TORCH特异性抗体检测在儿科临床中的应用

目的 探讨TORCH特异性抗体检测在儿科临床中的应用价值。方法 对178例拟诊为非细菌感染性疾病患儿采用酶免疫斑点技术检测TORCH血清特异性抗体IgG和IgM。结果 187例标本中，检出弓形体特异性IgG3例，IgM 2例；风疹病毒特异性IgG 58例，IgM 24例；巨细胞病毒特异性IgG 149例，IgM 31例；单纯疱疹病毒特异性IgG 119例，IgM 26例。临床确诊为弓形体感染1例，风疹病毒感染24例，巨细胞病毒感染31例，单纯疱疹病毒感染24例。结论 酶免疫斑点技术检测TORCH血清特异性抗体IgG和IgM，具有方法简单、敏感性高、特异性强、可快速获得结果等优点。     

先天性风疹综合征6例临床分析

目的　分析先天性风疹综合征 (CRS)临床特征及预后 ,探讨血清特异性风疹IgM抗体的诊断价值 ,提高对预防CRS的认识。方法　对 6例新生儿期CRS的临床特征和辅助检查结果进行分析 ,并进行追踪随访。结果　 6例CRS患儿的母亲均未接种风疹疫苗 ,其中 3例母亲孕早期有感染病史。 6例患儿平均入院日龄为 13d ,有 2例患儿为早产儿 ,1例患儿为过期产 ,1例患儿为小于胎龄儿。 6例患儿的主要临床表现为发热、惊厥、黄疸及肝脾肿大。所有 6例患儿及母亲血清风疹IgM抗体均阳性 ,其中 2例患儿脑脊液IgM抗体亦阳性。头颅CT异常 5例 ,脑电图异常 2例 ,脑干测听异常 2例 ,眼底检查异常 1例 ,心脏彩超异常 1例。 6例患儿中 1例死亡 ,2例有神经行为异常 ,1例正常 ,2例失访。结论　CRS的临床表现是多样的 ,特异性风疹IgM抗体检测可以作为先天性风疹感染的诊断依据 ,接种风疹疫苗是必要的。     

儿童中枢神经系统肺炎支原体感染26例

目的 探讨肺炎支原体(MP)引起的中枢神经系统(CNS)感染的临床表现、诊断、疗效及预后.方法 分析26例MP导致的CNS感染患儿的临床资料,按起病原因不同分为2组,第1组10例,以发热、头痛、呕吐等为首发症状.病程中始终无咳嗽;第2组16例,以发热、咳嗽等为首发症状,病程第7-12天出现神经系统症状.2组患儿均应用PCR法检测脑脊液(CSF)MP-DNA.采用颗粒凝集试验检测其血清MP特异性IgM和IgG抗体,并行脑电图及头颅影像学检查.总结小儿CNS MP感染的临床特点.结果 1.MP导致的CNS感染多见于5岁以上儿童,以发热(26/26例)、头痛(15/26例)、嗜睡(15/26例)及呕吐(12/26例)等为主要表现,惊厥(3/26例)少有发生;有呼吸道症状者在病程的7～12 d出现神经系统症状.2.第1组患儿,CSF MP DNA阳性,同期血MP特异性IgM和IgG抗体均阴性;第2组患儿出现神经系统症状后,CSF MP DNA阴性,MP特异性IgM和IgG抗体均阳性.3.脑电图异常(慢波)18例,4例患儿MRI呈脑灰质多灶异常信号,脑审旁斑片状高信号,经阿奇霉素、丙种球蛋白及脱水降颅压、止痉等治疗,患儿均痊愈出院.结论 MP是引起儿章CNS感染的病原体之一,CNS症状可在肺炎病程中或无肺部症状时出现,其临床症状与病毒性脑炎鉴别困难.CSF MP DNA检测阳性及血清MP特异性IgM和IgG抗体增高,对确诊MP感染、指导治疗预后评估有重要意义.MP CNS感染通常预后良好.实用儿科临床杂志,2009,24(10):763-764     

