7866例妊娠妇女TORCH感染状况分析

目的分析本地区来我院就诊的7866例妊娠妇女风疹病毒(RV)、弓形虫(TOX)、巨细胞病毒(CMV)、单纯疱疹病毒(HSV)的感染状况,为预防TORCH感染、指导优生优育提供实验数据。方法采用酶联免疫技术(ELISA)法检测孕期妇女血清中TORCH特异性Ig M抗体。结果 7866例孕妇风疹病毒、弓形虫病毒、巨细胞病毒、单纯疱疹病毒Ⅰ、单纯疱疹病毒Ⅱ的Ig M抗体阳性率分别为0.72%、0.03%、1.66%、0.55%和0.57%,以巨细胞病毒Ig M阳性率最高(1.66%)。结论本地区孕妇存在一定的TORCH感染率,孕妇应在孕前及孕早期进行TORCH特异性Ig M抗体检测,对防止病原体所致缺陷儿的出生,提高人口出生质量,落实优生优育具有重要意义。     

1064例孕早期巨细胞病毒感染的筛查分析

目的 探讨孕早期筛查巨细胞病毒感染的临床意义。方法 对1064例孕早期孕妇血清进行CMV-IgM抗体筛查检测。结果 1064例中，83例孕妇CMV-IgM抗体显示阳性，阳性率7．8％。此83例中经跟踪随访证实，有3例先兆流产并最终发展为难免流产，2例死胎，新生儿中1例唇裂，1例先天性心脏病，临床异常率8．4％。结论 孕早期母体巨细胞病毒感染可造成流产、死胎、胎儿先天性缺陷等。因此，对孕期母血清筛查CMV-IgM是减少出生缺陷发生的重要途径之一，是非常必要的。     

2962例孕早期女性TORCH-IgM筛查结果分析

目的探讨该地区孕早期女性TORCH(弓形虫、风疹病毒、巨细胞病毒、单纯疱疹病毒Ⅱ型等总称)感染状况及临床意义,为优生优育提供参考依据。方法采用酶联免疫吸附(ELISA)法检测2 962例孕早期女性血清TORCH-IgM抗体。结果 2 962例孕早期女性血清标本检测出51例TORCH-IgM抗体阳性,总感染率为1.72%,TOX-IgM、RV-IgM、CMV-IgM、HSV-Ⅱ-IgM的阳性率分别为0.27%、0.24%、0.34%、0.88%。结论该地区孕早期女性TORCH筛查感染率处于较低水平,HSV-Ⅱ型的感染率最高,为0.88%(26/2 962),对筛查阳性的患者进行全面系统地评价,采取早期干预措施,在改善妊娠和新生儿结局、提高该地区出生人口素质有重要的临床意义。     

妇女异常妊娠与弓形虫感染之间关系的探讨

目的探讨十堰地区妇女异常妊娠与弓形虫感染的相关性。方法采用酶联免疫吸附试验（ELISA）检测105例异常妊娠孕妇（实验组）及500名正常育龄孕妇（对照组）血清中弓形虫特异性抗体IgM、IgG,进行2组间感染率差异的分析。结果异常妊娠孕妇弓形虫IgM、IgG抗体阳性率分别为13．33％和23．81％,而同时间段正常孕妇相应的IgM、IgG抗体阳性率为3．60％和9．80％,2组间差异有统计学意义（P〈0．001）。结论孕妇弓形虫感染是异常妊娠的重要原因之一,应重视弓形虫感染的早期筛查和诊治。     

