人巨细胞病毒宫内感染胎儿3例临床病理学分析

目的探讨人巨细胞病毒(HCMV)宫内感染胎儿的临床病理学特征, 多小脑回畸形(PMG)的病因及发病机制, 以及与羊水HCMV-PCR结果的关系。方法收集广东省妇幼保健院病理科2022年1月至2023年7月经尸体解剖的3例HCMV宫内感染的引产胎儿, 回顾性分析胎儿产前超声、磁共振成像(MRI)、羊水HCMV-PCR检测结果、尸解病理资料及其他相关临床资料, 并复习相关文献。结果产前超声示胎儿宫内生长受限(FGR)、肠管回声增强1例, 胎儿双足内翻、侧脑室稍宽、颅内多发强光斑、左心室强光斑1例, 双侧室管膜下混合性声像、右侧侧脑室扩张、心脏增大1例。MRI示胎儿双侧大脑皮质发育异常2例。3例羊水HCMV-PCR均阳性。镜下观察PMG 2例。此外1例肾脏、肺脏、肝脏、肠管、甲状腺、垂体, 1例肾脏、肝脏, 1例肾脏、肺脏、肝脏、甲状腺、垂体、胸腺, 均可见HCMV感染细胞。胎盘2例, 呈淋巴浆细胞性绒毛炎, 但未见明确HCMV包涵体。3例均HCMV早期、晚期蛋白免疫组织化学染色阳性。结论并非羊水HCMV-PCR结果越高, 胎儿越会发生PMG;羊水HCMV-PCR结果越高, HCMV感染胎儿器官越多;影像学检查、羊水病毒检测及病理检查对于诊断HCMV宫内感染胎儿非常重要。

孕早期人巨细胞病毒宫内活动性感染的诊断方法学研究

目的 探讨诊断孕早期HCMV宫内活动性感染的实验方法及其价值。方法 留取 68例有异常妊娠史的早孕妇女绒毛组织 ,分为两份 ,一份提取总RNA ,采用RT PCR检测其中的HCMVmRNA ,一部分制成冰冻切片 ,分别采用原位杂交技术 (ISH)检测HCMVmRNA ,免疫组织化学法检测HCMV早期抗原。结果 采用RT PCR检测到的孕早期绒毛组织HCMVmRNA阳性率为 39 7% ;ISH阳性率为 2 3 5 % ;免疫组化检测HCMV早期抗原阳性率2 2 1 %。RT PCR检出率明显高于ISH(P <0 0 5) ,而ISH与免疫组化的阳性率无显著性差异 (P >0 0 5)。结论 测定绒毛组织中的HCMVmRNA、早期抗原是HCMV宫内活动性感染的客观指标。RT PCR的敏感性最高 ,但ISH与免疫组化可同时作定位、定量观察 ,可操作性强 。

妇科 妇科特殊检查

经阴道超声造影在附件包块诊断中的应用研究；腹腔镜诊治慢性盆腔疼痛的临床应用价值；宫腔镜下宫腔粘连分离40例近期疗效评价；宫腔镜结合腹腔镜诊治先天性子宫畸形的价值；人巨细胞病毒宫内感染产前诊断方法的研究。

Expression and its clinical significance of HLA-G in HCMV-infected placenta] villi at early pregnant stage

Objective：To study the expression and its clinical significance of HLA-G in HCMV intrauterine infected placental villi at early pregnant stage. Methods：PCR （polymerase chain reaction） was used to screen the peripheral blood for HCMV-DNA in 462 women who had willingly undergone induced abortion. Then immunohistochemistry was also used to detect expressions of mouse anti-HCMV early antigen （HCMV-EA） and mouse anti-HLA-G in HCMV-DNA positive cases＇ placental villi. The difference of HLA-G expressions between the intrauterine infection group（HCMV-EA positives）, the intrauterine infection-free group（HCMV-EA negatives） and the normal control group （50 cases of healthy early placental villi） was compared. Results： Of the 78 cases, which were detected HCMV-DNA positive, 11 （14.10%） were HCMV-EA positive. Compared with the other two groups, HLA-G expressions in the intrauterine infection group were both obviously decreased（both P〈0. 001）. HLA-G expression positions in all three groups were mainly located in the cytotrophoblast. Conclusion：Intrauterine HCMV infection at early pregnant stage is closely related to HLA-G expression at the maternal-fetal interface. The virogenetic products may affect the expression of HLA-G at the maternal-fetal interface and that of its immunological function, thus leading to different clinical outcomes.

Diagnostic value of human cytomegalovirus late mRNA detection in active intrauterine infection

OBJECTIVE: To study the diagnostic value of human cytomegalovirus (HCMV) late mRNA detection in active intrauterine infection. METHODS: The HCMV late mRNA in peripheral blood of 42 HCMV IgM positive pregnant women and their fetal attachments (such as chorionic villi, amniotic fluid, umbilical blood and placenta) were detected by reverse transcription polymerase chain reaction (RT-PCR). RESULTS: Late mRNA was detected in 23 of 42 HCMV IgM positive cases, a rate of 54.3%. Fetal appendages in 13 cases of late mRNA positive mothers were also tested, of which 7 were positive, with a vertical transmission rate of 53.8%. In 12 late mRNA negative mothers, only 1 case of fetal appendages tested was positive, with a vertical transmission rate of 8.3%. There was significant difference between the transmission rates of these two groups. CONCLUSIONS: Positive results of HCMV IgM cannot accurately reflect the activity of HCMV at the time of testing. However, the activity of HCMV is closely related to the mother-fetus vertical transmission rate. As an indicator of active HCMV infection, late mRNA can not only reflect the mother-fetus transmission rate during active HCMV infection, but also provide some information about HCMV activity in fetal tissue.

Diagnostic value of human cytomegalovirus late mRNA detection in active intrauterine infection

To study the diagnostic value of human cytomegalovirus (HCMV) late mRNA detection in active intrauterine infection Methods The HCMV late mRNA in peripheral blood of 42 HCMV IgM positive pregnant women and their fetal attachments (such as chorionic villi, amniotic fluid, umbilical blood and placenta) were detected by reverse transcription polymerase chain reaction (RT PCR) Results Late mRNA was detected in 23 of 42 HCMV IgM positive cases, a rate of 54 3% Fetal appendages in 13 cases of late mRNA positive mothers were also tested, of which 7 were positive, with a vertical transmission rate of 53 8% In 12 late mRNA negative mothers, only 1 case of fetal appendages tested was positive, with a vertical transmission rate of 8 3% There was significant difference between the transmission rates of these two groups Conclusions Positive results of HCMV IgM cannot accurately reflect the activity of HCMV at the time of testing However, the activity of HCMV is closely related to the mother fetus vertical transmission rate As an indicator of active HCMV infection, late mRNA can not only reflect the mother fetus transmission rate during active HCMV infection, but also provide some information about HCMV activity in fetal tissue