弓形虫既往感染在孕期内对胎儿的影响

目的探讨既往感染者孕期内弓形虫的活动情况及对胎儿的影响。方法对68例抗弓形虫抗体IgG阳性、IgM阴性孕妇的血清、脐血采用酶联免疫吸附试验检测弓形虫抗体IgG、IgM、弓形虫循环抗原（CAg）,PCR法检测虫体DNA;胎盘样本采用直接涂片、匀浆涂片及PCR法观察弓形虫感染情况。结果68例弓形虫抗体IgG阳性孕妇中脐血弓形虫抗体IgG阳性28例,IgG胎盘垂直传播率41.2%;脐血弓形虫DNA阳性6例,宫内感染发生率8.8%;胎盘组织中虫体DNA阳性9例,宫内感染发生率13.2%。结论既往弓形虫感染孕期内仍可导致垂直传播。     

Detection of Toxoplasma gondii DNA by PCR in mother's blood, amniotic fluid and child's blood in selected cases of pathological pregnancy

Prenatal screening of Toxoplasma gondii infection is controversial. The diagnosis is based on serological tests detecting IgM and IgG antibodies against T. gondii, but interpretation of these tests results is often confusing. It is commonly made retrospectively when serological screening indicates a possibility of recent infection. Most women have antibodies against T. gondii and serial testing is required only in monitoring of pregnancies where initial screening is negative. The introduction of Polymerase Chain Reaction (PCR) assay for detection of Toxoplasma gondii DNA in selected cases of pathologic pregnancies has permitted a more accurate and faster diagnosis of congenital toxoplasmosis infections.     

Detection of Toxoplasma gondii in human placenta by PCR and placental histologic findings

Since isolation of Toxoplasma gondii from human placenta strongly correlates with fetal infection, the aims of the study were: to detect fragments of T. gondii B1 gene in human placentae by PCR and to evaluate their pathology. 36 placentae included in three groups were obtained: group I (n = 7) from pregnancies with prenatal diagnosis of fetal toxoplasmosis; II (n = 17) from women with serologic features of primary infection during pregnancy; III (n and 13) from pregnancies with fetal T. gondii infection based on clinical signs. T. gondii DNA was found in 2/4 samples from the I group and in 1/14 from the II group. Villitis was identified in 3/15 other placentae from the II group. In the III group we did not recognize neither T. gondii DNA nor villitis. We consider PCR and pathologic evaluations of placentae as the two complementary methods. PCR can be especially helpful in pregnancies not screened against T. gondii as positive result in placenta can confirm mother's primary infection.     

DNA聚合酶链反应检测石蜡包埋人脑组织中弓形虫的研究

孕妇感染弓形虫是胎儿先天性畸形的危险因素。本文运用DNA聚合酶链反应检测30例先天性畸形儿尸检石蜡包埋脑组织中弓形虫。结果表明,30例先天性畸形儿石蜡脑组织切片经体外扩增后出现阳性条带者13例,而对照组无1例阳性(P<0.05)。研究结果进一步支持弓形虫感染与胎儿先天性畸形有密切关系。     

Case-control study of ectopic pregnancies in Myanmar: infectious etiological factors