孕产妇四种病原体感染血清学筛查的研究

目的 探讨正常孕妇弓形虫、风疹病毒、巨细胞病毒、单纯疱疹病毒(Torch)感染血清学筛查的意义，妊娠伴胚胎停止发育及产史不良与Torch感染的关系。方法 间接荧光法检测血清Torch—IgG抗体和酶免疫捕获法检测Torch—IgM抗体。303例孕妇、27例妊娠伴胚胎停育及192例产史不良妇女进行了弓形虫血清学筛查，进行风疹病毒血清学筛查的分别278，30和214例，巨细胞病毒(CMV)筛查的分别为280，31和228例，单纯疱疹病毒(HSV)筛查的分别为236，25和168例。结果 孕妇、妊娠伴胚胎停育和产史不良妇女血清弓形虫IgG／IgM抗体阳性率分别为2．3％／0．33％，0／0，1．04％／0；风疹病毒IgG／IgM抗体阳性率分别为93．2％／1．4％，96．7％／0，98．6％／0；CMV—IgG／IgM阳性率分别为88．6％／1．1％，87．1％／0，91．2％／0；HSV—IgG／IgM阳性率分别为93．2％/1.3％，88．0％／0，94．6％/0。外院Torch—IgM抗体阳性的31份孕妇血清标本仅确认1份为真正阳性。结论 孕妇弓形虫感染率低，常规筛查的价值需要探讨。妊娠前确定风疹的免疫状态对孕妇风疹筛查意义重大。孕妇CMV血清学筛查方案需要进一步研究。初筛Torch—IgM抗体阳性的血清标本应当复查和确认，以避免假阳性。未发现妊娠伴胚胎停止发育以及产史不良与Torch感染存在关联。     

南充地区孕妇及新生儿ToRCH感染状况前瞻性调查

目的了解南充地区孕妇及新生儿TORCH感染的状况,为优生优育提供相关信息。方法采用免疫化学发光检测系统测定孕妇及新生儿血清中弓形虫（Tox）、风疹病毒（RUV）、巨细胞病毒（CMV）和单纯疱疹病毒（HSV）（1＋2）特异度kG与IgM抗体。结果所调查的孕妇与新生儿中,ToRCHIgM抗体阳性率分别为16．03％,3．77％;二种以上病原体IgG抗体阳性率分别为80．43％,91．40％。孕妇组ToRCHIgM抗体阳性率分别为1．32％,1．76％,0．55％和13．17％,其中HSV（1＋2）近期感染率最高,秋季感染率相对较低。IgG抗体阳性率分别为5．75％,62．26％,96．74％,89．22％。新生儿组ToRCHIgM抗体阳性率分别为0,0．84％,1．05％和1．89％。IgG抗体阳性率分别为1．47％,51．22％,94．27％和87．32％。结论南充地区育龄妇女和新生儿人群TORCH感染的机率明显存在。和国内其它地区比较,其易感病原体种类存在一些差异。     

孕早期弓形虫抗体检测的临床意义初探

[目的]综合系列血清弓形虫抗体检测结果分析孕早期孕妇弓形虫感染状况。[方法]采用酶联免疫吸附法检测2083例妊娠早期（第6～12周）妇女血清中弓形虫抗体IgG和IgM,于2～3周后再采集IgG或IgM阳性受检者血清定量检测IgG并比较IgG滴度变化;如果IgG滴度变化小于30％或阴性于2周后再采集标本定量检测IgG。[结果]1928例IgG-和IgM-,未感染弓形虫,属易感人群;其余受检者按计划再采集血清定量检测IgG。在27例IgG-和IgM＋的受检者中,检出11例IgG抗体阳性,为近期原发感染;其余16例未检出IgG抗体,IgM为假阳性,未感染弓形虫,属易感人群。83例IgG＋和IgM-受检者中,检出1例IgG抗体滴度升高〉30％,但未产生IgM,属近期活动性感染;其余82例IgG抗体滴度没有明显变化,属既往感染。45例IgG＋和IgM＋受检者中,其中14例IgG抗体滴度升高〉30％,属近期活动性感染;其余31例IgG抗体滴度没有明显变化,属既往感染,但IgM持续存在。弓形虫感染率为6．67％,其中既往感染113例,近期活动性感染26例。[结论]综合系列血清弓形虫抗体IgG与IgM检测,可以辅助诊断孕早期妇女弓形虫的感染状况。     

天津地区不孕妇女和孕妇TORCH感染的检测分析

目的了解天津地区不孕妇女和孕妇妊娠期TORCH感染的情况。方法采用化学发光免疫分析法对2998倒育龄期不孕妇女及5075例孕妇TORCHIgM抗体进行检测分析。结果不孕妇女风疹病毒、巨细胞病毒、弓形虫、单纯疱疹病毒IgM抗体阳性率分别为0．57％、1．47％、0．13％和3．67％,总阳性率为5．84％;孕妇IgM抗体阳性率分别为1．04％、1．97％、0．18％和3．96％,总阳性率为7．15％;不孕妇女或孕妇所检测的4种病毒抗体阳性率进行组内比较差异有统计学意义（P〈0．001）,单纯疱疹病毒IgM抗体阳性率最高,弓形虫IgM抗体阳性率最低,且孕妇TORCH总感染率高于不孕妇女（P％0．05）。结论天津地区育龄期妇女存在一定的TORCH感染率,对天津地区不孕妇女及孕妇进行TORCH监测对于预防和降低胎儿TORCH感染具有重要意义和价值。     

