先天性巨细胞病毒感染对无症状患儿生长发育的影响

A perspective study on growth and development of children with asymptomatic congenital cytomegalovirus infection in poverty-striken mountain areas

目的探讨陕南贫困山区先天性巨细胞病毒(humancytomegalovirus,HCMV)感染对无症状患儿体格和智能发育的影响。方法对1997年10月至2000年10月在陕南贫困山区出生的34例先天性HCMV感染无症状儿(宫内感染组)、72例妊娠期活动性感染无先天性感染儿(无宫内感染组)和106例无妊娠期活动性感染儿(正常组)进行随访,随访内容包括:新生儿期和幼儿期的体格测量、幼儿期和学前期的智能测定、学前期听力测试。结果与正常组比较,宫内感染组和无宫内感染组新生儿出生时和幼儿期平均体质量、身长、头围,差异无显著性(P>0.05);无论在幼儿期或学前期,宫内感染组智能发育落后的发生率明显高于正常组,尤其是言语能力明显低下(P<0.05);与正常组相比,宫内感染组学前期纯音听阈异常的发生率显著增加(P<0.05)。结论HCMV先天性感染对无症状儿的体格发育无明显影响,但可影响患儿远期言语能力和听力,对智能发育有明显影响。应重视HCMV宫内感染儿远期智能和听力的监测,对语言能力和听力异常的患儿应适时采取干预措施。

Objective To explore the physical and intellectual development of children with asymptomatic congenital human cytomegalovirus （HCMV） infection. Methods A total of 106 newborns whose mothers were infected with active HCMV during pregnancy were collected between October 1997 to October 2000 in southern poverty-striken mountain areas of Shaanxi province, including 34 neonates with asymptomatic congenital infection and 72 neonates without congenital infection. Another 106 newborns were used as control, whose mothers were without active HCMV infection during gestational period. Follow-up included physical development in neo- natal and infant period, intellectual development in infant and pre-school period, hearing test in pre-school period. Results There was no significant difference between the asymptomatic congenital HCMV children or non-congenital HCMV children and the control children in average body weight, length, and head circumference. In infancy or pre-school period, the developmental and intellectual quotients of asymptomatic congenital HCMV children were all lower than that of the control children, especially in language behavior. Hearing dysplasia was more in asymptomatic HCMV children than that in the control children. Conclusion Congenital HCMV infection does not affect on physical development of asymptomatic congenital HCMV children, but affects on lan- guage and hearing capability of children in the future and can lead to obvious retardation of intellectual development. We should attach importance to the monitoring of long-term intellectual and hearing capability of asymptomatic HCMV children and carry out proper intervention to the children with language and hearing dysplasia.