TORCH筛查的再认识

Recognition of TORCH screening

TORCH是导致先天性缺陷的一组围产期感染病原体,母体感染大多无症状,这使得原发感染识别困难。TORCH血清学检测是目前临床首选的检测方法,检测指标包括TORCH特异性IgM抗体、IgG抗体和IgG抗体亲和力等。推荐孕前进行TORCH筛查,可以确定备孕女性的基础免疫状态,有助于后续孕期TORCH筛查决策和风险判断。关于妊娠期TORCH筛查,仍然存在诸多争议。妊娠期TORCH血清学检测,是确定母体感染的主要手段,但不能作为胎儿宫内感染的依据。妊娠期TORCH筛查应根据所筛查病毒的特点来确定筛查时间。妊娠期发生的TORCH感染是否会导致胎儿宫内感染,取决于孕妇的免疫状态、感染类型、感染持续时间。超声检查的特异性结果为发现宫内感染提供线索,对于是否进行侵入性产前诊断具有指导作用;对于明确的胎儿宫内感染,有无结构异常对于判断胎儿预后至关重要。羊水PCR检测常用于胎儿宫内感染的诊断。目前对TORCH宫内感染胎儿尚无有效的治疗手段。对于TORCH感染,尚需规范检测流程、正确解读检验结果、通过临床大数据研究,为中国人群提供循证医学证据支持。

TORCH is a group of perinatal infectious pathogens that cause congenital defects.Most of ma⁃ternal infections are asymptomatic,making it difficult to identify primary infections.At present,TORCH se⁃rological test is the preferred clinical detection method.The detection indexes include TORCH specific IgM antibody,IgG antibody and IgG antibody affinity.TORCH screening before pregnancy is recommended to determine the basic immune status of women pre⁃paring for pregnancy,which is helpful for TORCH screening decision-making and risk assessment during subsequent pregnancy.TORCH screening in pregnancy is still controversial.TORCH serological test during pregnancy is the main means to determine maternal infection,but it can not be used as the evidence of fetal infection in utero.The screening time of TORCH in pregnancy should be determined according to the characteristics of the virus being screened.Whether TORCH infection during pregnancy will lead to in⁃trauterine infection depends on the immune status of the pregnant woman,the type of infection,and the duration of infection.The specific results of ultrasound can provide clues for the detection of intrauterine in⁃fection and guide the invasive prenatal diagnosis,whether there is structural abnormality is very impor⁃tant for judging fetal prognosis in confirmed intra-uterine infection.PCR detection of amniotic fluid is often used in the diagnosis of fetal intrauterine infec⁃tion.At present,there is no effective treatment for TORCH intrauterine infected fetus.For TORCH in⁃fection,we need to standardize the detection process,correctly interpret the test results and provide evi⁃dence-based medical support for the Chinese popu⁃lation through clinical big data research.