大连地区孕妇及新生儿巨细胞病毒感染的调查

本文采用间接酶联免疫吸附法(ELISA)检测1119例孕妇血清1人巨细胞病毒(HCMV)特异性抗体IgM，并用聚合酶涟反应(PCR)检测41例新生儿尿液中HCMV—DNA。结果：孕妇HCMV活动感染率10．10％(113／1119)，晚期孕妇感染率略高于早中期(7．43％和10．50％)，其感染与孕妇的文化程度和职业有关。母血HCMV—IgM阳性的21例新生儿尿液HCMVDNA阳性6例，(28．57％)，41例新生儿尿液检测结果可见表．母血HCMV—IgM阳性与新生儿尿液HCMVDNA阳性密切相关。     

苏州地区孕妇风疹病毒感染情况的调查

目的 为了解孕妇风疹病毒（RV）感染情况。方法 采用酶联免疫吸附试验（ELESA）对孕妇静脉血清标本进行了RV—IgM和IgG检测。结果 2694例检测RV-TgM，阳性27例，阳性率1．00％；2668例检测RV—IgG，阳性2144例，阳性率80．36％；两项均阳性的27例，对RV有免疫力的占79．91％，近期RV感染率4．95％。结论 在孕妇中RV有一定的近期感染率，对RV有免疫力的孕妇不足八成，因此建议孕前检查RV—IgG，阴性者先注射风疹疫苗，3个月后再怀孕。     

人博卡病毒母婴感染的临床前瞻性研究

目的调查本地区人博卡病毒母婴感染情况。方法用ELISA检测母婴血清人博卡病毒IgG抗体及用荧光定量PCR检测母婴血清人博卡病毒DNA。结果316例母婴配对标本中，孕妇血清人博卡病毒I蜘抗体阳性的有127例，阳性率为40．20％（127／316）；新生儿脐带血人博卡病毒IgG抗体阳性有93例，阳性率为29．43％（93／316）。新生儿人博卡病毒IgG抗体阳性占母亲人博卡病毒IgG抗体阳性的百分比为73．23％（93／127）。母婴同时人博卡病毒IgG抗体阳性为93例。316例母婴配对标本人博卡病毒DNA均为阴性。结论人博卡病毒IgG抗体可从孕妇经胎盘传给新生儿，但是否存在人博卡病毒母婴垂直传播尚有待于进一步研究。     

肾综合征出血热病毒宫内感染的临床研究

目的 研究肾综合征出血热(HFRS)病毒宫内感染情况及其对婴儿的影响。方法 对妊娠期感染HFRS病毒者，于其分娩时留取母血和脐带血进行抗—HFRS IgG检测，同时对顺产新生儿采取静脉血进行抗—HFRS IgM检测，并应用血凝抑制试验(HI)对HFRS病毒进行分型，另外对顺产的新生儿进行全面查体和定期随访观察。结果 母血抗—HFRS IgG均阳性，死胎的27例脐带血抗—HFRS IgG阳性23例，孕妇痊愈后自然分娩的12例中脐带血和静脉血有2例抗—HFRS IgG阳性，而抗—HFRS IgM阴性。并发现14例顺产新生儿生长发育全部正常。结论 HFRS病毒存在宫内感染，并易致死胎，但对顺产婴儿未发现致畸作用。     

长春地区新生儿弓形虫、衣原体(CT)、解脲支原体母婴传播及其防治研究

新生儿弓形虫（T）、衣原体（CT）、解脲支原体（UU）母婴传播问题．至今仍是一项重要优生措施。本文应用阿奇霉素（azithromycin）600mg．给孕妇T－DNA、CT－DNA及UU－DNA．PCR检测阳性孕母．每日1次，口服连服3天，获得了满意效果，320例孕妇经检测，阳性率分别为T－DNA、21．67％±2．31％．CT－DNA为19．33％、2．83％，UU－DNA为17．33％±2．13％。孕妇T－DNA阳性者母婴传播率为48．49％，阴性者235例，传播率为1．28％．P＜0．01。孕妇CT－DNA阳性者，母婴传播率为65．52％．阴性者242例，母婴传播率为0．82％，P＜0．01。孕妇UU－DNA阳性者26例．母婴传播率为57．69％．阴性248例，母婴传播率为1．61％，P＜0．01。孕母T－DNA阳性32例，CT－DNA阳性率29例及UU－DNA阳性26例，母婴传播率便为9．38％、3．45％及11．53％，孕妇阳性与阴性传播率间P＜0．01，新生儿DNA阳性者经治疗后．T－DNA、CT－DNA、及UU－DNA阴转率为100％，95％及94．5％。建议于孕期发现T-DNA、CT-DNA及UU-DNA阳性者应以阿奇霉素防治．以减少胎儿宫内发育不良及畸形儿。     