温州地区育龄期妇女及孕妇弓形虫感染情况调查

目的了解温州地区育龄期妇女及孕妇弓形虫感染情况,为预防弓形虫先天性感染提供参考资料。方法收集577份婚前体检的育龄期妇女及229份孕妇体检静脉血标本,分离血清,采用间接酶联免疫吸附试验(ELISA)检测弓形虫特异性抗体IgG和IgM,以OD490≥cut off值定为阳性。结果 577份育龄期妇女血清中弓形虫特异性抗体IgG阳性标本452例,阳性率为78.34%;弓形虫特异性抗体IgM阳性标本3例,阳性率为0.52%。229份孕妇血清中弓形虫特异性抗体IgG阳性标本171例,阳性率为74.67%;弓形虫特异性抗体IgM阳性标本16例,阳性率为6.99%。结论温州地区妇女人群(育龄期妇女和孕妇)弓形虫隐性感染较为普遍,而孕妇IgM抗体阳性的新近感染率明显高于育龄期妇女。     

不良妊娠结局与弓形虫感染相关性研究

目的探讨十堰地区妇女异常妊娠与弓形虫感染的相关性。方法采用酶联免疫吸附试验检测2007年7月～2010年6月105例异常妊娠孕妇(实验组)及500例正常育龄孕妇(对照组)血清中弓形虫特异性抗体IgM、IgG,并分析两组间感染率的差异。结果异常妊娠孕妇弓形虫IgM、IgG抗体阳性率分别为13.33%和23.81%,而同时间段正常孕妇相应的IgM、IgG抗体阳性率为3.60%和9.80%。异常妊娠孕妇弓形虫IgM、IgG抗体阳性率均明显增高(P<0.001)。结论孕妇弓形虫感染是异常妊娠的重要原因之一,应重视弓形虫感染的早期筛查和诊治。     

Evaluation of intrapartum antibiotic prophylaxis for the prevention of early-onset group B streptococcal infection

We retrospectively assessed the medical records of pregnant women who delivered at Asahikawa Kosei Hospital during a period of 3 years between January 2009 and December 2011 and their neonates. Our prophylactic measures against group B Streptococcus (GBS) infection are based on the Japanese guidelines. More specifically, we performed screening by examining bacterial cultures of vaginal–perianal swabs from pregnant women between gestational weeks 33 and 37. Then, sulbactam/ampicillin (SBT/ABPC) was given at a dose of 1.5 g through a drip intravenous infusion at delivery if pregnant women were screened positive for GBS. For neonates born to GBS carrier women, bacterial cultures of pharyngeal swabs, vernix caseosa, stool, and gastric juice were performed at birth. There were 2,399 deliveries and 2,499 births at our hospital. In 169 of the deliveries (175 of the births), GBS was isolated from specimens obtained from gestational weeks 33–37. According to delivery mode, there were 42 cases of cesarean section (45 births) and 127 cases of vaginal delivery (130 births). The GBS-positive neonates accounted for 4.1 % of all deliveries in pregnant women who tested positive for GBS at gestational weeks 33–37. In neonates born by vaginal delivery, the GBS-positive rate was 5.5 %. Of the 2,499 neonates born at our hospital during a period of 3 years, early-onset GBS infection occurred in 1 neonate. The incidence of early-onset GBS infection was 0.40 per 1,000 live births. From 1997 to 2001 (routine GBS screening of mothers was not performed), there were 2,097 deliveries and 2,166 births. Early-onset GBS infection occurred in 1 neonate during this period; thus, the incidence of early-onset GBS infection was 0.46 per 1,000 live births. There were no significant differences in the two periods. The present prophylactic measures such as screening of maternal GBS carriers and intrapartum antibiotic administration are inadequate to decrease the occurrence of early-onset GBS infection.     

