妊娠中晚期TORCH感染与出生缺陷发生关系分析

目的:探讨妊娠中晚期TORCH感染与出生缺陷发生关系。方法:选择2015年2月-2019年1月本院产前检查孕妇3594例,取空腹外周静脉血行TORCH检测,根据筛查结果分为感染组254例与非感染组3340例。随访至分娩,记录出生缺陷发生情况。对比不同感染孕妇出生缺陷发生情况,分析与出生缺陷发生的相关性。结果:3594例中TORCH感染254例,感染率7.07%,CMV感染率(3.53%)最高,其次为TOX(1.53%),其他感染最低(P<0.05)。3954例新生儿有中49例伴有出生缺陷,其中单发畸形44例,多发畸形5例,总发生率为13.63‰。先天性心脏病发生率(5.56%)最高,其次为唇腭裂(3.90%),指/趾畸形(1.67%)、脊柱裂(1.39%),外耳畸形(1.11%)发生率较低(P<0.05)。感染组出生缺陷发生率(14.96%)高于非感染组(0.33%)(P<0.05)。先天性心脏病发生与CMV、TOX、RV及HSV感染呈显著正相关(r>0,P<0.05),与其他感染不具有相关性(P>0.05);唇腭裂发生与CMV感染呈显著正相关(r>0,P<0.05),与TOX、RV、HSV及其他感染不具有相关性(P>0.05)。指/趾畸形、脊柱裂及外耳畸形与TORCH感染不具有相关性(P>0.05)。结论:CMV、TOX、RV及HSV感染与先天性心脏病发生,CMV感染与腭裂发生有一定关系,提示临床应重视孕期TORCH检查,加强预防与治疗以降低出生缺陷发生。     

TORCH感染对妊娠胎儿的影响

自1995年6月初至1997年6月对本院产科门诊的孕妇中进行巨细胞病毒,弓形体,支原体及衣原体筛查,发现49例孕妇为阳性,在孕期进一步进行水,脐血检测以及分娩后新生儿跟踪随访,孕妇受有关病毒及病原体感染可通过母婴垂传播而使胎儿造成一系列严重影响和疾病,这种TORCH感染对孕妇能致早期流产,对胎儿能致畸或新生儿死亡及儿童低智,但当孕妇经积极治疗后,再次受孕仍可分娩正常婴儿,故TORCH感染的防治问题是个值得重视的生殖健康问题。     

TORCH感染对妊娠及致畸的研究进展

TORCH感染筛查是优生优育的重要检测指标,典型的TORCH感染是指由弓形虫(TOX)、风疹病毒(RV)、巨细胞病毒(CMV)和单纯疱疹病毒(HSV)导致的感染.孕妇感染TORCH病原体可致流产、死胎、早产和胎儿畸形,对胎儿及孕妇造成严重影响,同时也给家庭及社会造成了极大的经济负担及精神压力.脉络膜视网膜炎、颅内钙化和...     

TORCH感染与孕妇不良妊娠结局的调查

目的 探讨孕妇TORCH感染与流产、死胎、宫内感染、胎儿生长受限(FGR)、先天畸形等不良妊娠结局的相关性.方法 采用酶联免疫吸附试验( ELISA)检测方法,对医院880例发生流产、死胎、宫内感染、胎儿生长受限、先天畸形等不良妊娠结局的孕妇进行血清TORCH-IgM抗体检测分析,并与同期正常的孕妇880例作对照.结果 不良妊娠结局孕妇的TOX-IgM、RV-IgM、CMV-IgM和HSVⅡ-IgM阳性率分别为3.2％、4.2％、6.9％、5.1％,正常妊娠孕妇的TOX-IgM、RV-IgM、CMV-IgM和HSVⅡ-IgM阳性率分别为0.5％、1.3％、2.7％、1.6％,不良妊娠结局孕妇明显高于正常妊娠的孕妇,差异有统计学意义(P＜0.01).结论 TORCH感染与不良妊娠结局有极其重要的关系,TORCH-IgM检测对优生优育有着很重要的意义.     