We studied the role of infections in ectopic pregnancy and the different methods of detecting Chlamydia trachomatis infection using serology, cervical and tubal PCR assays, by using a hospital-based, case-control study conducted between November 2007 and September 2009. The sample size was 339 with 113 cases and 226 controls. The cases were women admitted for the management of ectopic pregnancy while the controls were women admitted for spontaneous miscarriage. Both cases and controls were tested for syphilis and chlamydial infection by serology. In addition, cervical samples from controls and both cervical and tubal samples from cases were examined for the presence of chlamydia and gonococcal DNA. Sociodemographic data and past histories were collected using set Proforma. Independent variables for multivariate analysis included previous history of spontaneous abortion, ectopic pregnancy, symptoms of sexully transmitted infections (STI), and use of contraception. Women with a previous history of ectopic pregnancy (adjusted OR 28.3; 95% CI 5.8-138.8; p = 0.01) and a past history of having had symptoms of STI (adjusted OR 11.06; 95% CI 5.45-22.44; p = 0.0005) were significantly more likely to have an ectopic pregnancy than those without such a history. Syphilis serology was positive in 13.3% of ectopic pregnancy cases compared to only 3.5% of controls (crude OR 0.24; 95% CI -0.10-0.58; p = 0.001). From cervical swabs, chlamydia DNA was detected significantly more frequently in cases than controls (8.0% vs 2.2%; crude OR 0.261; 95% CI -0.09-0.80, p = 0.012) but gonorrhea DNA detection rates were not significantly different (3.5% vs 0.9%, crude OR 0.24; 95% CI -0.04-1.35; p = 0.1). Chlamydia was positive in cases only as diagnosed tubal samples for PCR in 17 (15.0%), cervical samples for PCR in 9 (8.0%) and IgM ELISA in 6 (5.3%). Among the three STI tested for in this study, C. trachomatis was the most frequently associated with ectopic pregnancy and was more frequently diagnosed by PCR on tubal samples than PCR on cervical samples or chlamydia IgM serology.     

Prenatal diagnosis of intrauterine infection with parvovirus B19 by the polymerase chain reaction technique.

Human parvovirus B19 is a recently recognized cause of fetal hydrops and death. Efforts to characterize the natural history of fetal infection with this virus have been hampered by the lack of sensitive and specific tests for diagnosis in utero. Using the highly sensitive polymerase chain reaction (PCR) assay, we determined the fetal infection status in 56 pregnancies by testing amniotic fluid, fetal serum, and maternal serum for B19 DNA and antibodies. Factors associated with a high risk of B19 infection were fetal disease, exposure to persons with erythema infectiosum, or signs or symptoms of acute B19 infection. Fifteen women (27%) were B19 IgM-positive, a status suggesting recent infection; the positivity of all of the corresponding fetal specimens for B19 DNA in the PCR was indicative of fetal infection. In four of these cases, serial ultrasonographic examinations documented spontaneous resolution of fetal hydrops. Twenty-four women (43%) were IgG-positive and IgM-negative; this pattern suggested prior infection. The PCR gave positive results, consistent with recent maternal infection, in four of these cases. Seventeen women (30%) were IgG-negative and IgM-negative, a pattern suggesting no prior infection; the PCR results in four cases were indicative of a possible early maternal infection or a possible atypical immune response. The PCR is a sensitive and rapid method for the diagnosis of intrauterine infection with human parvovirus B19 and promises to facilitate studies of the natural history and treatment of this infection.     

Diagnosis of Toxoplasma gondii infection in pregnant women using automated chemiluminescence and quantitative real time PCR

Objective: To identify serodiagnosis and quantification of Toxoplasma gondii(T. gondii) infection among pregnant women in Salmas, northwest of Iran. Methods: In this crosssectional study, 276 blood samples were collected from pregnant women referred to the health care centers in Salmas city. The demographic variables were also recorded. Titers of antiToxoplasma IgM and IgG antibodies(Ab) were determined using the chemiluminescence immunoassay. Quantitative real-time PCR targeting the T. gondii repeated element gene was also performed on the blood sample. Results: Out of all, 19.92%(55/276) and 2.17%(6/276) patients were seropositive for anti-Toxoplasma IgG and IgM Ab, respectively. Moreover, the presence of T. gondii DNA was observed in 12.31%(34/276) blood samples. A significant relationship was observed between the IgG Ab seropositivity and contact with the cat as a risk factor(P=0.022). Conclusions: The seroprevalence rate of T. gondii infection in pregnant women is relatively low. Consequently, the seronegative pregnant women are at risk, and a considerable rate of positive blood samples for the presence of parasite's DNA should not be ignored. Besides, quantitative real-time PCR could be considered as an accurate method for diagnosis of acute toxoplasmosis especially when the precise results are of the most importance in pregnancy. Limiting contact with cats is also suggested for pregnant women.     