应用荧光定量聚合酶链反应(FQ-PCR)检测孕妇巨细胞病毒感染

目的探讨荧光定量聚合酶链反应对孕妇巨细胞病毒(CMV)感染的临床诊断价值。方法用FQ-PCR检测1016例孕妇尿的CMV-DNA,同时用ELISA检测血中CMV IgG和CMV IgM。对20例感染孕妇的胎儿进行了产前诊断。结果FQ-PCR检测出36例CMV-DNA阳性,阳性率为3.5%(36/1016);阳性样本CMV-DNA在3.9×105~6.8×108拷贝/ml之间,平均为4.23×105拷贝/ml;ELISA检测CMV-IgG阳性率72.83%(740/1016);CMV-IgM阳性率3.15%(32/1016),CMV-IgG阴性率24.02%(244/1016)。20例产前诊断者有4例发生了宫内传播。结论FQ-PCR对CMV感染的诊断有重要的作用。     

新生儿先天性症状性巨细胞病毒感染与母源性原发及复发CMV 感染的相关性

目的:探讨新生儿先天性症状性巨细胞病毒(Cytomegalovirus,CMV)感染与母源性原发及复发CMV 感染的相关性。方法:选取48 例先天性症状性CMV 感染新生儿及其母亲为感染组,30 例未感染CMV 新生儿及其母亲为阴性组,应用化学发光法(CLIA)检测两组病例外周血特异性抗体IgM/ IgG(CMV-IgM/ IgG)及CMV-IgG 亲合力水平,荧光定量PCR 法检测两组母亲乳汁、新生儿外周血及尿液中CMV-DNA 含量,分析比较其检测结果的差异并回顾性分析比较了两组母亲孕早期CMV-IgG 的浓度水平与本次结果的差异。结果:感染组母亲外周血CMV-IgG 抗体水平及乳汁CMV-DNA 阳性率显著高于对照组,差异有统计学意义(P 均<0.01);病例组患儿与母亲CMV 特异性IgG 抗体比值小于对照组,差异有统计学意义(P 均<0.01);感染组子母间IgG 测定值为负相关性,差异有统计学意义(P<0.01); 阴性组子母间IgG 测定值为正相关性,差异有统计学意义(P<0.01);感染组母亲孕早期CMV-IgG 浓度水平显著低于本次结果,差异有统计学意义(P<0.01);阴性组母亲孕早期CMV-IgG 浓度水平与本次结果无显著性差异(P>0.05)。结论:孕妇体内CMV 活化或再感染导致CMV-IgG 水平升高,是新生儿先天性症状性CMV 感染的高危因素,孕期应关注CMV-IgM/ IgG 动态监测。     

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。     

荧光定量聚合酶链反应（FQ-PCR）定量测定尿液CMV在孕妇普查中的应用及意义

目的对妇产科门诊孕前、产前检查妇女尿液CMV—DNA进行普查，达到尽早发现、提前预防，避免早孕流产、孕妇CMV—DNA的垂直传播、生产过程中新生儿CMV感染的目的。方法采用FQ—PCR方法进行尿液、乳汁CMV—DNA定量测定。结果围产期孕妇尿液CMV阳性率为3．4％；孕前检查妇女尿液CMV阳性率为1．79％；产前尿CMV阳性产后乳汁CMV阳性率为35．7％。结论育龄妇女怀孕前及孕妇围产期、哺乳期和婴儿期进行CMV测定，是优生和全面提高人口素质强有力的保障。     

