孕妇与胎儿巨细胞病毒感染的血清学研究

测定了１７３例孕妇及８１例胎儿血清ＣＭＶ抗体。结果：１７３例孕妇血清中ＣＭＶ－ＩｇＧ阳性率为７０．５％（１２２／１７３），ＣＭＶ－ＩｇＭ阳性率为０．５８％（１／１７３），孕妇早、中、晚孕期ＣＭＶ感染率分别为５２％、７２．９％，７４．４％，妊娠次数≥４次的孕妇ＣＭＶ感染率较高。８１例脐血血清中ＣＭＶ－ＩｇＧ阳性率为５４．３％（４４／８１），ＣＭＶ－ＩｇＭ阳性率为６．２％（５／８１），５例先天性ＣＭＶ感染儿分别为４例胎儿畸形及１例产前咨询者，后者取脐血查到ＩｇＭ阳性后１个月，胎死宫内。提示脐血中一旦查到ＣＭＶ－ＩｇＭ阳性，胎儿有严重后果。因此，产前诊断胎儿ＣＭＶ感染，早期发现ＣＭＶ感染儿，是非常重要的。     

斑点核酸杂交技术检测胎儿巨细胞病毒感染的研究

用￣３２Ｐ标记的巨细胞病毒（ＣＭＶ）探针通过斑点核酸杂交技术，对胎盘、脐血及胎儿组织中的ＣＭＶＤＮＡ进行了检测。结果表明，死胎、胎儿畸形的５２份胎盘组织及４８份胎肾组织中ＣＭＶＤＮＡ阳性者分别为４份及５份，正常好妊娠组（早、晚期人耳流产与足月产）的７７份胎盘及３２份胎肾组织中ＣＭＶＤＮＡ均为阴性，同一病例胎盘与胎肾组织中ＣＭＶＤＮＡ均阳性者３例。２例畸形胎儿脐血白细胞中ＣＭＶＤＮＡ阳性者１例，另一例胎儿畸形脑组织及腮腺组织中ＣＭＶＤＮＡ阳性，而正常足月产的２４例脐血白细胞中ＣＭＶＤＮＡ均阴性。共诊断８例胎儿感染ＣＭＶ，正常妊娠组无１例胎儿感染ＣＭＶ，从分子水平上证实ＣＭＶ是致死胎与胎儿畸形的重要病原。     

应用聚合酶链反应和酶联免疫吸附试验检测孕妇和胎儿巨细胞病毒感染的研究

目的探讨酶联免疫吸附试验（ＥＬＩＳＡ）和聚合酶链反应（ＰＣＲ）两种方法对孕妇和胎儿人巨细胞病毒（ｈｕｍａｎｃｙｔｏｍｅｇａｌｏｖｉｒｕｓ，ＨＣＭＶ）感染的临床诊断价值。方法１８８１例孕妇用ＥＬＩＳＡ检测血清ＨＣＭＶ－ＩｇＭ，其中６５６例同时用ＰＣＲ检测血ＨＣＭＶＤＮＡ。９９例感染孕妇和４７例非感染孕妇的胎儿同样应用ＥＬＩＳＡ和ＰＣＲ法检测。结果本组孕妇血清ＨＣＭＶ－ＩｇＭ阳性率为２．４％，血ＨＣＭＶＤＮＡ阳性率为１２．０％。感染孕妇的胎儿血ＨＣＭＶ－ＩｇＭ和（或）ＨＣＭＶＤＮＡ阳性率为１７．２％。ＨＣＭＶ－ＩｇＭ、ＨＣＭＶＤＮＡ单项阳性或合并阳性的孕妇宫内传播率分别为１８．５％、１４．８％、２７．３％。ＥＬＩＳＡ和ＰＣＲ同时检测６５６例孕妇和１４６例胎儿血，结果显示有相关性。ＰＣＲ检测阳性率显著高于ＥＬＩＳＡ检测阳性率。结论ＥＬＩＳＡ与ＰＣＲ同时检测可提高对孕妇和胎儿ＨＣＭＶ感染的诊断率。     