安徽省淮南地区部分孕产妇TORCH感染检测分析

目的:探讨淮南地区部分孕产妇TORCH感染对胎儿宫内发育的影响。方法:采用间接ELISA法检测1529例孕产妇血清TORCH特异性IgM、IgG抗体。结果:孕产妇TORCH感染的血清学阳性率特别是IgG阳性率与全国各地的相近。结论:孕产妇TORCH感染对孕产妇和围产儿的危害不容忽视,应加强筛查和积极预防。     

孕妇TORCH感染4种病原体的检测

TORCH是对优生危害最大的病原微生物 ,尤其是孕妇的原发性和活动性感染会导致胎儿的先天性感染 ,并引起严重后果 ,因此TORCH的检测尤为重要 ,该文论述了目前TORCH检测的主要方法以及各种方法的特点。TORCH检测的方法主要有病原学、核酸、血清学检查 ,其中PCR、ELISA是目前最常用的两种方法 ,近年发展了一些改良方式。蛋白质芯片检测技术作为一门新型技术因其特有的优势 ,在TORCH感染病原体的检测方面将发挥重要作用     

An assessment of the effects of maternal age and parity in different components of perinatal mortality

Perinatal mortality has several components which may have distinct epidemiologic features. In an investigation of the total singleton birth population of New York City in 1976-1978 (n = 320,726), the authors divided perinatal mortality into four components: late fetal deaths that occurred before labor (late antepartum fetal deaths), fetal deaths during labor (intrapartum fetal deaths), neonatal deaths, and perinatal deaths attributed to congenital anomalies, and they assessed the relation of each of these to maternal age and parity, controlling for relevant confounding factors. In analyses which controlled for prior fetal loss, type of service (public vs. private), race, marital status, and mother's educational attainment in a multiple logistic regression model, the authors found that: 1) increasing maternal age was strongly associated with antepartum fetal deaths but not with intrapartum fetal deaths, while older maternal age was also associated with perinatal deaths attributed to congenital anomalies; 2) high parity bore a strong relationship to intrapartum fetal deaths, but none to antepartum fetal deaths, neonatal deaths, or congenital anomaly deaths; and 3) for neonatal death, there was a statistically significant (p less than 0.001) interaction between parity and age such that mothers over 34 years old having their first birth were at especially high risk.     

A case-control study of pesticides and fetal death due to congenital anomalies

We examined the association between late fetal death due to congenital anomalies (73 cases, 611 controls) and maternal residential proximity to pesticide applications in ten California counties. A statewide database of all applications of restricted pesticides was linked to maternal address to determine daily exposure status. We examined five pesticide chemical classes. The odds ratios from logistic regression models, adjusted for maternal age and county, showed a consistent pattern with respect to timing of exposure; the largest risks for fetal death due to congenital anomalies were from pesticide exposure during the 3rd-8th weeks of pregnancy. For exposure either in the square mile of the maternal residence or in one of the adjacent 8 square miles, odds ratios ranged from 1.4 (95% confidence interval = 0.8-2.4) for phosphates, carbamates, and endocrine disruptors to 2.2 (95% confidence interval = 1.3-3.9) for halogenated hydrocarbons. Similar odds ratios were observed when a more restrictive definition of nonexposure (not exposed to any of the five pesticide classes during the 3rd-8th weeks of pregnancy) was used. The odds ratios for all pesticide classes increased when exposure occurred within the same square mile of maternal residence.     

The Lungs,the Environment,and Compensation

A continuing prospective study of the incidence of viral infections during pregnancy and their association with congenital malformations is described. Histories of illness during pregnancy are recorded, and blood samples are taken again at delivery. Infants are observed for one year. When anomalies are diagnosed and classified, the maternal sera, together with matched control specimens from mothers of normal infants, are tested for serological evidence of infection with selected viruses. Several viruses appear to be more frequently encountered during pregnancy by mothers of infants with certain types of anomalies. Most strikingly, a statistically greater incidence of infection with type B coxsackieviruses, and especially B3 and B4, has been observed in mothers of infants with congenital heart disease than in mothers of normal children.     