新生儿巨细胞病毒感染与SCE关系的探讨

本文对母亲HCMV—IgM阳性和阴性的两组新生儿脐带血进行SCE检测，并对HCMV—IgM阳性组的新生儿做了尿HCMV—DNA检测。结果表明，SCE率的升高与HCMV感染有关，尤其与HCMV—DNA阳性者密切相关。也说明SCE检测是从细胞分子水平检测HCMV感染的方法。     

婴幼儿巨细胞病毒感染与肝功能指标变化

目的研究巨细胞病毒活动性感染(IgM阳性)时婴幼儿肝功能指标的变化,及IgG阳性时,不同月龄的婴幼儿肝功能变化.方法回顾性调查2001年～2003年间,巨细胞病毒抗体(IgM或IgG)阳性的婴幼儿肝功能指标的变化.结果 101例抗体阳性的婴幼儿中有96例检查了肝功能,其中IgM阳性35例,大部分肝功能指标均较正常值有所升高,其中AST升高最为显著.IgG阳性61例,其中新生儿24例,29d至3个月11例,4～6个月14例,6个月以上至2岁12例,AST、ALT 随年龄进行性升高,其余指标进行性下降.结论 AST可做为较敏感的CMV活动性感染及近期感染的指标.     

孕妇巨细胞病毒感染对胎儿影响的前瞻性研究

用酶联免疫吸附试验（ＥＬＩＳＡ）及聚合酶链反应（ＰＣＲ）方法对沈阳市４５０名孕妇进行巨细胞病毒（ＣＭＶ）筛查，并前瞻性追查到其婴儿１００名ＣＭＶ感染状况。结果孕妇９７．１１％为既往感染，０．８９％为原发感染，１１．１１％为复发感染，仅２％为易感者。４５０例中感染组孕妇有畸形儿３例，流产３例，其胎儿感染率与致畸率明显高于对照组。１００例母婴检查结果：感染组孕妇所生先天性感染儿比对照组多１．４３倍（ＲＲ＝１．４３），感染组有２名低智儿，对照组无。本组早孕原发感染对胎儿危害最大，其宫内传播率为３３．３％。感染组孕妇９例感染儿中２例巨细胞包涵体病，７例无症状。为了早期诊断达到优生目的，对孕妇进行ＣＭＶ筛查是必要的，但筛查过程中发现有活动感染时处理要慎重，最好追查到羊水阳性时考虑终止妊娠。     

Detection of cytomegalovirus from clinical specimens in centrifugation culture by in situ DNA hybridization and monoclonal antibody staining.

An in situ DNA hybridization kit for cytomegalovirus (CMV) was evaluated for the detection of CMV in centrifugation culture. Of 61 clinical specimens, 17 (27.8%) were positive for CMV by monoclonal antibody staining following centrifugation. Of the 17 positive specimens, 15 were detected by DNA hybridization (24.5%). However, the earliest that CMV could be detected by DNA hybridization was 58 h as compared with 16 h with monoclonal antibodies following centrifugation. DNA hybridization remains of great interest for the study and detection of CMV infection. However, current DNA hybridization techniques are not sufficiently rapid to replace the use of monoclonal antibodies in centrifugation culture.     

Direct in situ hybridization for rapid detection of cytomegalovirus in bronchoalveolar lavage

Rapid detection of cytomegalovirus (CMV) from pulmonary specimens in immunosuppressed persons may provide an origin for pneumonia. In situ DNA hybridization has been effective for detection of CMV in otherwise nondiagnostic histologic material. Studies comparing bronchoalveolar lavage (BAL) with open-lung biopsy have shown the former to be superior in detecting most pulmonary pathogens affecting immunocompromised patients. Fifty consecutive BAL specimens were studied to compare direct in situ DNA hybridization, routine tissue culture, and conventional cytologic examination to assess the efficacy of the hybridization technic to rapidly detect CMV. Using tissue culture as the standard, a sensitivity of 90% (28 of 31) and specificity of 63% (12 of 19) were observed with the CMV probe. Discrepant results between the probe and tissue culture were present in ten cases. There were seven probe-positive, culture-negative cases, three of which had systemic CMV infection, including two patients with inclusions noted by conventional cytologic examination. Three probe-negative, culture-positive cases were found. In the authors' laboratory, the predictive value of a positive CMV probe is 80% (28 of 35). In contrast to the probe, conventional cytologic examination revealed CMV inclusions in only 23% (7 of 31) of the culture-positive cases. An average of 21 days was required for CMV cultures to become positive; probe results were available within 24 hours. The authors conclude direct in situ DNA hybridization is a useful rapid method for the detection of CMV in BAL specimens submitted for cytologic examination.     