应用套式聚合酶链反应技术检测孕妇与胎儿巨细胞病毒感染

目的评价套式聚合酶链反应技术（ＮＴ－ＰＣＲ）加限制酶分析在孕妇与胎儿人巨细胞病毒（ＨＣＭＶ）感染检测中的应用价值。方法应用ＮＴ－ＰＣＲ及限制酶分析、病毒分离、电镜观察和特异性抗体测定,对各孕期孕妇３６７例的外周血、部分孕妇脐血及死胎组织进行ＨＣＭＶ检测。结果孕早、中、晚期ＨＣＭＶ阳性检出率分别为８．６％、１．６％及７．０％,ＮＴ－ＰＣＲ检出率（４．９％）高于病毒分离（３．０％,Ｐ＜０．０２５）。６份ＨＣＭＶＤＮＡ阳性母血中,３份配对脐血ＨＣＭＶＤＮＡ也阳性。其中２对ＮＴ－ＰＣＲ、病毒分离及特异性ＩｇＭ、ＩｇＡ均阳性,１对ＮＴ－ＰＣＲ、病毒分离、特异性ＩｇＡ阳性,而ＩｇＭ阴性。２８例死胎组织中,发现１例死胎肺组织ＨＣＭＶＤＮＡ阳性。结论ＮＴ－ＰＣＲ能提高诊断ＨＣＭＶ感染的特异性与敏感性     

三城市孕妇人巨细胞病毒感染及其母婴传播的流行病学调查

目的：分析武汉、上海及沈阳三城市孕妇人巨细胞病毒（ＨＣＭＶ）感染及其母婴垂直传播状况。探讨早期诊断胎儿ＨＣＭＶ宫内感染的方法。方法：应用酶联免疫吸附法（ＥＬＩＳＡ）筛查５０１５例孕妇ＨＣＭＶ的特异性抗体（ＩｇＧ及ＩｇＭ），同时应用聚合酶链反应技术（ＰＣＲ）检测其中３０１例具有活动性ＨＣＭＶ感染者的胎儿附属物，新生儿血、尿及母乳的ＨＣＭＶＤＮＡ。结果：三城市孕妇ＨＣＭＶ感染率为８８．９３％；沈阳、上海分别为９６．７４％和９１．４２％，明显高于武汉（７９．５３％）；孕妇活动性感染率为５．４２％，武汉与沈阳分别为１１．２３％和１０．９８％，明显高于上海。有异常妊娠史孕妇的活动性感染率为１４．５９％；孕早期绒毛和孕中期羊水的ＨＣＭＶＤＮＡ阳性率分别为１６．００％和３５．３３％；羊水的ＨＣＭＶＤＮＡ阳性率与分娩期脐血、胎盘、新生儿血相比较，差异无显著性（Ｐ＞０．０５）。结论：我国城市孕妇ＨＣＭＶ感染有地区差异，三城市孕妇多数于孕前早已感染ＨＣＭＶ；孕妇于活动性感染时易传播胎儿，ＥＬＩＳＡ结合ＰＣＲ方法是当前诊断宫内ＨＣＭＶ感染的有效手段     

人巨细胞病毒宫内感染对胎婴儿生长发育的影响

探讨人巨细胞病毒宫内感染对胎儿生长发育的近期影响及其与智力发育落后等远期后遗症的关系。方法；采用ＥＬＩＳＡ法检测１４１９例孕妇血清，应用ＰＣＲ技术检测ＨＣＭＶ－ＩｇＭ阳性及部分阴性孕妇血，孕中期羊水和晚期脐血中ＨＣＭＶ，ＤＮＡ，依其结果分为Ａ组：孕妇血ＨＣＭＶ－ＩｇＭ，ＨＣＭＶ ＤＮＡ阳性及羊水和脐血ＨＣＭＶ ＤＮＡ阳性者，５３例；Ｂ组     

妊娠妇女及围产儿巨细胞病毒感染的研究

应用酶联免疫法（ＥＬＩＳＡ），对不同孕周孕妇２５６例及其中８４例巨细胞病毒ＩｇＭ抗体（ＨＣＭＶ－ＩｇＭ）阳性的妊娠晚期孕妇所分娩新生儿的脐血，进行ＨＣＭＶ－ＩｇＭ检测。结果：妊娠早期、中期妇女的４２份血清标本中，ＨＣＭＶ－ＩｇＭ阳性１７例，感染率为４０．４８％。妊娠晚期２１４份标本中，ＨＣＭＶ－ＩｇＭ阳性８４例，感染率为３９．２５％。ＨＣＭＶ－ＩｇＭ阳性者围产儿死亡率、新生儿窒息抢救率、胎儿畸形及有异常妊娠病史的妊娠妇女的比例均增加（Ｐ＜０．０１）。提示：ＨＣＭＶ－ＩｇＭ阳性表明妊娠妇女近期有巨细胞病毒（ＨＣＭＶ）感染，或既往有隐性的ＨＣＭＶ感染，在妊娠期复发（活动性感染）。     