小儿包虫病免疫球蛋白及IgG亚类抗体检测的诊断价值探讨

目的　研究小儿包虫病的免疫诊断方法 ,探索其抗体应答阴性反应原因。方法　采用间接ELISA和单克隆双抗体夹心ELISA方法 ,对 1998年 5月至 2 0 0 2年 5月新疆自治区人民医院普外科 5 5例小儿包虫病患儿血清的IgG及亚类IgG1、IgG2 、IgG3 、IgG4和IgA、IgM、IgE类抗体及抗原和循环免疫复合物 (CIC)进行检测。 结果　 8种抗体检查方法中IgG1亚型抗体检测的敏感性和特异性最好 ;15例IgG抗体阴性患儿中 ,有 12例分别检测出IgG亚类和 (或 )IgM、IgA、IgE ,有 3例患儿血清各种抗体均呈阴性反应 ;患儿IgM抗体阳性率高于成人 ;IgG1分别与其它种抗体联合检测 ,以IgG1 IgA IgM检出率最高 ;IgG阴性小儿患者血清的循环抗原和CIC阳性率分别为 4 0 %及 2 6 6 7%。结论　IgG1 IgA IgM抗体联合检测方法可提高小儿包虫病免疫诊断的敏感性。抗包虫总IgG抗体表达水平低下、抗体表达种类不同及CIC的形成 ,是造成包虫病患儿IgG抗体反应阴性的主要原因     

格林-巴利综合征患儿的免疫学指标及疗效观察

目的 观察格林-巴利综合征患儿免疫生化及激素治疗效果。方法 总结近年来23例小儿格林-巴利综合征，对部分患儿进行脑脊液和(或)血液免疫学、病原特异性抗体检测，并对激素治疗效果进行评价。结果 痛原学检查ll例，10例血柯萨奇病毒IgM、IgG均阳性，7例血EB病毒IgM阳性，2例血肺炎支原体IgM、I如阳性。50％血IgM增高，3例血IgG增高，1例血IgE增高。血T细胞亚群检查3例，2例降低，l例正常。14例(60．87％)脑脊液呈蛋白-细胞分离现象。10例(66．67％)脑脊液中可见寡克隆抗体电泳带(OB)。激素治疗22例，肌力开始恢复时间4～43d。结论 本征与感染密切相关，并同时存在异常体液、细胞免疫，激素治疗可能有效。     

单唾液酸神经节苷脂抗体阳性的急性脊髓炎 2 例报告#br#

目的探讨合并血浆单唾液酸神经节苷脂(GM1)抗体阳性的急性脊髓炎(AM)患儿的临床特点及治疗。方法回顾分析2例患儿的临床资料,并随访3个月;同时复习相关文献。结果 2例AM患儿,男女各1例,均为5岁,均有脊髓炎表现并伴有影像学改变,血清GM1-IgM和甲状腺抗体均为阳性,同时血清幽门螺杆菌抗体IgG阳性,1例肺炎支原体IgM抗体阳性。大剂量激素及丙球治疗后均好转出院。院外继续口服泼尼松并康复治疗,随访3个月后1例恢复,1例可下肢承重。结论免疫损伤在伴有GM1抗体阳性的儿童急性脊髓炎发病中有重要作用,其临床治疗效果及预后较好。     

应用抗μ链酶标记物ELISA法检测CMV-IgM抗体

本文报告采用过氧化物酶标记的抗人μ链抗体(抗μ—E)ELISA技术检测疑似HCMV感染患儿血清特异性IgM抗体,并与病毒分离、IgG抗体检测进行比较,结果前者阳性率较高。对18例双份血清IgM抗体检测,诊断符合率94.4％。抗原吸收2-ME阻断试验所测抗体均为特异性CMV-IgM抗体,与其他病毒感染患者阳性血清无交叉反应。不受RF、IgG影响。故本法具特异性强,敏感性高,快速简便等优点,可用于临床诊断。     

