基于实时荧光定量PCR方法分析新生儿先天性巨细胞病毒感染的临床特征

Analysis of the clinical features of neonatal congenital cytomegalovirus infection based on real-time QF-PCR method

目的探讨新生儿先天性巨细胞病毒感染HCMV-DNA载量与新生儿临床症状的关系。方法回顾性研究2016年1月至2018年12月在广东省妇幼保健院新生儿科收治的出生14天内新生儿,采用实时荧光定量PCR方法进行HCMV-DNA检测确认75例先天性HCMV感染,分析新生儿HCMV-DNA载量与临床特征、听力检测及疾病转归的关系。结果75例HCMV先天性感染新生儿常见的临床表现中黄疸占76%(57/75)、肺炎占74.7%(56/75)、贫血占42.6%(32/75)、颅内出血占36%(27/75),其中55例为新生儿,20例为早产儿,两组的贫血及室管膜下囊肿差异具有统计学意义。75例感染新生儿尿中HCMV-DNA平均数值1.79×10^(5)copies/ml(5.1×10^(2)~2.5×10^(7)copies/ml),其中56%(42/75)的HCMV-DNA在5.0×10^(2)~9.9×10^(2) copies/ml之间,18.6%(14/75)的HCMV-DNA在1.0×10^(3)~9.9×10^(3)copies/ml之间,25.3%(19/75)>9.9×10^(3)copies/ml。将HCMV-DNA数值与临床症状进行分析,发现24例贫血新生儿HCMV-DNA(≥1.0×10^(3)copies/ml)明显高于18例非贫血新生儿(<1.0×10^(3)copies/ml),差异具有统计学意义。结论新生儿先天性HCMV感染时的主要临床表现为黄疸、肺炎、贫血、肺炎及颅内出血,应及时进行尿HCMV-DNA检测,为是否采用更昔洛韦抗病毒治疗提供诊疗依据。

Objective Study on the relationship between HCMV-DNA load and clinical symptoms of neonates with congenital cytomegalovirus infection.Methods A retrospective study was conducted on newborns admitted to the Department of Neonatal Pediatrics of Guangdong Maternal and Child Health Hospital from January 2016 to December 2018.Real-time fluorescence quantitative PCR was used to detect HCMV-DNA in 75 cases of congenital HCMV infection.The relationship between neonatal HCMV-DNA load and clinical characteristics,hearing test and disease outcome was analyzed.Results The common clinical manifestations of 75 newborns with HCMV congenital infection included jaundice(57%),pneumonia(74.7%),anemia(42.6%)and intracranial hemorrhage(36%).Among them,55 cases were newborns and 20 cases were premature infants.There was significant difference in anemia and subependymal cyst between the two groups.The average value of HCMV-DNA in the urine of 75 infected newborns was 1.79×10^(5)copies/ml 5.1×10^(2)~2.5×10^(7)copies/ml,of which 56%(42)of the HCMV-DNA was between 5.0×10^(2)~9.9×10^(2)copies/ml.18.6%(14)of HCMV-DNA is between 1.0×10^(3)~9.9×10^(3),25.3%(19)>9.9×10^(3)copies/ml.By analyzing the value of HCMV-DNA and clinical symptoms,it was found that the HCMV-DNA of 24 anemic newborns(≥1.0×10^(3)copies/ml)was significantly higher than that of 18 non-anemic newborns(<1.0×10^(3)copies/ml).Conclusions The main clinical manifestations of neonatal congenital HCMV infection are jaundice,pneumonia,anemia,pneumonia and intracranial hemorrhage.Urinary HCMV-DNA should be detected in time to provide the basis for diagnosis and treatment of ganciclovir antiviral therapy.