不同孕周妊娠妇女血清总胆汁酸检测结果分析

目的了解正常不同孕周孕妇血清总胆汁酸的含量,以及在妊娠过程中总胆汁酸的变化特征及临床意义。方法采用BeckmanCX4全自动生化仪检测580例正常孕妇,400例非妊娠健康妇女血清总胆汁酸(TBA)。结果正常妊娠过程血清TBA有升高趋势,TBA浓度在中孕时开始明显升高。早孕、中孕和晚孕组的孕妇血清中TBA水平分别较非妊娠组升高14.4%、49.7%和65%,而且晚孕组比中孕组的孕妇血清中TBA水平也有明显升高。结论妊娠过程TBA水平持续升高,且明显高于同孕龄正常孕妇,应定期作TBA检测和动态观察,有利于妊娠肝内胆汁淤积症(ICP)及早预防和诊治。     

Relationship between seropositivity of husbands and primary cytomegalovirus infection during pregnancy

The role of the sexual transmission of human cytomegalovirus (CMV) as a cause of congenital infection was investigated. Serum samples were collected from 756 pregnant women at 10 to 12 weeks of gestation and at 32 to 36 weeks of gestation. Serum samples were also obtained from the husbands of women who seroconverted and women who were seronegative during pregnancy. Commercially available enzyme immunoassay kits were used to detect serum IgG, IgM, and IgA antibodies against CMV. CMV from neonatal urinary specimens was isolated according to a standard tissue culture technique, using MRC-5 cells. At 10 to 12 weeks of gestation, 634 of the 756 pregnant women (83.9%) had IgG antibody to CMV. At 32 to 36 weeks of gestation, 642 of the 756 women (84.9%) had IgG antibody to CMV. A meaningful rise of serum IgG-antibody titer (seroconversion) occurred in 8 women (1.1%). CMV was isolated from the urine of an infant born to a seroconverted woman within a week after birth. The prevalence of IgG antibody to CMV was significantly higher in the husbands of women who seroconverted during pregnancy than in the husbands of the women who were seronegative during pregnancy (P < 0.01). Understanding the epidemiology of CMV is a key element in the development of strategies for the prevention of infection. The transmission of CMV by sexual contact may be important in the pathogenesis of congenital infection. Entirely new approaches to the prevention and treatment of congenital CMV infection are necessary, including antiviral interventions and the development of a vaccine strategy. Received: December 14, 1999 / Accepted: April 10, 2000     

2011－2020年广东省HIV感染孕产妇不良妊娠结局情况及其影响因素分析

  目的   描述广东省人类免疫缺陷病毒（HIV）感染孕产妇不良妊娠结局的情况,分析导致不良妊娠结局的影响因素,促进艾滋病感染孕产妇及暴露儿童的健康。  方法   对广东省2011—2020年所有区/县确认的3 438例HIV感染孕产妇的相关信息进行χ2检验和非条件logistic回归分析。  结果   共3 438例HIV感染孕妇纳入研究, 955例孕妇发生不良妊娠结局,不良妊娠结局发生率为27.78%。 不同的文化程度、初检时期、传播途径、产次和确认感染时期和妊娠高血压会影响HIV感染孕产妇不良妊娠结局的发生,差异有统计学意义（P<0.05）。 多因素logistic回归分析显示,注射毒品感染、产时或产后确认感染和患有妊娠高血压的HIV感染孕产妇发生不良妊娠结局的OR值分别是1.65（1.04～2.58）、0.61（0.48～0.78）和2.27（1.35～3.80）。  结论   传播途径、确认感染时期及妊娠高血压和HIV感染孕产妇发生不良妊娠结局有关。 需要高度重视HIV感染孕妇的生殖健康,提供优质的咨询服务和孕期保健服务,保障HIV感染孕产妇的健康,改善妊娠结局。     