单唾液酸神经节苷脂抗体阳性的急性脊髓炎2例报告

目的探讨合并血浆单唾液酸神经节苷脂(GM1)抗体阳性的急性脊髓炎(AM)患儿的临床特点及治疗。方法回顾分析2例患儿的临床资料,并随访3个月;同时复习相关文献。结果 2例AM患儿,男女各1例,均为5岁,均有脊髓炎表现并伴有影像学改变,血清GM1-IgM和甲状腺抗体均为阳性,同时血清幽门螺杆菌抗体IgG阳性,1例肺炎支原体IgM抗体阳性。大剂量激素及丙球治疗后均好转出院。院外继续口服泼尼松并康复治疗,随访3个月后1例恢复,1例可下肢承重。结论免疫损伤在伴有GM1抗体阳性的儿童急性脊髓炎发病中有重要作用,其临床治疗效果及预后较好。     

正常新生儿脐带血弓形虫免疫球蛋白M、G检测情况

目的 了解正常出生新生儿弓形虫感染情况。方法 采集正常出生新生儿脐带血,利用酶联免疫吸附试验在脐带血清中分别检测抗弓形虫免疫球蛋白(Ig)G、IgM抗体。结果 在163个新生儿脐带血中,弓形虫IgG抗体阳性3例(1.8％),IgM抗体阳性1例(0.6％)。结论 正常新生儿弓形虫感染率较低,弓形虫IgG、IgM抗体阳性率间无显著差异。     

新生儿室管膜下囊肿预后的前瞻性观察

目的 观察新生儿室管膜下囊肿(SEC)的近期和远期预后。方法 对70例经头颅B超诊断为室管膜下囊肿的新生儿和70例无囊肿新生儿应用PCR方法分别进行血、尿巨细胞病毒(CMV)、血弓形虫(TOXO)的检测。同时应用ELISA方法对两组新生儿进行血CMV、弓形虫、风疹病毒抗体的检测。分别在3、6、12个月以及6岁时进行跟踪随访,检查内容包括头颅B超检查、体格测试、智能测试、脑干听觉诱发电位检查以及眼科检查。结果 在生后6年内,囊肿组患儿智能发育指数小于80的发生率始终显著高于对照组;其身高、体重在生后12个月内显著低于对照组,至6周岁时则接近对照组;两组的脑干听觉诱发电位及眼科检查均未见异常。结论 囊肿新生儿的体格发育在生后1年内可呈暂时落后,智能发育落后可持续至学龄前期。提示对新生儿进行常规头颅B超检查很有必要,对SEC患儿应进行长期跟踪随访。     

Recent Implications of Intrauterine and Postnatal Rubella

Many new facets of rubella virus infection, both natural and congenital, have been recently exposed. In its intrauterine role, the virus is curiously selective and it is possible that the genes of the fetus are important in determining both the occurrence and severity of infection. The risk to the fetus is highest if infection occurs in early pregnancy, but there is some risk up to 24 weeks gestation. Multiplicity of defects and chronic persistence of fetal infection are characteristic features of congenital rubella infection. The clinical manifestations, diagnosis and management of congenital rubella are discussed, with emphasis on the long term sequelae. Postnatal rubella may be difficult to diagnose, since many cases are subclinical and history is unreliable:— serological diagnosis is therefore critical during pregnancy. Vaccination programmes designed to prevent congenital rubella are evaluated; while these show promise, the ideal vaccine is yet to become available.     

