秦巴山区孕产期HCMV感染状况调查

Research on HCMV infection during pregnancy in Qinba mountain areas

目的研究贫困山区人巨细胞病毒(HCMV)的感染状况以及导致HCMV感染的危险因素。方法选择陕南贫困地区4个县434名中、晚期妊娠妇女,对其进行一般情况及孕期情况的问卷调查,应用酶联免疫吸附试验(ELISA)及PCR技术检测孕妇外周血抗HCMV-IgG、IgM抗体及HCMV DNA片段随访至其生产后(所有随访者均为足月生产),分别于产后2周内、3~14周内对随访产妇采集其乳汁及所生婴儿的尿液,继续进行HCMV的相关检查,区分先天性感染和围生期感染,并结合问卷分析HCMV感染的危险因素。结果①贫困山区妊娠妇女HCMV感染率为85.48%(371/434),活动性感染率为8.06%(35/434);总宫内传播率为4.58%(17/371),其中活动性感染者宫内感染率为31.43%(11/35),潜伏性感染者为1.79%(6/336),两组间宫内传播率有显著性差异(x^2=63.704,P<0.05);②产妇乳汁HCMV阳性率11.86%(44/371),其中活动性感染者乳汁排毒率为85.71%(30/35),潜伏性感染者乳汁排毒率为4.17%(14/336),两组间有显著性差异(确切概率0.000,P<0.05)。乳汁排毒组中继续母乳喂养者中有14.28%(1/7)发生围生期感染,乳汁无排毒组中无围产期感染,两组间围生期感染率有显著性差异(确切概率0.021,P<0.05);③年龄、文化程度、家庭经济状况在活动性、潜伏性感染与正常对照组间均无显著性差异(x^2值分别为4.088、5.610、5.380,均P>0.05)。孕产次、分娩方式在活动性、潜伏性感染与正常对照组间均有显著性差异(x^2值分别为9.383、17.746,均P<0.05)。结论秦巴山区妊娠妇女HCMV活动性感染率、宫内传播率较课题组之前的研究有所下降,但仍高于其他地区感染水平。妊娠期HCMV活动性感染是导致宫内传播和产后乳汁排毒的重要因素产后乳汁排毒可造成围生期HCMV感染。

Objective To investigate the recent human cytomegalovirus （HCMV） infection status and the risk factors of HCMV infection in poverty-stricken area. Methods Questionnaires were used to investigate the general information of 434 women at second and third trimester in 4 counties of poverty-stricken areas of Shaanxi Province. Anti-HCMV-IgG, IgM antibody and HCMV DNA fragments were detected by using enzyme-linked immunosorbent assay （ELISA） and PCR in peripheral blood of these pregnant women, who were followed up till delivery （all of the follow-up patients had term delivery）. Patients＇ milk and their infants＇ urine were collected within 2 weeks and 3-14 weeks respectively after delivery for HCMV detection. Congenital infection was distinguished from perinatal infection, and risk factors of HCMV were analyzed considering questionnaires. Results HCMV infection rate in pregnant women in poverty-stricken mountain area was 85.48% （371/434）, with active infection rate of 8.06% （35/434）. The total intrauterine transmission rate was 4.58% （17/371）. Intrauterine transmission rate of active infection patients was 31.43% （11/35）, and that of latent infection patients was 1.79% （6/336）. The difference was significant （χ2 = 63. 704, P 〈 0. 05）. Maternal milk HCMV-positive rate was 11. 86% （44/371）. The milk detoxification rate of active infection patients was 85.71% （30/35）, and that of latent infection patients was 4.17% （14/336）. There were significant difference between them （ exact probability = 0. 000, P 〈 0.05 ）. Perinatal infection occurred in 14.28% （ 1/7 ） of subjects continuing to feed baby in milk detoxification group, and there was no perinatal infection in the group without milk detoxification. The perinatal infection rate between two groups was significantly different （exact probability = 0. 021, P 〈 0.05 ）. Age, education and family economic conditions were not evidently different among active infection group, latent infection group and normal control group （χ2 value was 4. 088, 5. 610 and 5. 380, respectively, all P 〉 0.05 ） , while parity and delivery mode were significantly different among three groups （χ2 value was 9. 383 and 17. 746, respectively, both P 〈 0.05）. Conclusion Although the rate of active HCMV infection and intrauterine transmission rate in pregnant women in Qinba mountain area decrease compared with those in earlier period, they are still higher than the level of other areas. HCMV active infection is an important factor inducing intrauterine transmission and milk HCMV-positive. Postpartum milk detoxification may cause perinatal HCMV infection.