抗体联合亲和力检测诊断巨细胞病毒宫内感染的临床研究

Clinical study on diagnosis of intrauterine cytomegalovirus infection by antibody combined with affinity test

目的:通过人巨细胞病毒抗体联合IgG亲和力的检测,以鉴别感染时期,评估胎儿巨细胞病毒感染风险。方法:收集我院2016年1月~2017年11月130例孕妇巨细胞病毒IgM抗体和IgG抗体双阳性的标本,采用ELISA解离法测定孕妇血清HCMV-IgG亲和力,同时采用定量PCR方法进行孕妇尿巨细胞病毒核酸检测,跟踪随访胎儿结局;根据结果将入组孕妇分成3组,A组为高亲和力,B组为亲和力灰区,C组为低亲和力。结果:130例标本中,102例(78.46%)检测为高亲和力,HCMV-DNA均小于阈值,所产胎儿状况良好;11例(8.46%)检测为亲和力灰区,其中有1例HCMV-DNA阳性,所产胎儿诊断为先天性HCMV感染;17例(13.07%)检测为低亲和力,其中7例HCMV-DNA阳性,1例所产胎儿诊断为先天性HCMV感染,1例流产。结论:人巨细胞IgM阳性、IgG阳性及高IgG亲和力的孕产妇为宫内感染低风险,胎儿结局良好。IgM阳性、IgG阳性及低IgG亲和力的孕产妇宫内感染高风险,出现胎儿先天性HCMV感染的概率高。

Objective:To identify the infection stage by detection of human cytomegalovirus antibody and IgG affinity and assess the risk of fetal cytomegalovirus infection.Methods: A total of 130 pregnant women with IgM antibody and IgG antibody positive were collected from January 2016 to November 2017.The serum HCMV-IgG affinity of pregnant women were determined by ELISA dissociation method.At the same time,the urine cytomegalovirus nucleic acid of pregnant women were detected by quantitative PCR.The fetal outcome was followed up.According to the results,the pregnant women were divided into three groups:Group A with high affinity,and Group C with low affinity,Group B was gray district.Results: Among the 130 samples,102(78.46%) samples were detected with high affinity IgG and the DNA of HCMV-DNA was lower than the threshold value,and the fetal condition was good.11(8.46%) samples were affinity gray district,one of them was positive for HCMV-DNA,the fetus who produced was diagnosed intrauterine infection.17(13.07%) samples with low affinity were detected in 7 cases of HCMV-DNA positive fetus and 1 case of miscarriage.Conclusion: Although both human cytomegalovirus IgM and IgG were positive,high IgG affinity had low risk of intrauterine infection,low affinity with high risk of infection on the contrary.