围产期巨细胞病毒感染的前瞻性研究

Prospective study of perinatal infection of cytomegalovirus in infants

目的分析围产期婴儿巨细胞病毒（cytomegalovirus，CMV）感染的相关因素，以及围产期CMV感染对婴儿健康的影响。方法对围产期婴儿CMV感染进行多中心队列研究。采用巢式聚合酶链反应技术对非先天性巨细胞病毒感染婴儿在12周龄时进行尿CMVDNA检测，根据检测结果将婴儿分为围产期CMV感染组和非感染组。对两组婴儿的新生儿期状况、12周龄时的体格发育和临床情况进行比较；对影响围产期CMV感染的危险因素进行非条件Logistic多因素回归分析。结果518例婴儿中12周龄时尿CMVDNA阳性105例（感染组），阴性413例（非感染组），围产期CMV感染率20．27％。感染组中黄疸持续3个月者2例，曾患间质性肺炎者2例，但与非感染组（分别为2例）比较差异均无统计学意义（P均=0．184）。围产期CMV感染影响因素的非条件Logistic多因素回归分析显示有妇科病史为独立危险因素（OR=2．275，95％CI：1．137～4．551，P=0．020），非母乳喂养（混合喂养：OR=0．392，95％CI：0．185～0．830；人工喂养：OR=0．101，95％CI：0．013-0．769）和人均居住面积大（OR=0．948，95％CI：0．917～0．980）为保护性因素。结论母乳喂养是围产期CMV感染的重要影响因素；围产期CMV感染对足月儿和近足月儿近期健康没有明显影响。

Objective To determine the associated factors of perinatal cytomegalovirus （CMV） infection and the impact on infantile health. Methods A prospective multicenter cohort study was conducted. The urine CMV DNA in infants without congenital CMV infection were measured with nested-polymerase chain reaction at the age of 12 weeks. According to the results of nested-polymerase chain reaction, the infants were divided into perinatal CMV infection group and non-perinatal CMV infection group. Their motor and mental development in neonatal period and 12 months old were measured and analyzed. The risk factors of perinatal CMV infection were analyzed with multivariate Logistic regression analysis. Results Among 518 infants,105 were positive for CMV DNA in urine samples, the rest were negative. The percentage of perinatal CMV infection was 20. 27%. Logistic regression analysis showed that the maternal gynecologic history was the independent risk factor （OR = 2.275,95 % CI：1. 137-4. 551, P=0.020） , while non-breast feeding （breast and bottle feeding： OR =0. 392, 95% CI：0. 185-0. 830; exclusive bottle feeding： OR=0. 101, 95%CI： 0. 013-0. 769）, and per-capita living space （OR=0. 948,95% CI：0. 917-0. 980） were protective factors of CMV infection. Conclusions Breast feeding is the predominant factor for perinatal CMV infection. Perinatal CMV infection has no short-term influence on term or near-term neonatal health.