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。

Correlation with neonatal congenital cytomegalovirus infection,maternal primary infection and secondary infection

Objective:To explore the correlation with neonatal congenital cytomegalovirus infection,maternal primary infection and secondary infection.Methods: 48 neonates with congenital CMV infection were assigned to infection group with their mothers.And the other 30 couples without congenital CMV infection were assigned to negative group with their mothers.The level of CMV-IgM/ IgG and affinity of CMV-IgG in peripheral blood were tested by CLIA,and CMV-DNA in mother’s milk,peripheral blood and urine of the newborn was tested by fluorescent quantitation PCR.We also analyzed the differences of the test results between the two groups and performed a retrospective analysis to compare the levels of CMV-IgG of the mother with early pregnancy with the result of this test.Results: In the infection group,the level of CMV-IgG in peripheral blood and CMV-DNA in milk was significantly higher than those in the negative group,the difference was statistically significant(P<0.01).Ratio of CMV-IgG antibody in newborn babies and their mothers in the infection group was lower than the other group,the difference was statistically significant(P<0.01).There was negative correlation of IgG level between the newborn babies and their mothers in the infection group,the difference was statistically significant (P<0.01);While in the positive correlation in the negative group,the difference was statistically significant(P<0.01).The CMV-IgG concentrations of the mothers with early pregnancy was significantly lower than that of this infection group,the difference was statistically significant(P<0.01);but in the negative group,there was no significant difference between the CMV-IgG level of the mothers with early pregnancy and the results of this test(P>0.05).Conclusion: It is a high-risk factor for neonatal congenital cytomeg-alovirus infection that CMV-IgG level of the pregnant women is promted by the reactivation or reinfection of cytomegalovirus.It is important to monitor CMV-IgM/ IgG during pregnancy.