妊娠妇女感染人类细小病毒B19的研究进展

Women Infected With Human Parvovirus B19 During Pregnancy

人类细小病毒B19(B19V)作用于红细胞的前体细胞,是红细胞生成的抑制因子。妊娠妇女感染B19V时,可通过胎盘母婴垂直传播引起胎儿流产、贫血、非免疫性水肿等症状和胎儿宫内死亡,一般不引起胎儿畸形。母体血清中检测出B19V的IgG或IgM抗体是早期诊断该疾病最有效手段,而聚合酶链反应(PCR)检测B19V的DNA最敏感。当母体发生感染时,超声检测胎儿大脑中动脉收缩期峰值流速(MCA-PSV)是诊断胎儿贫血与水肿的有效的非损伤性方法。胎盘检查可发现绒毛内存在毛玻璃样嗜伊红病毒包涵体等特征形态。宫内输血可纠正胎儿贫血,减少水肿的发生,且预后良好。常与学前及学龄儿童接触的高危妇女应在妊娠期进行风险评估,以便采取不同处理方式,减少胎儿不良结局的发生。

Parvovirus B19 infects erythroid precursor cells and it is a potent inhibitor of hematopoiesis. Parvovirus B19 infected in pregnancy can be transmitted vertically from mother to fetus. This infection can cause several serious complications in the fetus, such as fetal abortion, anemia, no immune fetal hydrops and intrauterine fetal death. There is no evidence that Parvovirus B19 is a significant teratogen in human. Testing maternal serum for IgM and IgG antibodies against Parvovirus B19 and DNA detection by PCR can confirm maternal infection. If maternal infection has occurred, ultrasound investigation of the fetus and measurement of the peak systolic flow velocity of the middle cerebral artery are sensitive non-invasive procedures to diagnose fetal anemia and hydreps. There are characteristic glassy and brick-red intranuclear inclusions in the infectious placenta. Intrauterine transfusion is currently the effective treatment to alleviate fetal anemia, and the prognosis is good. Women who often contact children should be counseled during pregnancy in order to reduce the risk of adverse fetal outcome.