轻型地贫孕妇不同孕期SF、Hb、Ret-He及Ret％水平变化的临床观察

目的探讨血清铁蛋白(SF)、血红蛋白(Hb)、网织红细胞血红蛋白含量(Ret-He)以及网织红细胞百分率(Ret%)水平在轻型珠蛋白生成障碍性贫血(简称地贫)孕妇不同孕期补铁治疗前的变化特点及临床意义。方法选取不同孕期的轻型地贫孕妇245例(α-地贫149例,β-地贫96例)、铁缺乏(ID)孕妇155例、缺铁性贫血(IDA)孕妇117例及同期健康孕妇316例作为研究对象,并将ID组、IDA组、HC组统一归为非地贫组,分析5组孕妇的SF、Hb、Ret-He及Ret%水平随孕周的变化趋势,并比较α-地贫、β-地贫和非地贫孕妇不同孕期的ID和IDA发生率。结果与健康孕妇相同,随孕周增加,α-地贫和β-地贫孕妇SF水平呈下降趋势(P<0.05),β-地贫孕妇Hb水平为先下降后升高(P <0.05),Ret%水平除β-地贫组外,其余各组则逐渐增高(P <0.05)。α-地贫孕妇IDA主要发生于中孕期(61.5%)和晚孕期(60.3%),β-地贫孕妇IDA主要发生于晚孕期(61.9%),均高于同期非地贫组(P均<0.01);但ID更易发生在非地贫孕妇中孕期(29.0%)和晚孕期(39.9%)。结论α-地贫相对于β-地贫更早出现缺铁,但β-地贫比α-地贫贫血程度更重。SF、Hb、Ret-He以及Ret%水平检测用于轻型地贫患者妊娠期铁缺乏筛查及病情评估可提高准确性,其中Ret-He可作为地贫孕妇铁储备水平监测指标。     

Performance characteristics of the new ARCHITECT Toxo IgG and Toxo IgG Avidity assays

The ARCHITECT Toxo IgG and IgG Avidity assays have been developed as a fully automated panel for immune status determination and acute infection exclusion. Resolved relative specificity and sensitivity of the ARCHITECT Toxo IgG assay were 99.6% (1359/1365) and 99.7% (1096/1099) as determined on pregnant females, blood donor, and diagnostic specimens. Seroconversion sensitivity of the ARCHITECT assay was comparable with the AxSYM Toxo IgG assay. The ARCHITECT Toxo IgG Avidity assay detected 100.0% (124/124) of acute phase specimens (<4 months after infection) as low avidity, whereas the Vidas Toxo IgG Avidity assay detected 98.9% (89/90) as low avidity. In summary, the ARCHITECT Toxo IgG assay, using recombinant antigens, showed excellent specificity and sensitivity for acute phase as well as past infection specimens. The ARCHITECT Toxoplasmosis panel can be reliably used to rule out acute Toxoplasma gondii infection in pregnant women.     

Clinical factor associated with congenital cytomegalovirus infection in pregnant women with non-primary infection

The aim of this nested case-control study was to evaluate clinical factors associated with the occurrence of congenital cytomegalovirus (CMV) infection in pregnant women with non-primary CMV infection. In a cohort study of CMV screening for 2193 pregnant women and their newborns, seven newborns with congenital CMV infection were identified among 1287 pregnant women with non-primary CMV infection that was defined as negative IgM and positive IgG with IgG avidity index >45%. In the 1287 women with non-primary CMV infection, clinical findings and complications were compared between pregnancies with and without congenital CMV infection. Clinical factors associated with the occurrence of congenital CMV infection were evaluated. The birth weight of newborns with congenital CMV infection was less than that of newborns without congenital infection (p < 0.05). Univariate logistic regression analyses demonstrated that threatened premature delivery (OR 10.6, 95%CI 2.0–55.0; p < 0.01) and multiple pregnancy (OR 7.1, 95%CI 1.4–37.4; p < 0.05) were associated with congenital infection. Multivariable logistic regression analyses demonstrated that threatened premature delivery (OR 8.4, 95%CI 1.5–48.1; p < 0.05) was a single risk factor for congenital CMV infection in pregnant women with non-primary CMV infection. This study revealed for the first time that threatened premature delivery was associated with the occurrence of congenital CMV infection in pregnant women with non-primary CMV infection, the pathophysiology of which may be closely associated with CMV reactivation during pregnancy.     