Clinical features of polyhydramnios associated with fetal anomalies

The purpose of this study was to examine the clinical features of pregnancy complicated by polyhydramnios associated with fetal anomalies. Sixty-nine patients with a singleton pregnancy complicated by polyhydramnios were retrospectively analyzed. Based on prenatal ultrasonographic findings, 13 cases were considered to have idiopathic polyhydramnios and the remaining 56 cases were associated with fetal anomalies. Between these two groups, no significant difference was found in the gestational weeks when polyhydramnios developed. However, significant difference was noted in the maximum amniotic fluid index (AFI) values during the pregnancy period; 25.4 +/- 2.7 cm in the former, and 30.6 +/- 8.9 cm in the latter (P = 0.0004). In all of 13 cases with idiopathic polyhydramnios, AFI values remained less than 30 cm until delivery. Twenty-two patients (39%) with fetal anomalies required a prenatal treatment such as amnioreduction and tocolysis, whereas only one patient (7.7%) with idiopathic polyhydramnios needed tocolysis therapy (P = 0.03). There was a significant risk of premature delivery with fetal anomalies (35.6 +/- 3.9 weeks' gestation vs. 38.8 +/- 1.5 weeks' gestation, P = 0.004) because of refractory polyhydramnios, rupture of membranes, non-reassuring fetal status, and intrauterine fetal death, and although most infants with idiopathic polyhydramnios were appropriate-for-dates, many of the infants with congenital anomalies were small-for-dates. Significant risk of fetal anomalies should be considered in pregnant women with severe polyhydramnios (AFI > or = 30 cm), an increased trend of amniotic fluid during the pregnancy period, polyhydramnios requiring a prenatal treatment, or fetal growth restriction. On the other hand, based on our experience, a fetus without these conditions seems to have a low risk of congenital anomalies even if polyhydramnios is noted.     

La varicelle au cours de la grossesse

Varicella during pregnancy is a rare occurrence because of a high rate of spontaneous immunisation in the population. When a pregnant woman presents a typical rash, maternal complications, mainly respiratory distress, can occur and be life threatening. Fetal complications include two types of consequences. Before 24 weeks of gestation, transplacental transmission is estimated around 6%, with about one third of infected fetuses presenting clinical manifestations. Congenital varicella syndrome includes growth retardation, neurological effects as microcephaly, limbs malposition, lung or bowel hyperechogenicity. But most infected fetuses will not show any anomaly. A very few might develop shingles in the first year of life. Peripartum contamination brings a much higher risk of transmission (around 25%). Neonatal varicella infection can be life threatening for the new born baby, especially if premature. A specific treatment should be started as soon as the contamination is discovered. Zoster during pregnancy does not lead to a risk of fetal infection.     

Parvovirus-Mediated Fetal Cardiomyopathy With Atrioventricular Nodal Disease

Acute parvovirus B19 infection (API) in pregnancy has been associated with fetal anemia and hydrops fetalis. Direct myocardial damage from API in a fetus and an infant has been described. This report presents a case of fetal second-degree heart block and cardiomyopathy secondary to API. A 19-year-old G4P1112 (gravida 4 para 2 with 1 term delivery, 1 preterm delivery, 1 termination, and 2 living children) was referred at 20 weeks gestation for fetal bradycardia. A 2:1 atrioventricular block was identified by fetal echocardiography at 23 weeks. Hydrops developed at 25 weeks. Amniocentesis and percutaneous umbilical blood sampling demonstrated API. At 31 weeks, the patient presented with preterm labor and delivered a viable female infant, who died of poor cardiac function and arrhythmia on the first day of life. In addition to fetal anemia and hydrops fetalis, API in pregnancy may cause direct fetal myocardial damage and conduction system disease.     

