不同实验方法在诊断和监测新生儿先天性巨细胞病毒感染中的临床研究

目的　探讨外周血白细胞巨细胞病毒(cytomegalovirus, CMV)抗原(即刻早期抗原和早期抗原)检测、唾液聚合酶链反应(PCR)检测CMV DNA和血清学检测CMV IgM三种实验方法在诊断和监测新生儿先天性CMV感染中的作用。　方法　对98 例患儿之母在孕期血CMV IgM阳性的高危新生儿出生后14 d 内检查血CMV IgM、外周血白细胞CMV抗原和唾液PCR CMV DNA,比较三种方法的检测结果,并对新生儿进行临床观察和随访。　结果　(1)98 例中,48 例诊断先天性CMV感染。症状性感染7 例,无症状性感染41 例;无一例CMV IgM阳性。症状性感染组CMV抗原、PCR阳性检出率分别为7/7、5/7;无症状性感染组阳性检出率分别为71%(29/41)、46%(19/41)。CMV抗原检测法、PCR检测法的诊断敏感性分别为75%、54%。症状性感染儿每5 万白细胞中CMV阳性细胞数16~52个,无症状性感染儿3~31个,症状性感染儿CMV抗原指数水平显著高于无症状感染儿(P<0.05)。(2)随访10例患儿,2 例症状性感染儿CMV抗原和PCR转阴,症状消失;1例CMV肝炎治疗后CMV抗原和PCR检测仍阳性,最后发展为肝硬化。7 例无症状性感染儿,CMV抗原在6个月内转阴或减少至低水平;2 例伴唾液PCR阳性,复查时1 例转阴,1 例仍阳性。　结论　CMV抗原检测法具有早期、敏感、量化的特点,PCR法能发现潜伏性感染

Clinical study of different methods on early diagnosis and monitoring of neonatal congenital cytomegalovirus infection

Objective To evaluate the feasibility and utility of three different assays on early diagnosis and monitoring of neonatal congenital cytomegalovirus infection. Methods Ninety-eight neonates whose mother was CMV-IgM positive during pregnancy were examined on the 14th days after birth for CMV antigen in blood and PCR-CMV-DNA in the saliva. Three different methods were applied including CMV antigenemia assay, PCR for CMV-DNA and ELISA for serum CMV-IgM. Neonates were followed up for six months. Results (1) Forty-eight of the 98 neonates were diagnosed as congenital CMV infection including 7 symptomatic infection and 41 asymptomatic. None of the 98 subjects was CMV-IgM positive. Among the 7 symptomatic cases, the positive rates of CMV antigen and PCR-CMV-DNA were 100%(7), 71.4%(5), and 70.7%(29/41), 46.3%(19/41) in the asymptomatic group, respectively. The sensitivity of CMV antigenemia assay and PCR was 75.0% and 54.2%, respectively. The CMV antigenemia index of the symptomatic cases was significantly higher than that of asymptomatic ones (16-52)/50 000 vs (3-31)/50 000 white blood cells, P<0.05]. (2) Ten cases were followed up. The CMV antigen and PCR result were negative in 2 symptomatic infected cases and remained positive in 1 case after treatment of CMV hepatitis. The last case finally progressed to hepatic cirrhosis. For the 7 asymptomatic cases, the CMV antigenemia decreased to a lower level or became negative within 6 months. One of the two positive PCR-CMV-DNA cases became negative, while another still remained positive. Conclusions The combination of CMV antigenemia assay with PCR for CMV-DNA seemed to be a better method for the early diagnosis and monitoring of neonatal congenital CMV infection. But serum CMV-IgM is less sensitive in early diagnosis of neonatal congenital CMV infection.