孕妇围生期HCMV感染与婴儿先天性疾病关系

Relationship between infant congenital disease and perinatal infection of human cytomegalovirus

目的探讨孕妇人巨细胞病毒(HCMV)活动性感染对婴儿的近期影响。方法采用ELISA和PCR相结合的方法,采集74例HCMV活动性感染孕妇及50例无HCMV活动性感染孕妇的婴儿血进行HCMV-IgM及HCMV-DNA检测,并对感染婴儿定期随访至生后6个月,追踪其近期预后。结果孕期HCMV活动性感染组的婴儿先天性感染率为36.49%,围产期感染率为45.95%,显著高于孕期无HCMV活动性感染组(P<0.005);HCMV活动性感染孕妇的婴儿中,先天性感染组症状性感染发病率高于围生期感染组(P<0.025);神经系统异常、先天畸形及全身性感染发病例数多于围生期感染组(P<0.05);先天性感染组中,症状性感染婴儿治疗后肝功能恢复、HCMVHCMV-IgM和/或HCMV-DNA转阴率及近期预后比围生期感染组差(P<0.05)。结论孕期HCMV活动性感染与婴儿先天性感染及围生期感染显著相关。孕期HCMV活动性感染引起的先天性感染较围生期感染严重,预后差,故应重视孕期HCMV感染的检测,预防和阻断HCMV先天性感染的发生。

Objective To explore the relationship between the vertical transmission and congenital and perinatal infection of human cytomegalovirus（HCMV） and the effects of HCMV infection on early development of infants. Methods Serum HCMV- IgM and HCMV- DNA were detected in 74 infants born to HCMV actively infected pregnant women and 50 infants born to HCMV inactively infected pregnant women by enzyme- linked immunosorbent assay（ELISA）and polymerase reaction（PCR）. HCMV infected infants were followed up regularly to 6 months old. Results The incidence of congenital and perinatal infection in theinfants born to HCMV actively infected pregnant women（36.49 % and 45.95 %, respectively）were significantly higher than that of the inactively - infected（ P 〈 0. 005 ）. Of the infants born to HCMV actively infected pregnant women, the incidence of symptomatic infection, nerve system abnormities, congenital malformations and generalized infection of congenital infected infants was significantly higher than that of the perinatal infected（ P 〈 0.05）. The recovery of liver function, the darkening of HCMV HCMV - IgM and/or HCMV - DNA and the prognosis of short term follow - up in the congenital infected group were worse than those in the perinatal infected group（ P 〈 0.05 ）. Conclusion HCMV active infection during pregnancy is significantly correlated with congenital and perlnatal infection. HCMV congenital infected infants have more serious symptoms, worse prognosis and higher mortality than perinatal infected ones. Supervision about HCMV active infection during pregnancy should be strengthened in order to prevent and intercept the congenital infection in time.