产前超声检查胎儿侧脑室增宽的临床意义

目的 探讨产前超声检测胎儿侧脑室增宽的临床意义. 方法 对孕20～ 41周的孕妇进行胎儿系统筛查,选择侧脑室＞10 mm的胎儿,每3～4周进行1次超声检查,观察侧脑室的动态变化及其他异常情况,进行染色体及病毒学检查,直至足月分娩,并随访至1岁. 结果 共检出133例侧脑室增宽的胎儿,其中轻度增宽的胎儿（10 mm＜侧脑室≤12 mm）79例;77例自行消退,预后良好;2例因染色体异常引产.中度增宽的胎儿（12 mm＜侧脑室≤15 mm）43例;25例自行消退,预后良好;4例宫内缺氧或发育迟缓,3例预后良好;12例因染色体异常或巨细胞病毒感染或合并其他畸形引产;2例侧脑室进行性增宽,最终因＞15 mm引产.重度增宽的胎儿（15 mm＜侧脑室）11例;9例合并其他畸形胎儿引产;2例孕至足月,其中1例出生后出现脑瘫,1例出生后智力和生长发育明显低于同龄儿. 结论 对侧脑室轻中度增宽的胎儿进行动态观察,并进一步进行染色体和病毒学检查,不合并其他畸形的胎儿妊娠结局良好,重度侧脑室增宽及合并其他畸形的胎儿,其妊娠结局不良.     

Specific role of maternal weight change in the first trimester of pregnancy on birth size

The specific role of weight change in the first weeks of gestation in fetal growth has not been fully explored in humans. Our aims were to investigate: (1) the specific association between weight change in the first trimester of pregnancy (WCT1) and size at birth in term pregnancies; and (2) the role of placental weight in this relationship. From 2002 women included in the French EDEN study, 1744 mother–child pairs reached term, had pre‐pregnancy weight available and at least five measures of weight in pregnancy. We extrapolated women's weight at each week of gestation with a three‐degree polynomial model and estimated weight change during each trimester of gestation. We used a multivariate linear model to investigate the associations between WCT1 and birth size after taking into account potential confounders (age, parity, BMI, tobacco use, educational level, length of gestation, newborn gender, weight change after the first trimester and centre of study). Then, we performed path analysis to investigate whether the relation between WCT1 and birth size could be mediated by placental weight. After taking into account weight gain in later gestation, WCT1 was positively associated with birthweight. Results of path analysis showed that there was no direct association between WCT1 and birth size, but that this association was mediated by placental weight. Weight change during the first weeks of pregnancy may impact on fetal growth independently of weight change later in pregnancy through its effects on placental growth and function.     

Anthropometry of fetal growth in rural Malawi in relation to maternal malaria and HIV status

OBJECTIVE: To describe fetal growth centiles in relation to maternal malaria and HIV status, using cross sectional measurements at birth. DESIGN: A cross sectional study of pregnant women and their babies. Data on maternal socioeconomic status and current pregnancy, including HIV status and newborn anthropometry, were collected. Malaria parasitaemia was assessed in maternal peripheral and placental blood, fetal haemoglobin was measured in cord blood, and maternal HIV status was determined. SETTING: Two district hospitals in rural southern Malawi, between March 1993 and July 1994. OUTCOME VARIABLES: Newborn weight, length, Rohrer's ponderal index. RESULTS: Maternal HIV (adjusted odds ratio (AOR) 1.76 (95% confidence interval 1.04 to 2.98)) and first pregnancy (AOR 1.83 (1.10 to 3.05)) were independently associated with low weight for age. Placental or peripheral parasitaemia at delivery (AOR 1.73 (1.02 to 2.88)) and primigravidae (AOR 2.13 (1.27 to 3.59)) were independently associated with low length for age. Maternal malaria at delivery and primiparity were associated with reduced newborn weight and length but not with disproportionate growth. Maternal HIV infection was associated only with reduced birth weight. The malaria and parity effect occurred throughout gestational weeks 30-40, but the HIV effect primarily after 38 weeks gestation. CONCLUSION: Fetal growth retardation in weight and length commonly occurs in this highly malarious area and is present from 30 weeks gestation. A maternal HIV effect on fetal weight occurred after 38 weeks gestation.     