正常孕妇,新生儿及异常胎儿血清中人微小病毒B19感染的研究

目的：了解人微小病毒Ｂ１９在母婴中的感染状况以及该病毒对胎儿的危害。方法：应用聚合酶链反应技术（ＰＣＲ）检测３５０例正常孕妇及新生儿血清、９例异常胎儿组织血清人微小病毒Ｂ１９ＤＮＡ。结果：正常孕妇血清Ｂ１９ＤＮＡ阳性率为１．１４％，新生儿脐血阳性率为０．２８％；９例异常胎儿中有６例孕妇血清及脐血Ｂ１９ＤＮＡ阳性（６／９）。应用原位杂交的方法在ＰＣＲ阳性的异常胎儿脑和脾组织中也检出了Ｂ１９ＤＮＡ阳性颗粒。结论：应用ＰＣＲ法检查孕妇及新生儿Ｂ１９病毒具有高度敏感、简便、特异的特点，而原位杂交方法可对病毒感染进行定位，以了解感染部位的病理变化。     

套式聚合酶链反应检测各孕期孕妇巨细胞病毒感染

目的评价套式聚合酶链反应（ＮＴ－ＰＣＲ）加限制酶切分析在各孕期人类巨细胞病毒（ｈＣＭＶ）感染检测中的应用。方法ｈＣＭＶ检测采用病毒分离、血清学试验、ＮＴ－ＰＣＲ加限制内切酶谱分析。结果３６７例孕妇中孕早、中、晚期ｈＣＭＶ阳性检出率分别为８．６％、１．６％及７．０％。经ＮＴ－ＰＣＲ检测，１８例ｈＣＭＶＤＮＡ阳性，阳性率为４．９％，而病毒分离，特异性ＩｇＭ及ＩｇＡ阳性率分别为３．０％、１．１％及２．２％。ＮＴ－ＰＣＲ阳性检出率高于病毒分离等其它方法（Ｐ＜０．０２５），与ＰＣＲ法比较，病毒分离特异性为１００％，敏感性为６１．１％，近３０％ｈＣＭＶ感染的孕妇ＰＣＲＤＮＡ阳性，表现为ＤＮＡ血症。结论ＮＴ－ＰＣＲ能早期检出孕妇ｈＣＭＶＤＮＡ，对孕妇ｈＣＭＶ感染的监控有重要意义。     

孕早期绒毛CMV感染与hCG、hPL、E_3水平变化关系的研究

目的观察孕早期绒毛ＣＭＶ感染与ｈＣＧ、ｈＰＬ、Ｅ_３水平变化的关系。方法用多聚酶链反应（ＰＣＲ）技术检测了９６例妊娠７～８ｗ绒毛组织中的ＣＭＶＤＮＡ，用放射免疫法（ＲＩＡ）检测了相应孕妇外血周血清中的ｈＣＧ、ｈＰＬ和Ｅ_３水平。结果９６例孕早期绒毛组织中ＣＭＶＤＮＡ阳性１３例，阳性率为１３．５４％，此组孕妇血清中ｈＣＧ为８１．７９±３１．７１ｍＩＵ／Ｌ，与阴性组的１１０．０２±４２．２１ｍＩＵ／Ｌ比较，差异有显著性（Ｐ＜０．０１）。前者ｈＰＬ和Ｅ_３虽有降低，但两组差异无显著性。结论孕早期绒毛ＣＭＶ感染可减少ｈＣＧ的分泌量，这可能是ＣＭＶ感染所致胎儿发育异常的机理之一。     

