妊娠早期巨细胞病毒感染和产前诊断案例分析

目的 分析妊娠早期动态定量检测巨细胞病毒（cytomegalovirus，CMV）抗体水平的意义，为临床医师对妊娠期CMV筛查和诊断提供参考依据。 方法 随机抽取2021年1—12月在惠州市中心人民医院妇产科门诊进行常规妊娠期检查的孕妇810例为研究对象。所有孕妇均在妊娠12周内采用电化学发光法定量检测CMV的IgG和IgM，间隔1~2周复查1次。结合2次抗体定量结果判断孕妇是否感染和感染类型。对诊断为CMV感染并引产的胎儿做病理分析。 结果 810例样本中CMV感染者为801例，其中既往感染者为783例（96.7%），CMV原发感染和复发感染各1例，原发感染率和复发感染率均约为0.1%，IgM持续阳性共16例（2.0%）；CMV未感染者9例（1.1%）。1例引产胎儿病理诊断为播散性先天性CMV感染。结论 妊娠早期动态定量检测CMV抗体可反映孕妇感染情况和感染类型，有效排除临床诊治中的干扰，避免过度医疗干预。科学规范的妊娠期CMV检测是出生缺陷防控的核心所在。

Case Analysis of Cytomegalovirus Infection and Prenatal Diagnosis in Early Pregnancy

Objective: To analyze the significance of the dynamic quantitative detection of cytomegalovirus (CMV) antibody levels in early pregnancy, and to provide a reference for clinicians to conduct the screening and diagnosis of CMV during pregnancy. Methods: A total of 810 pregnant women who were randomly selected from routine pregnancy examination in the Outpatient Department of Obstetrics and Gynecology of Huizhou Municipal Central Hospital from January to December 2021. All pregnant women were tested for IgG and IgM of CMV by electrochemiluminescence assay within 12 weeks of gestation, and were reviewed once every 1 to 2 weeks. Combine the two antibody quantification results to determine whether the pregnant woman was infected and the type of infection. Pathological analysis was performed on fetuses diagnosed with CMV infection in induced labor. Results: Among the 810 samples, 801 cases were infected with CMV, among which 783 cases (96.7%) were previously infected, 1 cases of CMV primary infection and 1 case of CMV recurrent infection. The primary infection rate and recurrent infection rate were both about 0.1%, 16 cases (2.0%) were IgM persistently positive, and 9 cases (1.1%) were not infected with CMV. One fetus of induced labor was diagnosed as disseminated congenital CMV infection. Conclusions: Dynamic and quantitative detection of CMV antibodies in early pregnancy can reflect the infection situation and infection type of pregnant women, effectively exclude the interference in clinical diagnosis and treatment, and avoid excessive medical intervention. Scientific and standardized CMV testing during pregnancy is the core of birth defect prevention and control.