正常妊娠妇女不同孕期血常规参数变化的研究

目的对不同孕期的妊娠妇女血常规检测结果进行分析,为临床诊断建立参考区间提供实验室数据。方法将3 222例正常妊娠妇女按照孕周不同分为孕早期、孕中期和孕晚期,分别对3个孕期的孕妇进行红细胞(RBC)、血红蛋白(Hb)、血细胞比容(HCT)、白细胞(WBC)、中性粒细胞百分比(N%)、淋巴细胞百分比(L%)的测定和统计分析,并与作为对照组的355例非孕健康育龄妇女的相应检测项目进行比较。结果正常妊娠者在不同孕期RBC、Hb、HCT水平均比对照组妇女低,在孕中期下降达孕期最低水平(P0.05),不同孕期之间比较差异有统计学意义(P0.05)。正常妊娠者WBC、N%均比对照组高,而L%则比对照组低(P0.05)。不同孕期之间WBC参数比较差异也有统计学意义(P0.05)。正常妊娠者血小板(PLT)计数较对照组降低,正常妊娠者在孕晚期达到最低值(P0.05)。结论建立正常妊娠妇女的血常规参数参考区间,有利于对妊娠贫血、感染、妊娠高血压综合征等疾病的诊断。     

不同妊娠期妇女血微量元素水平变化分析

目的探讨不同妊娠期妇女血液微量元素变化情况。方法用原子吸收光谱分析法分别测定294例孕妇和47例健康妇女（对照组）Se、Mn、Fe、Cu、Zn水平。结果Se,与对照组（79．524&#177;10．55μg／L）比较,早孕组（72．16&#177;9．48μg／L）、中孕组（72．40&#177;11.58μg／L）,P〉0．05,晚孕组（56．76&#177;13．85μg／L）,P〈0．01;Mn,与对照组（15．00&#177;3．25μg／L）比较,早孕组（14．10&#177;3．73μg／L）、中孕组（15．57&#177;3．49μg／L）,P〉0．05,晚孕组（24．24&#177;5．43μg／L）,P〈0．01;Fe,与对照组（18．64&#177;3．76μmol／L）比较,早孕组（22．20&#177;4．68μmol／L）、晚孕组（12．68&#177;4．31μmol／L）,P〈0．01,中孕组（17．76&#177;6．13μmol／L）,P〉0．05;Cu,与对照组（16．28&#177;2．69μmol／L）比较,早孕组（23．28&#177;5．62μmol／L）、中孕组（25．48&#177;3．45μmol／L）、晚孕组（28．82&#177;4．36μmol／L）,P〈0．01;Zn,与对照组（12．83&#177;1．16μmol／L）比较,早孕组（10．85&#177;2．17μmol／L）、中孕组（9．71&#177;1.70μmol／L）、晚孕组（7．81&#177;1．36μmol／L）;P〈0．01。结论健康孕妇微量元素水平反映了微量元素之间协同、拮抗作用。随着妊娠期的推移,Fe的下降导致Mn的水平上升,Se的水平下降;而Cu的水平不断上升导致Zn水平不断下降,妊娠晚期各元素水平上升或下降尤为显著。     

孕期人乳头状瘤病毒感染的结局分析

目的:探讨人乳头状瘤病毒(human papillomavirus,HPV)的感染分型及母婴垂直传播情况。方法:对2011年1月—2012年12月在复旦大学附属中山医院青浦分院产科门诊就诊的500例孕妇的宫颈脱落细胞进行HPV-DNA分型检测,并对HPV阳性孕妇分娩的新生儿的口咽部和生殖器黏膜细胞进行HPV-DNA分型检测,分析HPV亚型感染状况。结果:500例孕妇中HPV阳性者102例,感染率20.40%;感染HPV最常见的亚型为HPV16(4.2%)、HPV52(2.20%)、HPV33(1.80%)、HPV58(1.80%)、HPV18(1.60%)、HPV39(1.20%)。HPV阳性孕妇中,单型别感染88例(86.27%);多重型别感染14例(13.73%),其中二重感染11例,三重感染3例。母婴HPV垂直传播7例(6.86%)。25~30岁年龄段孕妇HPV感染率较高,不同孕期孕妇HPV感染率差异无统计学意义(P0.05)。结论:孕期HPV感染以HPV16型为主,并可母婴垂直传播;妊娠期妇女早期筛查对降低宫颈癌发病率和新生儿感染率非常必要。