Prospective study on maternal, intrauterine, and perinatal infections with cytomegalovirus in Japan during 1976-1990.

Since 1976, sera obtained serially from 10,218 pregnant women during the first, second, and third trimesters of gestation and cord sera were tested for CMV complement-fixing (CF) and immunofluorescent (IF) antibodies. CMV IgG-IF antibody was positive in 9,735/10,218 (95%) in the first trimester, and a significant rise of CF antibodies during pregnancy was found in 70/9,206 (0.76%) of the seropositive group and in 5/438 (1.14%) of the seronegative group. IgM antibody was found in 6/9,206 (0.06%) of seropositive women during the first trimester and in 7/70 (10.0%) of seropositive mothers with CF antibody rise and in 4/5 of seroconverted mothers of the seronegative group, suggesting that the incidence of primary infection with CMV during pregnancy was approximately 1% of susceptible women. All the mothers with immune response had infants with neither viruria nor IgM antibody in the cord blood, whereas seropositive mothers without an immune response had infants with viruria (7/1,826; 0.4%) or with IgM antibody in the cord blood (6/9,136; 0.06%). None of these 13 babies, shedding CMV or with IgM IF antibody, had physical or mental retardation. CMV IgG-IF antibody was present in almost 80% of infants between 7 and 12 months of age in 1988, suggesting that perinatal or postnatal CMV infection may occur in infants born to seropositive mothers in 70-80% of pregnancies.     

Comparison of polymerase chain reaction, DNA hybridization, and histology with viral culture to detect cytomegalovirus in immunosuppressed patients.

Formalin-fixed, paraffin-embedded lung tissue from 34 autopsies and eight open-lung biopsies of bone marrow transplant recipients was analyzed for cytomegalovirus (CMV) infection. The cases were studied by the polymerase chain reaction (PCR), in situ DNA hybridization, and histologic examination. The results were compared with viral culture for CMV taken at the time of biopsy or autopsy. In the autopsy series, hybridization and histology identified CMV in 15% of the cases, whereas PCR detected CMV in 24% of the cases. In the open-lung biopsy cases, both PCR and hybridization were found to be equivalent to culture in detecting CMV. Histology was less sensitive, with the molecular biology methods detecting CMV in 50% of the lung biopsies while histologic examination identified only 25%. Specificity was high (100%) since CMV was not detected in any culture-negative case by either PCR or hybridization. However, PCR, hybridization, and histology failed to identify CMV in three known culture-positive autopsy cases. Overall, PCR and hybridization were found to be more sensitive than histology, and PCR was more sensitive than hybridization for the detection of CMV. The advantage of high sensitivity and specificity combined with more rapid diagnosis (24 to 48 h) compared with viral culture (average, 16 days in this study) makes the molecular biology methods useful adjuncts to histology for detection of CMV in formalin-fixed, paraffin-embedded tissue.     

Maternal and neonatal anti‐cytomegalovirus IgG level and risk of postnatal cytomegalovirus transmission in preterm infants

Immunological mechanisms influencing the risk of mother‐to‐child cytomegalovirus (CMV) transmission in preterm infants have not been studied sufficiently. In this study, the correlation between maternal and neonatal serum anti‐CMV IgG levels and risk of postnatal CMV transmission in preterm infants was assessed. Anti‐CMV IgG levels of 79 CMV seropositive mothers and their 94 infants were determined in peripheral blood samples collected within 3 days after delivery. Postnatal CMV infection was detected in 39/94 (41%) infants by PCR on urine at term‐equivalent age (gestational age 40 weeks) after congenital infection was excluded. Maternal or infant anti‐CMV IgG levels were not significantly different between infants with and without postnatal CMV infection. The anti‐CMV IgG infant–mother ratio showed a significant positive correlation with gestational age (range 25–32 weeks, R² = 0.218, P < 0.001), reaching 1.0 at 32 weeks of gestation. Anti‐CMV IgG infant–mother ratio was significantly lower in infants with postnatal CMV infection (P = 0.015). In conclusion, the risk of postnatal CMV transmission is related to low gestational age and low anti‐CMV IgG infant–mother ratio. J. Med. Virol. 85:689–695, 2013. © 2013 Wiley Periodicals, Inc.     

