三城市孕妇人巨细胞病毒感染及其母婴传播的流行病学调查

TheEpidemiologicalStudyonHumanCytomegalovirusInfectionofPregnantWomenandtheMater┐nal┐FetalTransmissioninThreeChineseMetropolis

目的：分析武汉、上海及沈阳三城市孕妇人巨细胞病毒（ＨＣＭＶ）感染及其母婴垂直传播状况。探讨早期诊断胎儿ＨＣＭＶ宫内感染的方法。方法：应用酶联免疫吸附法（ＥＬＩＳＡ）筛查５０１５例孕妇ＨＣＭＶ的特异性抗体（ＩｇＧ及ＩｇＭ），同时应用聚合酶链反应技术（ＰＣＲ）检测其中３０１例具有活动性ＨＣＭＶ感染者的胎儿附属物，新生儿血、尿及母乳的ＨＣＭＶＤＮＡ。结果：三城市孕妇ＨＣＭＶ感染率为８８．９３％；沈阳、上海分别为９６．７４％和９１．４２％，明显高于武汉（７９．５３％）；孕妇活动性感染率为５．４２％，武汉与沈阳分别为１１．２３％和１０．９８％，明显高于上海。有异常妊娠史孕妇的活动性感染率为１４．５９％；孕早期绒毛和孕中期羊水的ＨＣＭＶＤＮＡ阳性率分别为１６．００％和３５．３３％；羊水的ＨＣＭＶＤＮＡ阳性率与分娩期脐血、胎盘、新生儿血相比较，差异无显著性（Ｐ＞０．０５）。结论：我国城市孕妇ＨＣＭＶ感染有地区差异，三城市孕妇多数于孕前早已感染ＨＣＭＶ；孕妇于活动性感染时易传播胎儿。

Objectives:Toanalyzethestateofhumancytomegalovirus(HCMV)infectionofpregnantwomenandthematernal-fetaltransmissioninthreechinesemetropolis,andtostudythemethodsofearlyprenataldiagnosisforintrauterineinfection.Methods:Enzymelinkedimmunosor-bentassay(ELISA)techniquewasemployedtoscreenHCMVspecificantibodiesin5015pregnantwomenofdifferenttrimesters.Fromthiscohortstudy,301casesofactiveinfectionwereselectedtodetectHCMVDNAbypolymerasechainreaction(PCR)techniqueintheirappendagesoffetus,bloodandurineofneonates,aswelasbreastmilk.Results:TheoveralHCMVinfectionratewas88.93%inthethreemetropolisandtheywere96.74%and91.42%inShenyangandShanghaire-spectively,whichweresignificantlyhigherthanthat(79.53%)inWuhan.Theactiveinfectionratewas5.42%generalywhiletheywere11.23%and10.89%inWuhanandShenyangrespectively,whichweresignificantlyhigherthanthatinShanghai.Inaddition,theactiveinfectionrateofwomenwithhistoryofabnormalpregnancywassignificantlyhigherthanthatwasofthecontrolgroup(14.59%vs3.70%).ByPCRtechnique,thedetectiverateofHCMVDNAwere16.00%inchroionicviliofearlypregnancyand35.33%inamnioticfluidofmid-trimester,whichwerenotsignificantlydiferentfromtheseinumbilicalblood,placenteaatdeliveryandneonatalblood.Conclusions:InChina,theHCMVinfectionratesduringpregnancyvariedindiferentregions.Amajorityofwomenatchildren-bearingagehadHCMVinfectionbeforepregnancies;theverticaltransmissionfrequentlyoc-cursfromtheactivelyinfectedmother.ELISAcombinedwithPCRtechniquesisavaluablemethodforearlyprenataldiagnosisofHCMVcongenitalinfection.