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目的评估北京地区新生儿先天性巨细胞病毒(CMV)感染状态及其对新生儿的危害。方法选择2004年11月至2008年3月在北京居住、怀孕12周之内的孕妇,分别于孕早期和孕中期进行血清CMV IgG定量和CMV IgM定性检测;活动感染者接受CMV IgG亲和力、CMV pp65抗原血症和白细胞CMV巢式聚合酶链反应(nPCR)检测;白细胞CMV DNA阳性孕妇接受羊水CMV nPCR检测。所有入选孕妇分娩的新生儿出生后均检测脐血CMV nPCR,阳性者于生后2周内复查尿CMV nPCR。结果本研究共收入孕妇1752例,新生儿1756例;孕期血清学检查CMV活动感染51例,占2.91%(95%CI 2.12%~3.70%),其中原发活动感染2例,占全部孕妇的0.11%(95%CI 0.10%~0.41%);CMV nPCR阳性的孕期活动性感染占0.34%;活动感染孕妇羊水CMV nPCR检测全部阴性;新生儿先天性CMV感染发生率0.23%(95%CI 0.06%~0.58%)。所有先天性CMV感染新生儿出生时均为无症状性感染。结论北京地区CMV感染垂直传播率低,先天CMV感染发生率0.23%,未见到症状性先天性CMV感染患儿。
Objective To evaluate the status of neonatal congenital cytomegalovirus (CMV) infection in Beijing and its impact on neonates. Methods Pregnant women residing in Beijing and within 12 weeks of pregnancy from November 2004 to March 2008 were tested for serum CMV IgG and CMV IgM qualitatively during the first trimester and the second trimester respectively. CMV pp65 antigenemia and neutrophil CMV nested polymerase chain reaction (nPCR) detection; CMV DNA positive pregnant women receiving amniotic fluid CMV nPCR detection. All newborn infants of selected pregnant women were tested for cord blood cytomegalovirus (nPCR) after birth, and positive ones were examined for urinary CMV nPCR within 2 weeks after birth. Results A total of 1752 pregnant women and 1756 newborns were enrolled in this study. 51 cases (2.91%) were infected with CMV during pregnancy, accounting for 2.91% (95% CI 2.12% ~ 3.70% (95% CI 0.10% -0.41%). CMV nPCR-positive pregnant women accounted for 0.34% of the pregnant women during the first trimester of pregnancy. The positive rate of CMV nPCR in pregnant women with active infection was all negative. The incidence of congenital CMV infection was 0.23% (95% CI 0.06 % ~ 0.58%). All newborn babies born with congenital CMV infection are asymptomatic at birth. Conclusions The vertical transmission rate of CMV infection in Beijing is low and the incidence of congenital CMV infection is 0.23%. There is no symptomatic congenital CMV infection in children.