孕妇巨细胞病毒感染对胎儿影响的前瞻性研究

The prospective study of the influence of cytomegalovirus (CMV) infection of pregnant women to fetus

用酶联免疫吸附试验（ＥＬＩＳＡ）及聚合酶链反应（ＰＣＲ）方法对沈阳市４５０名孕妇进行巨细胞病毒（ＣＭＶ）筛查，并前瞻性追查到其婴儿１００名ＣＭＶ感染状况。结果孕妇９７．１１％为既往感染，０．８９％为原发感染，１１．１１％为复发感染，仅２％为易感者。４５０例中感染组孕妇有畸形儿３例，流产３例，其胎儿感染率与致畸率明显高于对照组。１００例母婴检查结果：感染组孕妇所生先天性感染儿比对照组多１．４３倍（ＲＲ＝１．４３），感染组有２名低智儿，对照组无。本组早孕原发感染对胎儿危害最大，其宫内传播率为３３．３％。感染组孕妇９例感染儿中２例巨细胞包涵体病，７例无症状。为了早期诊断达到优生目的，对孕妇进行ＣＭＶ筛查是必要的，但筛查过程中发现有活动感染时处理要慎重，最好追查到羊水阳性时考虑终止妊娠。

Screening of CMV infection in 450 pregnant women in Shenyang was carried on by ELISA and PCR methods, and CMV infection was detected in 100 of their infants prospectively. The results were 97 11% of pregnant women with past infection, 0 89% with primary infection, 11 11% with recurrent infection, only 2% were susceptible. From 450 pregnant women, there were 3 infants with congenital defects and 3 abortions in active infective group, who were positive for IgM antibody, CMV DNA were positive in heparin peripheral blood, cervical secretion, placenta or amnionic fluid. The fetal infection rate and congenital defect rate in infective group were higher than that in inactive control group. Within 100 maternal-infant pair group, congenitally infected infants were 1 43 times higher in infective group than that in control group (RR=1 43). Two infants with mental retardations (MDI<70) were born in infective group, but none in control group. In our study, primary infection of early pregnancy was most harmful to fetus, the intrauterine transmission rate was 33 3%. Among nine infected infants born from the infective group, two infants were with CID, and seven were symptomless. CMV screening is important for pregnant women in view of eugenic. When active CMV infection is found in early pregnancy, termination of pregnancy is better considered while CMV detection of amniotic fluid is also positive.