人巨细胞病毒宫内感染对胎婴儿生长发育的影响

EfectsonFetalandInfant′sDevelopmentofIntrauterineCytomegalovirusInfection

目的：探讨人巨细胞病毒（ＨＣＭＶ）宫内感染对胎儿生长发育的近期影响及其与智力发育落后等远期后遗症的关系。方法：采用ＥＬＩＳＡ法检测１４１９例孕妇血清，应用ＰＣＲ技术检测ＨＣＭＶ－ＩｇＭ阳性及部分阴性孕妇血、孕中期羊水和（或）晚期脐血中ＨＣＭＶＤＮＡ，依其结果分为Ａ组：孕妇血ＨＣＭＶ－ＩｇＭ、ＨＣＭＶＤＮＡ阳性及羊水和（或）脐血ＨＣＭＶＤＮＡ阳性者，５３例；Ｂ组：孕妇血ＨＣＭＶ－ＩｇＭ、ＨＣＭＶＤＮＡ阳性而羊水和（或）脐血ＨＣＭＶＤＮＡ阴性者，８７例；Ｃ组：上述各项均为阴性者，３４例。动态观察宫内胎儿及分娩后新生儿状况，并应用贝利婴幼儿发育量表测试Ａ、Ｃ两组出生后２～３０个月婴幼儿的智力及精神运动发育指数。结果：Ａ组死胎、畸形、胎儿生长迟缓、新生儿窒息等的发生率均高于Ｂ、Ｃ两组（Ｐ＜０．０５），而新生儿平均身高、体重低于Ｂ、Ｃ两组（Ｐ＜０．０５），婴幼儿期智力发育也显著落后于Ｃ组（Ｐ＜０．０１）。结论：ＨＣＭＶ宫内感染可引起出生缺陷、婴幼儿期发育落后。

Objective:Tostudytheearlyefectsoffetaldevelopmentandremotesequalaeofmentaldevelopmentofinfantsafterintrauterinehumancytomegalovirus(HCMV)infection.Meth-ods:Enzyme-linkedimmunoabsorbantassay(ELISA)wereusedforscreeningHCMVantibodiesintheserumof1419pregnantwomen.HCMVDNAwereexaminedbyPCRinmaternalblood,amni-oticfluidand/orumbilicalbloodforthosewithserumHCMV-IgMpositiveandsomewithHCMVnegative.Accordingtotheresults,groupA(n=53)includedwomenwithpositiveserumHCMV-IgMandHCMVDNA,andalsopositiveHCMVDNAinamnioticfluidand/orumbilicalblood;groupB(n=87)werewomenwithpositiveserumHCMV-IgMandHCMVDNAbutnegativeHCMVDNAinamnioticfluidand/orumbilicalblood;groupC(n=34)servedascontrolwithalnegative.Theabove174caseswerecarefulymonitoredforfetaldevelopment.Baleyscalesofinfantdevelopment(BSID)wereusedtotestbothmentaldevelopmentindex(MDI)andpsychomotordevelopmentindex(PDI)at2～30monthsafterbirthforbabiesingroupAandC.Results:Theoccurrencesoffetalin-trauterinedeath,congenitalmalformation,fetalgrowthretardationandneonatalasphyxiaweresig-nificantlyhigheringroupAthanthatingroupBandC(P<0.05)andtheaveragebirthweightandheightwerealsosignificantlyloweringroupA(P<0.05).ThementaldevelopmentofinfantsingroupAwereremarkablyslowerthanthatofgroupC(P<0.01).Conclusion:ActiveHCMVin-trauterineinfectionmaycausecongenitalinfection,birthdefectsandmentalretardationinchildhood.