人巨细胞病毒感染跟踪调查研究

目的:探讨孕期HCMV活动性感染引起宫内传播及对胎、婴儿影响的相关因素。方法:ELISA法孕前筛查2602例育龄妇女HCMV-IgM、HCMV-IgG抗体,并根据抗体检测结果分为4组,应用ELISA和PCR两种技术,跟踪检测4组616例中444名孕妇早、中晚孕期外周血、羊水及新生儿脐带血感染情况,对新生儿行跟踪调查。对107例中发生在不同孕期的活动性感染的不良妊娠结局进行分析。结果:孕前育龄妇女活动性感染率为10.2％;4组孕期活动性感染率高达24.1％(107/444),以原发、复发组发生率最高(46.9％、41.7％)占孕期活动性感染的75％;孕期活动性感染自然流产率(17.8％)显著高于非活动性感染(10.4％);孕期活动性感染发生宫内感染的危险度为34.6％;孕期活动性感染新生儿先天性感染检出率为8.9％;发生在孕早期的活动性感染的不良妊娠结局最为严重。结论:孕前感染类型与孕后发生活动性感染危险度密切相关,且不同类型对妊娠结局影响不同;孕期活动性感染自然流产率高,能够引起宫内垂直传播;胎盘及母体的特异性IgG抗体对胎儿的保护作用不可忽视;重点预防早孕期HCMV感染。

Investigations and Studies on Hcmy Infection.

Objective:To study the unsteady HCMV infection during pregnancy,its intrauterine dissemination, and the interrelated factors to the foetus and infants. Method:Screening the HCMV -IgM and IgG antibodies of 2602 women of child - bearing age before pregnancy and dividing them into groups. Using ELISA and PCR to examine the infection situation of peripheral blood,ammiotic fluid (in the early,middle,late state of 444 pregnant women),and new-born babies'umbilical blood about the four infection type groups. Analysis the results of 107 cases with the infection in the different period of pregnancy. Results : the unsteady infection rate of women of child - bearing age before pregnancy was 10. 2% ;the unsteady infection rate during pregnancy among women who had been infected before pregnancy was to 24.1% (107/444), the highest rate was in the primary infection group and the relapsing group(46. 9% ,41. 7%) .constituting 75% of the unsteady infection rate duing pregnancy; the natural abortion rate(17. 8%) was apparently higher than that of the steady infection group (10. 4%); the intrauterine infection rate from the unsteady infection during pregnancy was 34.6%) the infection rate of new -born baby was 8. 9% ;the infection ocurred in the early pregnancy resulted in the most serious. Conclusion:Infection before pregnancy is closely related with that during pregnancy; different infection types have different results;the rate of natural abortion is high and the infection can disseminate into the uterus;the specific IgG antibody from the placenta and the mother plays a very important role in the protection the foetus;pay much attention to prevent HCMV infection in the early pregnancy.