小于胎龄儿临床分型及其与先天HCMV感染的相关性研究

Association Between Classification of Small-for-Gestational Age Infants and Congenital Cytomegalovirus Infection

[目的]探讨先天人巨细胞病毒(HCMV)感染对胎儿宫内生长发育的影响。[方法]对88例小于胎龄儿(SGA)用酶联免疫吸附法和:PCR法分别检测血HCMV特异性IgM抗体及尿HCMV-DNA,并对SGA及其不同临床分型与先天HCMV感染的相关性进行分析。[结果]①88例SGA中按体质量指数分匀称型占89.77％(79/88),按身长/头围比值分匀称型占85.23％(75/88),两种分型方法结果的符合率为78.4％;而按SGA定义分型,其匀称型为57.95％(51/88)。②SGA的先天HCMV感染率与正常足月儿和早产适于胎龄儿相比,差异有显著性统计学意义(P<0.001)。③按体质量指数和按身长/头围比值分型,其匀称型与非匀称型SGA的先天HCMV感染率差异均无统计学意义(P>0.05)。但按SGA定义分型,其匀称型与非匀称型SGA的先天HCMV感染率差异有统计学意义(P=0.022)。[结论]本文结果提示:①该研究SGA的匀称型比率偏高;②先天性HCMV感染与SGA的发病密切相关。③SGA匀称型比率偏高的原因,可能与我国孕妇孕早期感染发病率高有关。④与按SGA定义分型相比,我国目前的体质量指数及身长/头围比值分型方法对匀称型诊断的正确率过低,提示后者的分型标准值得进一步探讨。

[Objective] The study aims to examine the effects of congenital infection of human cy-tomegalovirus (HCMV) on the growth and development of fetus in uterus. [Methods]The HCMV infection status of small for gestational age infants (SGA) with different gestational age was proved by testing urine HCMV-DNA and plasma HCMV-specific IgM using PCR and ELSIA respectively. The association of HCMV infection status with the gestational age and classification by different criteria was examined in 88 SGA. [Results](1)Of the 88 SGA, the percentage rate of symmetric SGA was 89. 77% and 85. 23% as classified by the ponderal index and crown-heel length-to-head circumference ratio (CHL/HC), respectively. The accordance rate of the two criteria was 78.4%. However, there was only 57. 95% of SGA whose crown-heel length, birthweight and head circumference were less than 10 percentile. (2) SGA had a significantly higher rate of HCMV infection than normal term infant and preterm infant AGA ( P < 0. 001). (3)There was no significant difference in HCMV infection rate between symmetric SGA and asymmetric SGA by the weight index and crown-heel length -to-head circumference ratio (CHL/HC) in SGA (P < 0. 05). However, a higher infection rate was observed in SGA with crown-heel length, birthweight and head circumference below 10% percentile ( P=0. 022). [Conclusion] Our findings suggest that (1) the studied SGA children had a high symmetric rate; (2) congenital infection of HCMV is closely correlated with the occurrence of SGA; (3) a higher rate of symmetric SGA may possibly be due to a higher HCMV infection rate among pregnant women at early pregnancy; (4) a low specificity in the diagnosis of symmetric children by body length - head circumference ratio and weight index currently used in China suggests these criteria might not be appropriate for such classifications.