婴儿人巨细胞病毒感染病原学和临床分析

Pathogen and spectrum of disease in infants with human cytomegalovirus infection

目的了解婴儿人巨细胞病毒(HCMV)活动性感染的疾病诊断情况,探讨病原学结果与临床症状之间的关系。方法经血清HCMV IgM和抗凝外周血PP65抗原检测确定的HCMV活动性感染的婴儿378例,对其疾病诊断、病原学结果和临床症状之间的关系进行分析。其中107例患儿,使用套式聚合酶链反应(nPCR)加限制性长度多态性分析(RFLP)进行HCMV糖蛋白B(gB)基因分型。结果在378例HCMV感染患儿中,全身性感染和单脏器感染分别占27．78％和72．22％,肝炎、HCMV包涵体病、血小板减少性紫癜、肺炎等4种疾病分别以33．07％、27．78％、13．49％、6．35％占较大比例。≤2周HCMV包涵体病患儿的比例,明显多于3～12周(P＜0．05)和＞12周的患儿(P＜0．01)。高水平PP65阳性细胞率的患儿全身性感染率明显高于低水平PP65阳性细胞率的患儿(P＜0．01)。HCMV IgM和HCMV PP65、HCMV IgM和HCMV DNA、HCMV PP65和HCMV DNA的阳性符合率分别为31．4％、61．4％、57．1％。三项指标均阳性的患儿全身性感染的比例,明显高于一项或两项指标阳性的患儿(P＜0．01)；IgM和HCMV-PP65两项阳性的患儿全身性感染的比例,也明显高于其中一项阳性患儿(P＜0．01)。107例患儿HCMV糖蛋白B(gB)基因的分型结果为gBⅠ型53例,gBⅡ型20例,gBⅢ型18例,gBⅡ、Ⅱ混合型7例,gBⅠ、Ⅲ混合型5例,gBⅡ、Ⅲ混合型4例,未发现gBⅣ型。gBⅠ型占多数(49．53％)。结论婴儿HCMV感染临床表现多样；多种指标的检测,可提高检出率；婴儿HCMV感染,以gBⅠ型HCMV占多数。

Objective To investigate the correlation between pathogens and spectrum of disease in infants with human cytomegalovirus（HCMV） active infection. Methods A total of 378 cases of HCMV infection diagnosed by the identification of HCMV IgM or PP65 antigen of HCMV. HCMV gB genotyping was carried out by nested PCR and restriction fragment length polymorphism（RFLP） in 107 cases. The results of pathogen, spectrum of disease and clinic feature were analyzed. Results In all 378 infant patients with HCMV, 27. 78% were systemic infection and 72. 22% involved just single organ. Hepatitis, HCMV inclusion disease, thrombocytopenic purpura, pneumonia were pre dominant with 33.07%, 27.78%, 13.49%, 6.35% respectively. The rate of HCMV inclusion dis ease in infants younger than 2 weeks was higher than in those aged from 3 -12 weeks（P 〈0.05） and children older than 12 weeks（P〈 0.01）. Infants with higher rate of PP65 antigen positive cells were apt to systemic infection than those with lower rate of PP65 positive cells（P〈 0.01）. Infants, who were positive by detections of all three methods, were apt to systemic infection than others（P〈0.01 ）. Moreover, infants positive of IgM and PP65 antigen were apt to systemic infection than those just positive by one of the two methods（P 〈 0. 01）. The result of gB genotype analysis in 107 cases showed 53 cases of gBⅠ , 20 of gBⅡ , 18 of gBⅢ , 7 of gB Ⅰ ＋gBⅡ , 5 of gBⅠ ＋gBⅢ and 4 of gBⅡ ＋gBⅢ , and gB Ⅳ was not found. Conclusion HCMV could infect multiple organs and have some different clinic features. Combination of different methods can increase the sensitivity to detect the pathogen. The gBⅠ genotype is most prevalent in these infants.