新生儿室管膜下囊肿的病因研究

An etiological study on subependymal cysts in neonates

为了探讨新生儿室管膜下囊肿（ＳＥＣ）与先天性感染的关系，采用ＥＬＩＳＡ酶标法检测母婴双方囊肿组与对照组各７０例血巨细胞病毒（ＣＭＶ）、风疹病毒、弓形虫的抗体，并应用聚合酶链反应（ＰＣＲ）技术直接检测病原ＤＮＡ（风疹病毒除外），同时作尿ＣＭＶ的ＰＣＲ检测。结果：囊肿组新生儿血ＣＭＶ－ＩｇＭ抗体和ＣＭＶ－ＰＣＲ阳性率显著高于对照组（分别为１７．１％、５．７％和１２．９％、２．９％）；且尿ＣＭＶ－ＰＣＲ的阳性率达４０．０％（２８／７０），高于对照组的１７．１％（１２／７０）；分别进行两组自身对照，尿ＣＭＶ－ＰＣＲ的阳性率显著高于血ＣＭＶ－ＰＣＲ阳性率（Ｐ＜０．０５）。囊肿组母亲的尿ＣＭＶ－ＰＣＲ阳性率亦显著高于对照组（３０％、１０％、Ｐ＜０．０１）。提示新生儿ＳＥＣ是宫内感染损害中枢神经系统的表现之一，与先天性ＣＭＶ感染有关，尿ＣＭＶ－ＰＣＲ检查可作为宫内ＣＭＶ感染的首选实验室诊断方法。

The aim of this study was to investigate the relationship between subependymal cysts (SEC) and congenital cytomegalovirus (CMV) infection. Using cranial ultrasound, SEC was screened in all neonates within 7 days of age. Seventy neonates with SEC (SEC group) and 70 normal neonates (control group) were recruited in this study. Blood antibodies (IgG and IgM) for CMV, toxoplasma (Toxo) and rubella virus were measured. Polymerase chain reaction (PCR) was used for CMV and Toxo DNA detection for infants and their mothers of the two groups. The results showed that the positive rates of blood CMV IgM and CMV DNA in SEC group were significanty higher than those of control group (17.1% vs 5.7% and 12.9% vs 2.9%, respectively). The positive rates of urinary CMV DNA in SEC group was also significanty higher than that of control group (40% vs 17.1%). The positive rates of urinary CMV DNA in both groups were higher than those of blood CMV DNA ( P < 0.05). A statistically significant difference in urinary CMV DNA positive rate between mothers of those in SEC group and of control group was also observed (30% vs 10% P <0.01). It was concluded that SEC was one of the manifestations of central neurological damage induced by CMV infection, and was closely correlated with congenital CMV infection. Hence, the urinary CMV PCR should be considered as the first choice of laboratory tests to diagnose congenital CMV infection.