先天性无症状性巨细胞病毒感染对婴儿期发育的影响

目的 通过对先天性无症状性巨细胞病毒(HCMV)感染的新生儿进行系统随访,观察其听力学、体格发育、智能发育、行为发育等多方面的改变,探讨先天性无症状性HCMV感染对婴儿期发育的影响.方法 按照1998年宜昌会议通过的<巨细胞病毒感染诊断方案>标准及美国Fowler标准确定先天性无症状性巨细胞病毒感染.2003年7月至2005年7月符合人选条件感染病例41例,对照组21例.进行静脉血荧光定量PCR(FQ-PcR)检测确定HCMV感染.感染组与对照组于新生儿期、3月龄、6月龄、1岁分别进行新生儿20项行为神经检查(NBNA)、听力学检查包括耳声发射听力检查(OAE)、听力脑干诱发电位检查(ABR)、Bayley婴幼儿发育量表评估发育智商、52项运动神经检查(Amid-Tison法)和体格发育检查、一般状况检查.结果 (1)两组新生儿12～14 d时加项NBNA得分分别为38.8±2.75和38.5±2.29,差异无统计学意义(t=0.98,P＞0.05).(2)ABR检查:感染组中23例做ABR检查者V波阈值升高异常率为15.2%;对照组21例未发现V波阈值升高,差异有统计学意义,所有病例均通过OAE检查.(3)感染组中38例1岁时行Bayley婴幼儿发育量表检查智力发育指数(MDI)及精神运动发育指数(PDI)分别为106.86±10.24和108.45±18.25,与对照组2l例(107.49±19.31和107.19±10.98)差异亦无统计学意义(t=0.33,P＞0.05,t=0.35,P＞0.05).(4)52项运动神经发育:两组比较,差异无统计学意义(t=0.02,P＞0.05).结论 (1)先天性无症状HCMV感染在婴儿期即可出现脑干听性反应V波阈值升高,而OAE听力筛查未能检出异常.(2)先天性无症状性HCMV感染对新生儿期行为神经、婴儿期智力、婴儿期神经运动发育无明显影响.

Influence of congenital asymptonmtic cytomegalovirus infection on development of infants

Objective Human cytomegalovims(HCMV)is a ubiquitous human-specific DNA virus and is the main cause of congenital virus infection worldwide.Although 90% of the congenitally infected infants are clinically asymptomatic at birth.evidences show that these infants ale at risk for audiologic.neumlogic.and developmental sequelae.The aim of this study Wag to evaluate the outcome of children with asymptomatic eongenital human cytomegModms infection identified from a cohort of newborn infants screened for congenital HCMV infection compared with matched uninfected control subjects.Methoils Between July 2003 and July 2005,eligible hospitalized infanm were recruited into the cohort.Serum was collected within two weeks of birth and transported to the labemtory within 24 hours,and stored at-20℃.Then Real-time fluorescent quantitative polymeraae ehain reaction(FQ-PCR)for the presence of HCMV DNA Wag used as a screening tool for the detection of congenital cytomegalovims infection.Asymptomatic congenital HCMV infection(ACCMV)was defined as detection of HCMV during the first 2 weeks of life in the absence of any abnormal signs,symptoms,or laboratory findings.The study enrolled 41 siblings with asymptomatic congenital HCMV infection and 21 children whose neenatal screening for congenital HCMV infection showed negative results.Then they were followed up prospectively for the first years of life.A pediatric assessment,including neonatal behavioral neurological assessment(NBNA)WaS performed at neonatal period by a qualified pediatrician,at which time the CMV status of the infants was not yet known.At one year of age other standarclised clinical evaluations were performed by the pediatrician. The Bayley scale of infant development were used to determine the intellectual and neurological development deficits,and the ageadequate neurological examinations based on the criteria by Amiel-Tisen to evaluate the general movements for neurological development. Hearing screening were completed for all children to determine their hearing status. Auditory brain-stem response (ABR) and distortion product otoaconstie emission (DPOAE) have been used to accurately diagnose moderate to profound congenital sensorineural hearing los. Result There was no significant difference between the mean NBNA score of HCMV group ( 38. 8±2. 75 ) and the control group (38. 5±2. 29 ) ( t = 0. 98,P ＞ 0. 05 ). Significant difference was found between the occurrence of hearing loss in infants bern with asymptomatic congenital HCMV infection compared with the control group.Audiologie abnormalities (senserineural hearing loss,SNHL) were present in 5 of 23 congenitally infected children,however,no hearing abnormalities were detected in uninfected children ( X2 =6. 94,P ＜0. 01 ).The mean Bayley score of HCMV group ( MDI 106. 86±10. 24 and PDI 108. 45±18.25 ) and the control group( MDI 107.49±19.31 and PDI 107. 19±10.98) did not differ significantly (t=0. 33,P＞0. O5,t=0. 35,P ＞ 0. 05 ). Otherwise,there was no significant difference in 52 Amiel-Tison neurological scale between the two groups. Conclusion These data suggest that asymptomatie congenital cytomegalovirns infection may be associated with a broad range of audiologic differences in early infancy. Continued monitoring of their heating status in the first years of life is necessary in these children because further progression of hearing loss is possible. However,asymptomatie congenital HCMV infection is not associated with abnormalities in growth,or neurodevelopmental deficits.