Birth weight-specific causes of infant mortality, United States, 1980

To describe underlying causes of infant death by birth weight, we used data from the 1980 National Infant Mortality Surveillance project and aggregated International Classification of Diseases codes into seven categories: perinatal conditions, infections, congenital anomalies, injuries, sudden infant death syndrome (SIDS), other known causes, and nonspecific or unknown causes. Compared with heavier infants, infants with birth weights of 500-2,499 grams (g) are at increased risk of both neonatal and postneonatal death for virtually all causes. Sixty-two percent of neonatal deaths (under 28 days of life) were attributed to "conditions arising in the perinatal period," as defined using codes from the International Classification of Diseases. Prematurity-low birth weight and respiratory distress syndrome (RDS) were the leading causes of such deaths among infants with birth weights of 500-2,499 g, while birth trauma-hypoxia-asphyxia and other perinatal respiratory conditions were the leading causes among heavier infants. For all birth weight groups, congenital anomalies were the second leading cause, representing 27 percent of neonatal deaths. Although perinatal conditions caused nearly one-third of postneonatal deaths (28 days to under 1 year of life) among infants with birth weights of 500-1,499 g, for the other birth weight groups these conditions were much less important; predominant causes of postneonatal death were sudden infant death syndrome (SIDS), congenital anomalies, infections, and injuries. Black infants had a roughly twofold higher risk of neonatal and postneonatal death than did white infants for all causes except congenital anomalies, which occurred with almost equal frequency in blacks and whites. However, for infants with birth weights of 500-2,499 g, blacks had lower risks of neonatal death from RDS and congenital anomalies. Between 1960 (the latest year for which national birth weight-specific mortality statistics had been available) and 1980, SIDS emerged as a major diagnostic rubric. Otherwise, except for infections and congenital anomalies among infants with birth weights of 500-1,499 g, all causes of death declined in frequency among all birth weight groups.     

产前超声筛查胎儿先天性心脏病的诊断价值及高危因素分析

目的 探讨产前超声筛查胎儿先天性心脏病的临床价值并分析其高危因素。方法 应用回顾性分析2019年1月—2020年7月在本院接受产前胎儿先天性心脏病超声筛查的2 869例孕妇的临床资料,计算超声对胎儿先天性心脏病的诊断灵敏度、特异度及准确度。将发生胎儿先天性心脏病者作为先天性心脏病组,未发生者作为正常组。采用Logistic回归分析胎儿发生先天性心脏病的高危因素。结果 2 869例孕妇中126例发生胎儿先天性心脏病,检出率为4.39%,超声检查结果灵敏度为87.30%(110/126)、特异度为88.52%(2 428/2 743)、准确度为88.46%(2 538/2 869)。与正常组相比,先天性心脏病组胎儿早期颈项透明层(nuchal translucency,NT)值高或患有颈部淋巴水囊瘤(61.90%)、母亲患有结缔组织病或糖尿病(64.29%)、先天性心脏病家族史(77.78%)、羊水异常(62.70%)占比均高于正常组的35.29%、46.85%、60.30%、44.29%(χ2=36.850、14.688、15.480、16.479,P值均＜0.001)。经Logistic回归分析,胎儿早期NT值高或患有颈部淋巴水囊瘤、母亲患有结缔组织病或糖尿病、先天性心脏病家族史与羊水异常均为导致胎儿先天性心脏病的高危因素(P＜0.001)。结论 产前超声筛查对于胎儿先天性心脏病的诊断价值高,胎儿早期NT值高或患有颈部淋巴水囊瘤、母亲患有结缔组织病或糖尿病、先天性心脏病家族史与羊水异常均为导致胎儿先天性心脏病的高危因素。     

Current situation of bovine virus diarrhoea-mucosal disease (BVD-MD) virus infections and their antigenic diversity in Hokkaido, Japan

The current situation of bovine virus diarrhoea-mucosal disease (BVD-MD) virus infections is briefly reviewed, with special reference to problems arising from fetal infection in the Hokkaido district, a northern island of Japan. The results of some investigations on BVD-MD virus carried out in Japan are also described. Although bovine congenital anomalies caused by BVD-MD virus and mucosal disease may be late sequelae to fetal infection and occur sporadically, it appears that their incidence and importance in the Hokkaido district have increased in recent years. The results of antigenic characterisation of the recent isolates and serologic survey on bovine sera suggested that BVD-MD viruses with various antigenic properties are widespread among cattle in the district. There is also a possibility that clinical manifestations in infected cattle may differ with the antigenicity of the viruses. In addition, the virological investigations on experimental and naturally occurring mucosal disease suggested that persistently infected cattle are populations at high risk of developing mucosal disease. The antigenic homology of non-cytopathogenic persistent virus and cytopathogenic virus is probably an important factor in the pathogenesis of mucosal disease.     

