巨细胞病毒性疾病的诊断

Diagnosis of cytomegalovirus diseases

小儿巨细胞病毒性疾病是由巨细胞病毒(CMV)引起的疾病,简称CMV病。在作诊断时,必须了解我国小儿主要由母婴传播获得感染,多在婴幼儿期患病。以后病毒长期潜伏在宿主体内。由于年龄特点、个体差异和各脏器致敏性不同,小儿CMV病临床变化众多。总的来说,新生儿(包括胎儿)可以产生以中枢神经系统受损为主的疾病;婴儿感染后多数可有不同程度的肝胆受损,少数发生间质性肺炎;其他大年龄小儿,仅为无症状性CMV感染(有时CMV也可复制,但不引起疾病)。诊断CMV性疾病必须具备活动性CMV感染和宿主脏器病变临床表现这两个基本条件。由下列检测中任何一项阳性即为活动性CMV感染,如病毒分离阳性,病毒抗原pp65检测阳性,病毒核酸检测特异性CMV mRNA阳性,血清学检测CMVIgM阳性。由于婴儿期CMV病以肝胆和肺部疾病多见,除非直接从病变组织中检出活动性CMV感染标记物,才可确定是由CMV引起,若从血、尿等标本查得,就必须排除能够引起同样临床表现的其他病因和病原。

Cytomegalovirus （CMV） causes a variety of diseases （CMVD） in children. In order to diagnose theses diseases, we it must be recognized that most CMV infections in Chinese children are caused by direct mother-infant transmission. Hence, CMVD are usually found in infancy and the virus persisted in the host for the rest of life. Due to age, individual difference and sensitivity of different organs, there are various clinical manifestations in pediatric CMVD. Generally, central nervous system diseases mainly occur in neonates （including fetus） while different degrees of hepatobiliary damage develop in infancy. Few infants have interstitial pneumonia. Most of the elder children are presented with asymptomatic infections only （sometimes the virus replicates but did not cause diseases）. The major diagnostic criteria of CMVD should include two basic principles： active CMV infection; and clinical presentation of host organ pathology. Active CMV infection is defined by positive findings in any of the following： isolation of virus in culture, detection of pp65 antigen, expression of specific CMV-mRNA and serological detection of CMV-IgM. Since infant CMVD are usually presented as hepatobilary and pulmonary diseases, active CMV markers must be confirmed in these affected organs. If the positive markers are detected in blood or urine samples, differential diagnosis must be made to exclude other diseases that may have similar clinical presentations.