孕妇与胎儿巨细胞病毒感染的研究

目的 :探讨孕妇巨细胞病毒 (CMV)感染 ,早期诊断胎儿CMV感染。方法 :用酶联免疫法 (ELISA)和多聚酶链反应 (PCR)技术检测孕妇血中CMV特异性抗体及CMVDNA ,诊断孕妇CMV感染 ;检测羊水或脐血中CMVDNA诊断胎儿CMV感染。结果 :15 64例孕妇血清中CMV IgM阳性 2 9例 (占 1.8% ) ,CMV IgG阳性 130 6例 (83.5 % ) ,CMVDNA阳性 12 6例 (8.1% ) ;CMV IgM阳性者其CMVDNA均阳性。CMVDNA阳性的 12 6例孕妇其羊水或脐血中CMVDNA阳性 5 2例 (占 4 1.2 % ) ,CMV感染胎儿中有 5例胎儿畸形、2例死胎、3例IUGR ,出生时无明显症状的婴儿中 3例生后 1个月内患黄疸性肝炎 ,1例患新生儿肺炎。 1例发现室间隔缺损、2例出现单侧耳聋。结论 :孕妇CMV感染可造成胎儿严重危害 ,孕妇CMV感染后取羊水或脐血检测CMVDNA是诊断胎儿及新生儿CMV感染的最佳方法。     

Effects of cytomegalovirus infection in pregnant women to fetuses: study with DNA-DNA hybridization method]

DNA of cytomegalovirus (CMV) was examined in 131 placentae and 28 umbilical blood specimens by DNA-DNA hybridization. The result revealed that CMV DNA was detected in 4 of 50 placentae from abnormal fetuses (31 fetal deaths, 19 fetal deformities). 77 placentae from normal fetuses showed negative results. One of 2 cord blood samples from fetal deformities showed CMV DNA positive. 25 umbilical blood samples from normal term newborns showed negative. 4 placentae and 1 cord blood sample from premature infants showed negative results. The results indicate that CMV may play a great role in fetal death and fetal deformity through the infected maternal-fetal circulation.     

应用荧光定量聚合酶链反应技术诊断胎儿弓形虫感染

目的　探讨荧光定量聚合酶链反应 (FQ PCR )技术用于产前诊断胎儿弓形虫 (TOX)感染及其防治措施。方法　采用FQ PCR技术 ,检测 70例孕期TOXDNA阳性孕妇的羊水和 (或 )脐血的TOXDNA ,阳性者为胎儿TOX感染。对其中 48例TOX感染孕妇给予螺旋霉素常规剂量治疗 2个疗程 ,观察其治疗效果。结果　 (1) 70例TOXDNA阳性孕妇中 ,胎儿TOXDNA阳性 2 1例 ,胎儿宫内TOX感染率为 3 0 % ,羊水和脐血中的TOXDNA阴、阳性结果一致。 (2 )胎儿宫内TOX感染与孕妇血中TOXDNA含量高低有关 ,孕妇血中TOXDNA含量高时 ,对胎儿危害严重 ,胎儿宫内感染率也最高(5 5 % ) ;TOXDNA含量低时 ,胎儿宫内感染率也最低 (2 0 % ) ,两者比较 ,差异有显著性 (P <0 0 5 )。 (3 )经螺旋霉素治疗的孕妇 ,其胎儿宫内感染率为 2 1% ,明显低于未治疗者的 5 0 % ,两者比较 ,差异有显著性 (P <0 0 5 )。结论　孕妇TOX感染可危害胎儿 ,FQ PCR检测羊水中TOXDNA可准确地诊断胎儿TOX感染 ,孕期治疗可降低宫内TOX感染率     

Study of intrauterine cytomegaloviruses infection in pregnant women and fetuses

Detection of cytomegaloviruses (CMV) DNA in urine samples from pregnant women and newborns' cord blood was done by DNA-DNA hybridization. 33.3% of pregnant women showed CMV DNA sequences in the 1-3 months, 36.4% in the 4-6 months and 38.2% in the 7-9 months. The results suggested that the CMV infection rate of pregnant women increased as time went on.75.0% women with history of abnormal pregnancies showed CMV in their urine and 30.4% newborns' cord blood was positive for CMV. It is apparently that CMV infection rate in women with history of abnormal pregnancies was much higher than that of normal pregnant women and the danger of miscarriage in pregnant women with primary CMV infection at early pregnancy increased. CMV congenital infection rate was also high in newborns.     

Carcinoembryonic antigen in high risk pregnancies

The significance of carcinoembryonic antigen (CEA) measurement was evaluated in 25 pregnant women with diabetes mellitus, 15 Rh negative sensitized and nine prolonged pregnancies. Another 114 women with normal pregnancy served as controls. Values in maternal and umbilical cord serum and in amniotic fluid did not change appreciably through 24-42 weeks' gestation. No significant difference in maternal serum, cord serum and amniotic fluid CEA values was found between diabetic, Rh negative sensitized and normal pregnancies at the corresponding weeks. Similar findings were obtained in prolonged pregnancies, except the values in amniotic fluid which were significantly higher than in normal pregnancies due to the presence of meconium. These results suggest that the measurement of CEA in high risk pregnancies is not useful in predicting fetal condition.     