孕妇弓形虫感染妊娠结局及危险因素调查

目的 目的 了解孕妇感染弓形虫感染后的妊娠结局及其危险因素。 方法 方法 2010-2013年采用酶联免疫吸附试验 （ELISA） 对在涿州市妇幼保健院行孕前检查的2 740例孕期妇女进行弓形虫IgM和IgG抗体检测并追踪随访, 观察其妊娠 结局; 采用问卷调查孕妇弓形虫感染的危险因素。 结果 结果 2 740例被调查的孕期妇女中, 弓形虫抗体检测阳性195例, 抗体 阳性率为7.12%, 其中IgM抗体阳性44例 （占22.56%）, IgG抗体阳性151例 （占77.44%）。随访结果表明, 195例感染弓形虫 的孕妇中41例出现不良妊娠结局 （占21.02%）, 包括32例IgM抗体阳性孕妇 （占78.05%） 和9例IgG抗体阳性 （占21.95%）; 未感染弓形虫孕妇6例出现不良妊娠结局 （占2.86%）, 两者差异有统计学意义 （P ＜ 0.05）。问卷调查表明, 与动物密切接 触、 喜吃生肉、 喜吃火锅或烧烤、 品尝生肉馅等是孕妇感染弓形虫的重要危险因素 （与未感染组比较, P ＜0.01）。 结论 结论 孕 妇感染弓形虫可导致不良妊娠结局的发生, 养成良好的生活卫生习惯是避免不良妊娠结局的有效途径。     

乙酰螺旋霉素联合阿奇霉素治疗孕期弓形虫感染的临床效果

目的 目的 探讨螺旋霉素联合阿奇霉素治疗孕期弓形虫感染的综合治疗方法。方法 方法 应用ELISA方法检测孕妇血清 特异性弓形虫IgG和IgM抗体, 并采用PCR方法检测羊水中弓形虫感染情况; 选取其中3例弓形虫IgM抗体阳性孕妇作为 治疗对象, 应用螺旋霉素联合阿奇霉素进行综合治疗, 通过血清学特异性抗体检测和PCR检测结果初步判断其疗效。结 结 果 果 经ELISA检测, 孕期妇女血清特异性弓形虫IgG和IgM抗体的阳性率分别为5.97% （17/285） 和1.05% （3/285）, 对3例血 清IgM抗体阳性孕妇的羊水进行PCR检测特异性弓形虫基因, 有2例呈阳性。经过2种药物的联合治疗, 这2例孕妇血清 特异性弓形虫IgM抗体滴度阴转, PCR检测产妇脐带血中弓形虫基因为阴性。结论 结论 螺旋霉素联合阿奇霉素治疗孕期弓 形虫感染安全、 有效。     

孕早期妇女弓形虫感染对妊娠结局的影响

目的 目的 探讨孕早期妇女弓形虫感染对妊娠结局的影响。方法 方法 采用酶联免疫吸附试验检测2 993例孕妇外周血 中弓形虫IgM和IgG抗体, 将感染者分为急性感染组、 既往感染组、 活动性感染组, 并从非感染者中随机抽取200 名孕妇作 为对照组, 对4组进行随访, 观察比较4组的妊娠结局。结果 结果 共检测出弓形虫感染者286例, 总感染率为9.56%（286/ 2 993）, 其中急性感染43例、 既往感染156例、 活动性感染87例; 以上3组及对照组不良妊娠结局发生率分别为13.95% （6/ 43）、 1.92% （3/156）、 5.75% （5/87） 和1.50% （3/200）。急性感染组和活动性感染组不良妊娠结局发生率与对照组比较, 差异 均有统计学意义 （P均＜0.05）; 既往感染组与对照组比较, 差异无统计学意义 （P＞0.05）。结论 结论 弓形虫急性感染和活动性 感染与孕早期妇女不良妊娠结局密切相关, 应将弓形虫IgM抗体检测作为育龄妇女孕前常规检查项目。     

Acute parvovirus B19 infection in pregnant women—An analysis of serial samples by serological and semi-quantitative PCR techniques

