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目的 :探讨高危孕妇中TOX、CMV、HSV感染对妊娠结局关系。方法 :随机抽样对 2 0 9例高危孕妇 ,采用套式PCR检测TOX、CMV、HSV感染率并随访妊娠结局。结果 :① 2 0 9例高危孕妇中 10 9例来自农村。有 1 3种病原体感染者达88% ,但HSV、TOX、CMV感染率分别为 5 8%、46 %、2 7%。新生儿死亡率 2 7‰ ,高于同期新生儿死亡率 2 .45‰ (P <0 .0 1) ,畸形儿占 6 .2 % ,略高于同期分娩畸形儿 4.8% (P >0 .0 5 )。② 141例TOX、HSV、CMVDNA(+ )孕妇产时对羊水、脐血、尸体肝、脑复查DNA ,诊断为宫内感染者 10 0例 ,3种病原体的垂直传播率分别为 5 5 %、49%、40 % ,3者无明显差异 (P >0 .0 5 )。③活胎宫内感染率 6 5 .8% ,显著低于死胎 85 .7% (P <0 .0 1)死胎中 16 /2 4例≤ 33孕周 ,7/2 4例有 3种病原体感染。④宫内感染儿 32例在产后一周内复查血DNA ,2 2例同种DNA阳性 ,10例阴性。⑤ 41例有宫内感染的婴儿在 10 15个月随访生长发育正常 39例 ,DDST正常 38例 ,复查血DNA已转阴者 2 2项次 ,其中CMV、HSVDNA转阴者 16例中 14例IgG(+ )。结论 :①高危孕妇TORCH感染率较高 ,乡村妇女尤然。②孕早、中期有多种病原体严重感染易致死胎、畸形、早产 ,增加围产儿死亡率。文中讨论了防治措施。
Objective: To investigate the relationship between TOX, CMV, HSV infection and pregnancy outcomes in high-risk pregnant women. Methods: Totally 290 high risk pregnant women were randomly sampled. The infection rates of TOX, CMV and HSV were detected by nested PCR. The pregnancy outcome was followed up. Results: ① Of the 209 high-risk pregnant women, 109 cases came from rural areas. The infection rate of HSV, TOX and CMV was 58%, 46% and 27% respectively, with 88% of the 13 pathogens infected. The neonatal mortality rate was 27.7%, higher than the neonatal mortality rate 2.45% (P <0.01) in the same period. The deformity accounted for 6.2%, slightly higher than the 4.8% (P> 0). 0 5). ② The 141 cases of TOX, HSV and CMVDNA (+) were diagnosed as intrauterine infection in 100 cases of amniotic fluid, umbilical cord blood, cadaver liver and brain at the time of delivery. The vertical transmission rates of the three pathogens were 55% 49%, 40%, 3 no significant difference (P> 0.05). ③ The intrauterine infection rate was 65.8%, which was significantly lower than that of stillbirth 85.7% (P0.01). In the stillbirth of 16/24 cases ≤ 33 gestational weeks, 7 of 24 cases had 3 kinds of pathogens infection. ④ 32 cases of intrauterine infection in the post-natal week review of blood DNA, 22 cases of the same type of DNA positive, 10 cases were negative. ⑤ 41 cases of intrauterine infection in infants at 10-15 months of follow-up normal growth and development in 39 cases, DDST was normal in 38 cases, review of blood DNA has been negative in 22 cases, of which CMV, HSVDNA negative in 16 cases, 14 cases IgG (+). Conclusion: ①The infection rate of TORCH in high-risk pregnant women is high, especially in rural women. ② early pregnancy, mid-term infection with a variety of serious pathogenic lethal fetus, deformity, premature birth, increased perinatal mortality. The article discusses the prevention and treatment measures.