荆州地区3851例孕妇TORCH感染的调查分析

目的:了解荆州地区TORCH三项〔弓形虫(TOX)、风疹病毒(RUV)、巨细胞病毒(CMV)〕的感染状况。方法:应用酶联免疫吸附试验(ELISA)检测3 851例孕早期妇女血清TORCH三项。结果:孕早期妇女血清TORCH三项检测中以CMV-IgM、IgG的阳性率最高,且CMV、TOX、RUV的感染人数和阳性率逐年升高(P<0.01);TORCH感染在一年四季均可能发生,但冬春季感染率比夏秋季高(P<0.05)。结论:荆州地区孕妇TORCH感染率逐年上升,积极监测和预防先天性TORCH感染是非常必要的。     

Modeling the potential impact of vaccination on the epidemiology of congenital cytomegalovirus infection

Background

Understanding the potential for vaccination to change cytomegalovirus (CMV) epidemiology is important for developing CMV vaccines and designing clinical trials.

Methods

We constructed a deterministic, age-specific and time-dependent mathematical model of pathogen transmission, parameterized using CMV seroprevalence from the United States and Brazil, to predict the impact of vaccination on congenital CMV infection.

Findings

Concurrent vaccination of young children and adolescents would result in the greatest reductions in congenital CMV infections in populations with moderate and high baseline maternal seroprevalence. Such a vaccination strategy, assuming 70% vaccine efficacy, 90% coverage and 5-year duration of protection, could ultimately prevent 30–50% of congenital CMV infections. At equilibrium, this strategy could result in a 30% reduction in congenital CMV infections due to primary maternal infection in the United States but a 3% increase in Brazil. The potential for an increase in congenital CMV infections due to primary maternal infections in Brazil was not predicted with use of a vaccine that confers protection for greater than 5 years.

Interpretation

Modeling suggests that vaccination strategies that include young children will result in greater declines in congenital CMV infection than those restricted to adolescents or women of reproductive age. Our study highlights the critical need for better understanding of the relative contribution of type of maternal infection to congenital CMV infection and disease, the main focus of vaccine prevention.     

Masern, Mumps und Röteln in der Schwangerschaft

Measles, mumps and rubella are common childhood diseases. Therefore, frequent and intense contact with children of preschool age may be associated with a higher infection risk for childcare providers. This overview summarizes current knowledge on possible adverse effects of these infections on pregnant women, pregnancy outcome and the fetus. Acute rubella or mumps virus infections are apparently not more severe in pregnant than non-pregnant women. In contrast, measles virus infection in pregnancy is linked to a higher incidence of pneumonitis and hospitalization. Evidence of congenital defects due to fetal infection is only provided in case of rubella virus infection in early pregnancy. Following rubella virus infection in the first trimester an increased fetal loss rate was reported. In 1966, a prospective study showed also a significant association between maternal mumps in the first trimester and an increased risk of abortion. But other investigators could not confirm this association. Measles and rubella but not mumps virus infections are linked to an increased premature birth rate. Occurring in late pregnancy, all three infections can result in birth of an infected infant. But severe disease occurs rarely and is mostly reported for premature infants with early neonatal measles. Preventive measures, aimed to reduce the risk of infection or severe complications for pregnant childcare providers, should consider the individual history of the employee (e.g. previous immunizations or antibody test results), the current epidemiological situation and possible interventions like passive immunization in case of exposure to measles.     

四腔心切面在产前超声诊断先天性心脏畸形中的作用

目的:分析四腔心切面所见异常在产前超声诊断先天性心脏畸形中的作用和临床意义。方法:据四腔心切面所见异常对产前超声诊断先天性心脏畸形所提供的心脏信息及对诊断意义的不同,将产前超声诊断的先天性心脏畸形胎儿病例71例分为3组。结果:第1组为根据四腔心切面所见异常即可明确诊断的胎儿先天性心脏畸形,共52例,占73.24%,但该组伴发的大动脉畸形25例,占48.08%,如果单用四腔心切面将全部漏诊;第2组为根据四腔心切面所见异常可以提供存在先天性心脏畸形重要线索,共12例,占16.90%;第3组为四腔心切面所见基本正常,但存在先天性心脏畸形,共7例,占9.86%。71例中合并心外畸形的病例39例,占54.93%。结论:四腔心切面在产前超声筛选新生儿先天性心脏畸形方面具有非常重要的作用和临床意义,90%以上的先天性心脏畸形在四腔心切面上或多或少有异常特征,但有局限性,大动脉畸形漏诊相当常见,如果能加上左、右心室流出道等切面则明显减少漏诊。     