Awareness of and knowledge about mother‐to‐child infections in Japanese pregnant women

To reduce the incidence of infants with congenital infections, women should be aware of and know prevention measures against maternal infection with mother‐to‐child infections during pregnancy. Our objective was to assess the awareness of and knowledge about mother‐to‐child infections in Japanese pregnant women. A survey of 343 Japanese pregnant women was completed. Awareness of 13 pathogens capable of mother‐to‐child transmission was surveyed. Knowledge about the transmission route, the most susceptible time of infection that may cause severe fetal disease during pregnancy, and methods to prevent maternal infection were investigated for four major pathogens (cytomegalovirus, rubella virus, Toxoplasma gondii, and parvovirus B19) and results were compared between these pathogens. The proportion of women aware of pathogens concerning TORCH syndrome was the following: rubella virus 76%, Treponema pallidum 69%, Toxoplasma gondii 58%, parvovirus B19 28%, herpes simplex virus 27%, and cytomegalovirus 18%. Only 8% knew how cytomegalovirus is transmitted, and only 12% knew how parvovirus B19 is transmitted; both were significantly lower than those who knew transmission routes for rubella virus or Toxoplasma gondii. The proportion of women who knew the most susceptible time for severe fetal infection by maternal acquisition of cytomegalovirus, Toxoplasma gondii, or parvovirus B19 was significantly lower than that for rubella virus. The vast majority of surveyed women were not aware of methods to prevent maternal infection with cytomegalovirus or parvovirus B19. In conclusion, current awareness of and knowledge about cytomegalovirus and parvovirus B19 infection are low in Japanese pregnant women.     

Cytomegalovirus‐associated acute hydramnios treated by amniocentesis and maternal indomethacin

A 22‐year‐old pregnant woman noticed a rapid increase of abdominal growth, uterine tenderness and irregular contraction, for which she hospitalized at 25 weeks of gestation. An ultrasound examination demonstrated a single fetus with normal anatomy and massive hydramnios. Serial therapeutic amniocentesis was performed for relief of maternal symptoms and indomethacin compress was initiated. Both the maternal and amniotic fluid IgM were positive for cytomegalovirus (CMV). Maternal compress indomethacin was discontinued at 32 weeks. Cesarean section was performed due to fetal distress at 34 weeks of gestation. A female infant was delivered and the neonatal examination was within normal limits with urine culture positive for CMV. At 1 year of age the child was developing normally with normal hearing and no clinical sequelae of intrauterine CMV infection. We postulate that serial and large volume reduction of amniotic fluid by amniocentesis and compress indomethacin in our case interrupted the natural course and provided sufficient time for the fetus to recover from the acute phase of viral infection.     

Five‐year survival without major disability of extremely preterm infants born at 22–27 weeks’ gestation admitted to a NICU

Aim: To compare the 5‐year survival without major disability in infants born at the threshold of viability at 22–25 weeks who were actively treated in the delivery room and admitted to a NICU to that of those born at 26–27 weeks of gestation. Methods: All infants between 22⁺⁰ and 27⁺⁶ weeks of gestation admitted to a regional intensive care unit during 1999–2003 were enroled prospectively. The survival and major disability at 5 years of age were analysed by gestational age. Results: Of 242 treated infants, 202 survived (83.5%). Although the overall survival rate was significantly higher in the 25–27 weeks’ gestation infants than the 22–24 weeks’ gestation infants (p < 0.001), the survival rate among infants 22–24 weeks (63.6%, 63.6%, and 70%) did not significantly differ, likewise infants 25–27 weeks (88.7%, 90.6%, and 92%) had similar results. Overall, 28 children (14.4% of assessed) had major disability. Both survival and survival without major disability were positively influenced by increasing gestational age, increasing birth weight, being born at 25–27 weeks and being female child. Conclusion: With an active approach in treatment, the outcome of infants born at 25 weeks is comparable to those born at 26–27 weeks. Thus, the ‘grey zone’ in which the risk of adverse outcome is high narrows to 22–24 weeks.