Cytomegalovirus infection in Gambian mothers and their babies.

A 15 month longitudinal study of cytomegalovirus (CMV) infection in 178 Gambian mothers and their babies was undertaken. Twenty five (14%) of the babies were congenitally infected despite the fact that 87% of their mothers were antibody positive to the virus. Two of the 25 congenitally infected infants had evidence of severe neurological damage; skin sepsis was also a prominent feature in congenitally infected infants. The other children soon became infected. At 6 months of age, 53% of the infants were shedding virus either in urine or saliva. By the age of 12 months 86% of the infants had serological evidence of CMV infection. Preliminary evidence suggests that sibling to sibling infection in crowded compounds might be a major route of transmission.     

Placental transfer of naturally acquired,maternal cytomegalovirus antibodies in term and preterm neonates

Maternal antibodies may protect the fetus and neonate against severe forms of CMV-caused disease, therefore this study investigated the efficiency of the placental transfer of naturally acquired, maternal total anti-cytomegalovirus (CMV) IgG and neutralizing antibodies at different gestational ages. The study was conducted on 182 healthy CMV-seropositive Brazilian mothers and their 196 infants who were not infected congenitally with CMV, as determined by CMV detection in urine. The study groups were composed of 44 infants aged 28-30 weeks; 51 infants aged 31-33 weeks; 62 infants aged 34-36 weeks, and 39 infants of gestational age > or = 37 weeks. Quantitative detection of total CMV IgG was carried out using EIA and virus neutralizing titers were determined by a microneutralization assay in sera from mothers and infants. CMV IgG levels and neutralizing titers of the infants correlated with maternal levels (r=0.873 and r=0.841, respectively). The efficiency of placental transfer of these antibodies was enhanced significantly as gestation progressed until 34-36 weeks, when values similar to those of full-term infants (90-100%) were found. Transfer ratios were significantly higher for neutralizing compared to total CMV IgG antibodies at gestational age 31-33 weeks (100% vs. 84%, respectively) and at gestational age 28-30 weeks (75% vs. 60%, respectively). We conclude that placental transfer of naturally acquired maternal CMV neutralizing and total CMV IgG antibodies are similarly efficient above 34 weeks of gestational age. At less than 34 weeks of gestational age, transfer of neutralizing antibodies may be favored and these antibodies reach the neonatal serum of 99% of these premature infants.     

Direct detection of cytomegalovirus from bronchoalveolar lavage samples by using a rapid in situ DNA hybridization assay.

An in situ DNA hybridization assay was compared with centrifugation culture for rapid detection of cytomegalovirus (CMV) from bronchoalveolar lavage (BAL) samples. Eighty BAL samples were inoculated into both centrifugation culture and standard culture. Cytospin preparations of the BAL samples were studied in a 75-min in situ DNA hybridization assay using the PathoGene CMV kit (Enzo Biochem, Inc., New York, N.Y.). Of the 80 samples, 39 (49%) were positive for CMV; 37 of 39 (95%) were positive by centrifugation culture, 34 of 39 (87%) were positive in standard culture, 24 of 39 (62%) were positive by in situ hybridization, and 20 of 39 (56%) were positive by histologic and/or immunofluorescence techniques. The in situ hybridization assay detected 23 of the 37 samples positive in centrifugation culture, for a sensitivity of 62% and a specificity of 98%. We conclude that the in situ hybridization assay is a specific and more rapid test than centrifugation culture and standard culture for diagnosis of CMV pulmonary infection. For the clinical laboratory, however, current hybridization methods are not sufficiently sensitive to replace centrifugation culture for detection of CMV in BAL specimens.