Summary The serological and virological course of parvovirus B19 infection was followed in 14 women who suffered symptomatic or subclinical acute infection during pregnancy. Serial serum samples from the patients were tested for IgG and IgM antibodies and the levels of parvovirus B19 DNA were monitored using a semi-quantitative PCR assay. In addition, the outcome of the pregnancies was documented by clinical information and by testing cord blood for parvovirus B19 specific antibodies as well as for parvovirus B19 DNA by PCR. Levels of IgG antibodies rose steadily within 2 months of infection and in some cases began to decline at the end of pregnancy. IgM antibodies were usually detected for at least 2 months and persisted for as long as 9 months in one case. Viral DNA was detectable for at least 8 weeks following infection and semi-quantitative analysis revealed a gradual reduction in virus load during the viraemic phase of infection. There were no apparent differences in the course of antibody development and duration of viraemia in symptomatic versus subclinical infections.     

孕妇与胎儿弓形虫感染状况的研究

目的　探讨孕妇与胎儿弓形虫 (Toxoplasma,TOX)感染的状况与关系。　方法　用酶联免疫吸附法及荧光定量多聚酶链反应技术检测孕妇血中 TOX特异性抗体及 TOX DNA,对 TOX感染孕妇检测羊水或脐血诊断胎儿感染。　结果　 15 6 4例孕妇中血清 TOX- Ig M阳性者 4 1例 (2 .6 2 % ) ,TOX- Ig G阳性 5 9例 (3.77% ) ,TOX DNA阳性 4 5例(2 .88% ) ,4 1例 TOX- Ig M阳性者其 TOX- DNA均为阳性。 4 5例 TOX感染孕妇中羊水或脐血 TOX- DNA阳性 13例(2 8.89% )。 TOX感染胎儿中 2例自然流产 ,1例死胎、1例胎儿生长受限 (Fetal growth restriction,FGR) ,9例出生时无明显症状的新生儿中 ,有 1例生后 1个月患黄疸性肝炎 ,1例有单侧耳聋 ,7例生长发育正常。　结论　孕妇 TOX感染可危害胎儿 ,孕妇 TOX感染后取羊水或脐血检测 TOX DNA是诊断胎儿 TOX感染的有效方法。     

Reactivation of human herpesvirus 6 during pregnancy

Reactivation of human herpesvirus 6 (HHV-6) and cytomegalovirus (CMV) during pregnancy and transmission of the viruses to the fetus were investigated by polymerase chain reaction (PCR) and serology. In all, 104 blood samples were obtained 3 times during pregnancy and once at delivery. In another 107 women, samples were obtained only at delivery. Cord blood samples were obtained from both groups of women. HHV-6 DNA was detected in 41%-44% of the samples during months 3-8 of pregnancy, in 25% at delivery, and in 24% of age-matched controls. HHV-6 DNA was found in 1.0% of the cord blood samples. CMV DNA was detected in 1.7% of leukocytes from 104 pregnant women but in no cord blood sample. IgG antibodies to HHV-6 were found in 96% and CMV IgG in 62.5% of the women. HHV-6 IgG titers were significantly higher in HHV-6 PCR-positive women. Thus, HHV-6 reactivation seems common during pregnancy, and transfer of HHV-6 to the fetus may occur in approximately 1% of pregnancies.     

淮南地区孕早期妇女TORCH感染筛查结果分析

【摘要】 目的  分析淮南地区孕早期妇女弓形虫、风疹病毒、巨细胞病毒和单纯疱疹病毒的检测结果,探讨其临床意义。 方法  采用酶联免疫吸附试验（ELISA）对淮南地区4 832例孕妇TORCH-IgM抗体和TORCH-IgG抗体进行检测分析。 结果  HSV-IgM和HSV-IgG阳性率最高,差异有统计学意义（P＜0.05）;因CMV感染导致的不良妊娠发生率为48.84%（21/43）,与其他病毒感染导致的不良妊娠相比有统计学意义（P＜0.05）;不良妊娠结局表现中,流产发生率为65.12%（28/43）,与其他不良妊娠结局表现相比,差异有统计学意义。 结论  淮南地区孕早期妇女存在一定的TORCH阳性率,TORCH感染是不良妊娠结局的重要危险因素之一,因此在孕早期或孕前进行TORCH检测对指导本地区优生优育工作及提高新生儿人口素质具有重要指导意义。     

