温州地区婴幼儿HCMV感染现状的分析及其临床意义

目的探讨婴幼儿人巨细胞病毒（human cytomegalovirus，HCMV）的感染状态与其感染标志物的关系及其临床意义。方法收集我院住院婴幼儿（0～3岁）病例，以化学发光法（chemiluminesence immunoassay，CLIA）定量检测其HCMV—IgM以及HCMV—IgG，以实时荧光定量PCR法（Fluorescence Quantitative PCR，FQ—PCR）检测HCMV-IgM阳性者尿液标本中病毒核酸载量，分析婴幼儿HCMV的感染状态及其临床意义。结果在900例患者中，HCMV—IgM阳性病例为161例（17．9％），即HCMV现症感染率达到17．9％；HCMV—IgG阳性者738例（82％），即82％的婴幼儿通过胎盘获得HCMV—IgG抗体，其中148例为HCMV—IgM及HCMV—IgG同时阳性（16．4％），即16．4％的婴幼儿在从母体获得了HCMV—IgG抗体的基础上感染了HCMV；HCMV—IgM及HCMV—IgG均阴性者为73例，即未获得HCMV感染及免疫力的患者占8．1％。在161例现症感染患者中，有59例检测到HCMV的DNA（36．7％），即约有一半的现症感染患儿出现了病毒活动性感染。结论虽然绝大部分婴幼儿从母体获得了HCMV—IgG抗体，但由于该抗体缺乏中和病毒的作用以及0～3岁婴幼儿免疫系统的不完善，有超过四分之一（17．9％±8．1％）已经感染HCMV或者将受到HCMV感染的威胁，且活动性HCMV感染主要发生在婴儿组（28d～1岁）。该病毒感染是导致婴幼儿肝功能损害的重要病原体之一，因此加强HCMV的防治具有十分重要的意义，尤其是目前出现了对更昔洛韦等抗病毒药物耐受的病毒突变，开发疫苗将是行之有效的手段。

The Analysis and Clinical Value of the HCMV Infection Status in the Infant of Wenzhou City

Objective To analyze the clinical value of the relationship between the markers of human cytomegalovirus （ HCMV ） infection and its infection status in the infants. Methods To collect in-patient blood samples of infants between 0-3 years old, of which the HCMV- IgM and HCMV-IgG were quantitatively detected by chemiluminesence immunoassay （ CLIA ）, and urine would be collected from the IgM positive children to be analyzed for HCMV DNA load by Fluorescence Quantitative PCR, to analyze the current status of HCMV infection in this population. Results Among the 900 samples, 161 were positive for HCMV-IgM, meaning a current infection rate of 17.9%, while 738 were positive for HCMV-IgG, meaning 82% children inherited HCMV-IgG by placental circulation, among which, 148 were double positive for the two HCMV-IgG ＆ HCMV-igM meaning a current infection occurred with a presence of HCMV-IgG （ 16.4% ）. The rest was double negative for HCMV-IgM and HCMV-IgG, meaning 8.1% were not infected or passively immuned. Among the 161 current infected,76 were positive in HCMV-DNA test, meaning an active infection rate of about 47.2%. Conclusion Tough most infant can inherit HCMV-IgG from mother, over one fourth of the children between 0-3 years old have been infected by HCMV or at risk of infection because of the insufficiency of neutralization of HCMV-IgG and infant＇ s immature immune system. Furthermore, the active infection more likely occurs in the infant between 28 days to 1 year old, HCMV is one of the most important pathogens that cause infant liver damage, so the prevention and treatment of HCMV infection showed an absolute importance, especially when the virus occurred mutation to withstand ganciclovir, making the vaccination looks more workable to prevent HCMV infection.