超声在围产期监测宫内感染所致胎儿畸形的临床价值

Evaluation of Ultrasonography for Monitoring Fetal Malformation Induced by Intrauterine Infection in Perinatal Period

【目的】了解母亲血清病毒抗体阳性胎儿畸形的发生率及脐血病毒抗体阳性婴儿器官受损情况。【方法】于 1999～ 2 0 0 0年对 2 2 4 5例孕妇进行巨细胞病毒 (CMV)、弓形虫 (TOXO)、风疹病毒 (RV)血清抗体IgG、IgM检测 ,并同步进行超声的系统监测 ,新生儿脐血的检测及随访。【结果】超声检测母亲病毒抗体阳性胎儿畸形的发生情况 :CMV IgG阳性 5 / 831例 (0 .6 % ) ,CMV IgM阳性 2 / 80例 (1.2 % ) ;TOXO IgG阳性 2 /5 7例 (3.5 % ) ,TOXO IgM阳性 1/ 75例 (1.3% ) ;RV IgG阳性 2 / 2 17例 (0 .92 % ) ,RV IgM阳性 4 / 92例(4 .4 % )。新生儿期的随访 :脐血RV IgG阳性 2例、RV IgM阳性 1例、发生先天性耳聋 2例 ;CMV IgG阳性2 4例、CMV IgM阳性 2例、发生先天性耳聋 1例、室管膜下囊肿 3例、法洛四联征 1例、单心房 1例。【结论】超声可提供胎儿器官结构及生长指标重要的诊断信息 ,对降低出生缺陷的发生率有重要意义。

To understand the rate of congenital malformation in fetus with virus antibody positive of maternal serum and the organ damage in fetus with virus antibody positive of umbilical cord blood.Serum levels of virus antibody IgG and IgM against cylomegalovirus (CMV), toxoplasma (TOXO) and rubella virus (RV) in 2245 parturients were detected during 1999～2000 yr. Synchronous ultrasonographic monitoring , examination of serum antibody in neonatal umbilical cord blood and subsequent follow-up of neonates were carried out.In case of maternal serum with virus antibody(+),the fetal congenital malformation rates demonstrated by ultrasonography in positive CMV-IgG, CMV-IgM, TOXO-IgG TOXO-IgM, RV-IgG and RV-IgM were 0.6%(5/831), 1.2% (2/80), 3.5%(2/57),1.3%(1/75),0.92%(2/217) and 4.4%(4/92), respectively. Follow-up of umbilical cord blood in neonatal period showed 2 cases of RV-IgG (+), 1 case of RV-IgM (+)and 2 cases of congenital deaf ; 24 cases of CMV-IgG(+), 2 cases of CMV-IgM (+),1 case of congenital deaf ,3 cases of subependymal cyst, 1 case with tetralogy of Fallot and 1 case of single atrium .[Conclusion]Ultrasonography can provide important diagnostic information concerning the structure of fetal organs and criteria of growth. It is essential to the reduction of birth defect rate.