Prenatal diagnosis of fetal primary cytomegalovirus infection

Objective To determine the reliability of prenatal diagnosis for congenital cytomegalovirus in women with primary infection.
Design Retrospective analysis of case records between 1992 and 1997.
Setting Fetal medicine unit of a large teaching hospital.
Population Forty-two pregnant women with primary cytomegalovirus infection.
Methods Fetal diagnosis was made by amniocentesis for viral culture and amplification of cytomegalovirus DNA by polymerase chain reaction (   n = 37  ), or by cordocentesis for the detection of cytomegalovirus -specific IgM antibodies (   n = 13  ). All patients had serial ultrasonographic scans in order to detect those fetuses with abnormalities that could be associated with cytomegalovirus infection.
Results Fourteen pregnancies (33.3%) had evidence of vertical transmission. Nine out of 14 (64.3%) had positive amniotic fluid culture, while 11 (78.6%) had positive polymerase chain reaction results. The combination of both tests allowed antenatal diagnosis in 12 of the 14 infected fetuses (sensitivity 85.7%). All women who underwent cordocentesis for the detection of cytomegalovirus-specific IgM antibodies had negative results, but in two cases cytomegalovirus infection was detected by amniotic fluid studies. In five of the infected fetuses there were abnormal ultrasonographic findings. All pregnancies with evidence of vertical transmission were terminated and the remainder proceeded normally to term.
Conclusions Our data showed that amniotic fluid studies, preferably polymerase chain reaction amplification of viral DNA, are the best diagnostic tools for the detection of vertical transmission in pregnancies with primary cytomegalovirus infection. For women with positive amniotic fluid studies who elect to continue their pregnancies, cordocentesis and serial ultrasound scans may be useful for assessment of fetal status.     

A study on cytomegalovirus infection in 199 pregnant women and their infants

Cytomegalovirus (CMV) infection is common in human, and exerts harmful effects during pregnancy upon fetuses. In order to get a clear knowledge of CMV infection rate in pregnant women and their infants and of the relationship between maternal infection and congenital infection in our city, we tried to detect the CMV specific IgG and IgM in 199 paired serum samples of mother and infant. The results showed that 183 maternal serum samples and 179 umbilical cord serum samples were CMV-IgG positive, a positive rate of 92% and 90% respectively. While 6 maternal serum samples and 7 umbilical cord serum sample were CMV-IgM positive, a positive rate of 3.0% and 3.5% respectively. The close correlation of CMV-IgM levels between mothers and their babies indicates that the infant may acquire congenital infection from his CMV-IgM positive mother.     

Prenatal diagnosis of congenital toxoplasmosis

Ninety-three pregnant women with Toxoplasma gondii seroconversion during pregnancy underwent prenatal diagnosis of fetal toxoplasmosis. The following tests were used: (1). amniocentesis for mouse inoculation (93 subjects), (2). amplification of T. gondii DNA by polymerase chain reaction (PCR) (79 subjects), and (3). cordocentesis for the detection of T. gondii-specific IgM antibodies (13 subjects). All patients had serial ultrasonographic scans to detect those fetuses with abnormalities that could be associated with congenital toxoplasmosis. Eighteen pregnancies (19.4%) had evidence of vertical transmission. A total of 11/18 (61.1%) had positive amniotic mouse inoculation test, while 10/12 (83.3%) had positive PCR results. The combination of both tests allowed the prenatal diagnosis in 17/18 infected fetuses (94.4%). All patients who underwent cordocentesis for the detection of T. gondii-specific IgM antibodies had negative results. However, in two of the above cases fetal toxoplasmosis was detected by amniotic fluid studies. In five of the infected fetuses there were abnormal ultrasonographic findings. All pregnancies with evidence of vertical transmission were terminated, whereas the remaining pregnancies proceeded normally to term. The present data showed that amniotic fluid studies, preferably PCR amplification of T. gondii DNA, are the best diagnostic tools for the detection of vertical transmission in pregnancies with seroconversion during pregnancy.