孕妇巨细胞病毒,弓形虫感染及其可能导致宫内的传播

为评价聚合酶链反应在孕妇巨细胞病毒及弓形虫感染诊断中的应用，发现可能导致ＣＭＶ／Ｔｏｘ母婴传播的因素。采用病毒分离，血清学试验，套式ＰＣＲ加限制内切酶谱分析检测ＣＭＶ。     

弓形虫感染与输卵管妊娠关系的初步研究

目的探讨弓形虫感染与输卵管妊娠的关系及肿瘤坏死因子-α（TNF-α）与基质金属蛋白酶（MMP-9）在输卵管妊娠弓形虫感染者的输卵管黏膜上皮中的表达。方法应用聚合酶链反应（PCR）检测118例输卵管妊娠患者和47例行附件切除术、无输卵管妊娠史的卵巢囊肿患者（对照组）的宫颈分泌物和输卵管组织标本中弓形虫DNA。应用免疫组化技术检测TNF-α与MMP-9在其输卵管黏膜上皮中的表达水平。结果输卵管妊娠组宫颈分泌物和输卵管黏膜上皮组织中弓形虫DNA的阳性检出率分别为17.80%（21/118）、14.41%（17/118）,对照组则分别为4.26%（2/47）和2.13%（1/47）,两组差异均有统计学意义（P均〈0.05）。输卵管妊娠组输卵管黏膜上皮TNF-α与MMP-9表达与对照组比较,差异均有统计学意义（P均〈0.05）;弓形虫感染阳性和弓形虫感染阴性的输卵管妊娠组与对照组比较,差异亦均有统计学意义（P均〈0.05）;而弓形虫感染阳性和弓形虫感染阴性的输卵管妊娠组间差异则无统计学意义（P（0.05）。结论弓形虫感染与输卵管妊娠的发生关系密切,输卵管妊娠组弓形虫感染可致输卵管黏膜上皮TNF-α与MMP-9的表达增加。     

无锡地区不良妊娠结局妇女弓形虫感染及弓形虫病知识知晓率调查

目的 调查无锡地区不良妊娠结局妇女弓形虫感染情况及弓形虫病相关知识知晓率。 方法 以2011年1月至2015年12月无锡市217例不良妊娠结局妇女作为研究对象（试验组）,以250例正常妊娠妇女作为对照。采用ELISA法检测并比较试验组和对照组血清抗弓形虫抗体阳性率。采用自行设计的问卷对试验组和对照组妇女进行问卷调查,比较两组弓形虫病相关知识知晓率。 结果 试验组妇女血清抗弓形虫抗体阳性率为30.88%,显著高于正常妊娠妇女的8.80%（[χ2]= 36.70,P < 0.01）;抗弓形虫IgG和IgM抗体阳性率分别为20.74%和10.14%,显著高于对照组的6.00%和2.80%（[χ2]= 22.53和10.74,P 均 < 0.01）。此外,以胎停、自然流产、早产和出生缺陷为妊娠结局的妇女血清抗弓形虫抗体阳性率及血清抗弓形虫IgG和IgM抗体阳性率均显著高于正常妊娠妇女（P均< 0.05）。试验组妇女对“你听说过弓形虫或弓形虫病吗？” （P < 0.01）、“你知道养宠物猫和犬会感染弓形虫吗？”（P < 0.05）和“你知道孕期需要进行弓形虫感染检查吗？”（P < 0.01）等3道问题的知晓率显著低于对照组,而两组妇女对“你知道吃火锅会感染弓形虫吗？”、“你知道家中砧板生熟不分可能会导致弓形虫感染吗？”、“你知道孕妇感染弓形虫会传给胎儿吗？”、“你知道孕期弓形虫感染会导致流产、死胎、胎儿畸形等不良妊娠结局吗？”和“你知道孕妇感染弓形虫需要治疗吗？”等问题的知晓率差异无统计学意义（P 均> 0.05）。结论 无锡市地区不良妊娠妇女弓形虫感染率显著高于正常妊娠妇女。考虑到孕妇感染弓形虫的危害以及孕妇对弓形虫病相关知识知晓率较低的现状,应进一步加大弓形虫病相关知识宣传和健康教育力度,特别是对备孕妇女开展有针对性的弓形虫病健康教育,以降低孕妇弓形虫感染率、提高优生优育水平。     

