北京地区新生儿先天巨细胞病毒感染状况研究

Prevalence of congenital cytomegalovirus infection in Beijing

目的评估北京地区新生儿先天性巨细胞病毒(CMV)感染状态及其对新生儿的危害。方法选择2004年11月至2008年3月在北京居住、怀孕12周之内的孕妇,分别于孕早期和孕中期进行血清CMV IgG定量和CMV IgM定性检测;活动感染者接受CMV IgG亲和力、CMV pp65抗原血症和白细胞CMV巢式聚合酶链反应(nPCR)检测;白细胞CMV DNA阳性孕妇接受羊水CMV nPCR检测。所有入选孕妇分娩的新生儿出生后均检测脐血CMV nPCR,阳性者于生后2周内复查尿CMV nPCR。结果本研究共收入孕妇1752例,新生儿1756例;孕期血清学检查CMV活动感染51例,占2.91%(95%CI 2.12%～3.70%),其中原发活动感染2例,占全部孕妇的0.11%(95%CI 0.10%～0.41%);CMV nPCR阳性的孕期活动性感染占0.34%;活动感染孕妇羊水CMV nPCR检测全部阴性;新生儿先天性CMV感染发生率0.23%(95%CI 0.06%～0.58%)。所有先天性CMV感染新生儿出生时均为无症状性感染。结论北京地区CMV感染垂直传播率低,先天CMV感染发生率0.23%,未见到症状性先天性CMV感染患儿。

Objective This study aimed to study the prevalence of CMV infection during pregnancy and perinatal period, as well as to evaluate the incidence and symptoms of congenital CMV infection in neonates. Methods Prospective cohort study was conducted in four hospitals in Beijing. From November 2004 to March 2008, pregnant women within 12 week gestation were recruited for the study. Serum quantitative CMV-IgG and qualitative CMV-IgM were measured during early- and mid- pregnancy periods. Women who were found having active CMV infection received the CMV-pp65 antigen assay, the CMV IgG affinity and the white blood cell CMV nPCR testings. Pregnant women with positive CMV DNA received amiontic fluid CMV nPCR analysis. All fetus received prenatal ultrasound. Newborns of all the enrolled mothers received the umbilicus cord blood CMV nPCR testing; neonates who were tested positive had follow up urine CMV nPCR within 2 weeks to verify the CMV infection state. Results A total of 1752 pregnant women and 1756 newborns were enrolled in this study. Among them, 1590 （90. 75% ） pregnant women had past CMV infection; 51 patients （2.91%） were diagnosed with active CMV infection （95%CI 2. 12% -3.70% ） ; and only two patients （0. 11% ） were diagnosed with primary active CMV infection （95%CI 0. 10% -0.41% ）. For those women who had active CMV infection during pregnancy, 0. 34% revealed positive maternal serum CMV nPCR, however, none was tested positive for, CMV nPCR in amiontic fluid. Four newborns （0. 23% ） were tested positive for umbilicus cord blood CMV nPCR at birth and urine CMV nPCR at 2 weeks of life （95% CI 0. 06% - 0. 58% ）, therefore, were diagnosed with congenital CMV infection. All the infected neonates remained asymptomatic. Conclusions In the municipal Beijing area, the incidence of maternal primary active infection was low. The the maternal-fetal transmission rate was low with the incidence of neonatal congenital CMV infection at 0. 23%. All the CMV infected neonates remained asymptomatic.