clinicians should be aware, for infants and young children should pay special attention to liver enlargement of the spleen physical examination of the case, where the liver in children with splenomegaly should take into account both infected and uninfected infection factors, and timely liver blood tests function, in order to avoid misdiagnosis, delayed treatment.

Key words: Human parvovirus B19, infant fulminant hepatitis, Misdiagnosis