PCR-ELISA检测弓形虫实验研究

目的建立快速、敏感、特异、稳定的PCR—ELISA方法，并用其检测感染动物体内的弓形虫。方法将生物素标记的PCR产物与地高辛标记的特异性探针杂交，再通过酶免显色反应测出OD值。以判断弓形虫感染情况。测定该方法的敏感性、特异性及稳定性。再分别以10^4、10^3弓形虫RH株速殖子腹腔接种小鼠。取全血、肝组织用PCR—ELISA检测小鼠感染情况。结果本实验中，PCR-ELISA方法的检测闻值为20fg弓形虫DNA，其灵敏度是电泳法的10倍，并且与人、小鼠、疟原虫、旋毛虫等DNA均无交叉反应。同一样本重复测试5次，结果经统计学检验，一致性良好（Alpha=0．72）。检测感染动物肝组织及全血标本，10^4、10^3组分别在感染后第二d、第三d即可测出阳性，两种标本的阳性检出效率无统计学差异（P〉0．05）。结论PCR—ELISA是一种快速、敏感、特异、稳定的检测方法，可试用于临床弓形虫病的诊断及流行病学调查。     

ELISA IFAT和PCR/生物素探针检测中枢神经系统疾病中弓形虫感染

目的　比较 ELISA、IFAT和 PCR/生物素探针检测弓形虫感染的效果 ,了解中枢神经系统疾病中弓形虫感染的情况。方法　应用 EL ISA、IFAT和 PCR/生物素探针 (PCR-BP)对 164例脑囊虫病、10 8例疑似脑囊虫病、88例原发性癫痫患者和 115例健康人群进行了血清弓形虫抗体及血液中弓形虫特异序列 DNA检测和比较。结果　 ELISA和 IFAT检测各组人群抗弓形虫抗体阳性率分别为 15 .85 %、14 .81%、13 .64 %和 6.0 9% ,14 .0 2 %、14 .81%、14 .77%和 6.0 9%。PCR-BP检测各组弓形虫特异性 DNA阳性率分别为 2 .44 % (4 /164 )、3 .70 % (4 /10 8)、3 .41% (3 /88)、0 (0 /115 )。结论　 PCR/生物素探针适合诊断现症弓形虫感染 ,而 EL ISA和 IFAT可作为弓形虫感染的筛选方法。脑囊虫病、疑似脑囊虫病和原发性癫痫患者中存在弓形虫感染     

淮南地区孕妇弓形虫感染血清学分析

目的探索淮南地区孕妇弓形虫感染情况。方法运用酶联免疫吸附法(ELISA)检测228例孕妇(妊娠八周至七个月)静脉血中弓形虫(Toxoplasma godii,TO)抗体,即 Tox-IgG 抗体和 Tox-IgM 抗体。结果发现有猫犬接触史(指现在或曾经养过猫犬的)孕妇弓形虫感染率明显高于无猫犬接触史孕妇(P<0.01),两者有显著性差异;但城市与乡镇、适龄(≤35岁)与高龄(>35岁)孕妇弓形虫感染率无显著性差异(P>0.05);而首次妊娠孕妇与非首次妊娠孕妇弓形虫感染率有显著性差异(P<0.05)。结论有无描犬接触史是孕妇感染弓形虫的主要因素,二者相关性显著。