不良妊娠结局与TORCH感染相关性的临床研究

目的:探讨不良妊娠结局与妊娠期感染弓形体(TOX)、其他(OTH)、风疹病毒(RUV)、巨细胞病毒(CMV)、单纯疱疹病毒(HSV-Ⅱ)(TORCH)系列病原体的关系。方法:应用酶联免疫吸附试验(ELISA),检测48例有不良妊娠史的妇女(试验组)及48例正常孕妇(对照组)母血及胎儿脐血TORCH感染情况。结果:①试验组TORCH-IgG感染率分别为:TOX-IgG 14.58%,RUV-IgG 47.91%,CMV-IgG 45.83%,HSVⅡ-IgG 35.41%。②试验组TORCH-IgM感染率分别为:TOX-IgM 33.33%,RUV-IgM 52.08%,CMV-IgM 54.16%,HSVⅡ-IgM 58.33%。③试验组TORCH-IgG、IgM双项阳性发生率为:TOX 12.50%,RUV 37.50%,CMV 31.25%,HSV-Ⅱ18.75%。以上3个指标,试验组均显著高于对照组(P<0.01),不良妊娠结局发生率试验组亦显著高于对照组(P<0.01)。结论:TORCH系列病原体活动感染对围生儿预后会产生严重的不良影响,是导致妇女不良妊娠结局的重要原因之一,TORCH筛查应作为产前检查的常规项目。尤其对有不良妊娠结局史的妇女,行TORCH筛查对防止出生缺陷的发生是完全必要。     

Risk of congenital anomalies after the opening of landfill sites

Concern that living near a particular landfill site in Wales caused increased risk of births with congenital malformations led us to examine whether residents living close to 24 landfill sites in Wales experienced increased rates of congenital anomalies after the landfills opened compared with before they opened. We carried out a small-area study in which expected rates of congenital anomalies in births to mothers living within 2 km of the sites, before and after opening of the sites, were estimated from a logistic regression model fitted to all births in residents living at least 4 km away from these sites and hence not likely to be subject to contamination from a landfill, adjusting for hospital catchment area, year of birth, sex, maternal age, and socioeconomic deprivation score. We investigated all births from 1983 through 1997 with at least one recorded congenital anomaly [International Classification of Diseases, Ninth Revision (ICD-9), codes 7400-7599; International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), codes Q000-Q999]. The ratio of the observed to expected rates of congenital anomalies before landfills opened was 0.87 [95% confidence interval (CI), 0.75-1.00], and this increased to 1.21 (95% CI, 1.04-1.40) after opening, giving a standardized risk ratio of 1.39 (95% CI, 1.12-1.72). Enhanced congenital malformation surveillance data collected from 1998 through 2000 showed a standardized risk ratio of 1.04 (95% CI, 0.88-1.21). Causal inferences are difficult because of possible biases from incomplete case ascertainment, lack of data on individual-level exposures, and other socioeconomic and lifestyle factors that may confound a relationship with area of residence. However, the increase in risk after the sites opened requires continued enhanced surveillance of congenital anomalies, and site-specific chemical exposure studies. Key words: congenital malformations, epidemiology, landfill, small-area health statistics.     

孕前及孕早期母体因素与子代复杂先天性心脏病的相关性研究

目的 探讨孕前及孕早期母体环境暴露因素与子代复杂先心病的关系,为先天性心脏病（congenital heart disease ,CHD）的科学预防和干预提供依据。方法 选取2017年1月-2018年12月产前超声诊断为子代复杂先心病的孕妇62例为病例组,按照1∶2匹配正常孕妇为对照组,问卷调查后通过多因素logstic回归分析复杂先心病可能的危险因素和保护因素。结果 母亲不良生育史（OR:6.981, 95%CI:3.621～11.017）、孕前吸烟饮酒史（OR:2.418,95%CI:1277～6.757）、孕早期呼吸道感染（OR:3.906, 95%CI:1.115～5.242）、噪音环境（OR:2.391, 95%CI:0.898～4.710）、不良精神心理因素（OR:4.791, 95%CI:2.242～8.597）为子代复杂先心独立危险因素。而孕前及孕早期食用蛋、奶类等高蛋白物质（OR:0.517,95%CI:0.311～0.803）和补充叶酸及其它营养素（OR:2.979,95%CI:1.537～5.016）为子代复杂先心保护因素。结论 孕前及早孕期孕妇需避免上述危险因素的接触,增加高蛋白和叶酸摄入量,对降低及预防复杂CHD有重要价值。