江苏地区中孕期妇女巨细胞病毒感染率及感染状态与不良妊娠结局的关系

目的江苏省中孕期妇女的巨细胞病毒（cytomegalovirus，CMV）血清流行率，探讨母孕期感染状态与不良妊娠结局的相关性。方法根据2002-2004年江苏省12个市县17661例孕妇的新生儿结局，527例有不良妊娠结局的孕妇纳入病例组，同时随机选取496例正常妊娠结局的孕妇为正常对照。检测孕妇妊娠15～20周外周血CMV IgG、IgM和IgG亲合力指数（avidity index，AI）。结果1023例孕妇的CMV IgG阳性率为98.7％，其中病例组和对照组孕妇阳性率分别为99.4％和98.0％（P=0.039）。病例组孕妇活动感染率，即CMV IgG＋／IgM＋，明显高于正常对照组（3.8％vs.1.6％，P=0.033）。CMV IgG AI检测结果显示，对照组孕妇AI均大于30%，说明无原发感染，而病例组孕妇5例（0.9％）AI〈30％，提示原发感染（P=O.084），这5例母亲的新生儿均出现不良妊娠结局，包括新生儿死亡、头颅畸形和化脓性脑膜炎各1例，生长发育迟缓2例。多因素回归分析表明，母孕期CMV活动性感染是不良妊娠结局的独立危险因素（aOR 8.65，95％CI 1.85～40.41，P=0.006）。此外，母亲低学历和有既往不良妊娠史亦增加妊娠不良结局的发生风险。结论CMV感染在江苏地区孕妇人群中普遍存在。尽管仅少部分孕妇在孕期发生活动性感染，但仍是造成妊娠不良结局的独立危险因素。因此，应监测孕妇CMV感染状态并正确进行胎儿或新生儿感染风险的评估。

Cytomegalovirus seroprevalence in pregnant women and the impact of maternal infection status on adverse pregnancy outcomes in Jiangsu,China

Objective： To determine the provincial population-based seroprevalence of cytomegalovirus （CMV） in pregnant women and to further clarify the impact of maternal CMV infection status on adverse pregnancy outcomes across Jiangsu, China. Methods： The neonatal outcomes of 17 661 pregnant women, delivered during 2002-2004, from 12 cities and rural areas across Jiangsu were analyzed. All the 527 women with adverse pregnancy outcomes were included in the case group, and 496 pregnant women with normal pregnancy outcomes were randomly selected as the controls. We further determine the IgG, IgM and IgG avidity index （AI） in their serum samples collected at gestation age of 15-20 weeks. Results： The overall seroprevalence of CMV IgG in the 1023 pregnant women was 98.7%, with 99.4% and 98.0% in the case and control groups, respectively （P= 0.039） . The prevalence of CMV IgG＋/IgM＋, indicating active infection, was higher in the case group than that in the control group （3.8% vs. 1.6%, P=0.033） . CMV IgG AI assay showed that none in the control group were primarily infected, but 5 （0.9%） in the case group underwent primary infection （P=0.084） ; all the five infants of these women presented severe adverse neonatal/infant outcomes, including one neonatal death, two with growth retardation, one with skull deformity and one with purulent meningitis. Logistic regression analysis indicated that maternal active infection during pregnancy was associated with adverse pregnancy outcomes （aOR 8.65, 95%CI 1.85-40.41, P=0.006） . Maternal low education level and previous abnormal pregnancies also added risk for adverse pregnancy outcomes. Conclusions： CMV infection is ubiquitous in pregnant women across Jiangsu. Despite low prevalence, maternal active infection during pregnancy was an independent risk factor for adverse neonatal outcomes. Therefore, continuing surveillance and evaluating potential risks in pregnant women with active CMV infection should be encouraged.