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。

Serologic screening for Torch in pregnant women, pregnant women with embryo standstills as well as women with habitual abortion

Objective To evaluate the importance of Torch serologic screening in pregnant women and to investigate the relationship between Torch infection and pregnant women with embryo standstills as well as women with habitual abortion.Methods IIF and capture EIA were used for detection of Torch-IgG and IgM antibodies, respectively. Toxoplasma /rubella virus/CMV/HSV serologic screens were carried out in 303/278/280/236 pregnant women, 27/30/31/25 pregnant women with embryo standstills and 192/214/228/168 women with habitual abortions, respectively.Results The positive rates of toxoplasma(rubella virus, CMV, HSV)-IgG/IgM antibodies were found 2.3%/0.33% (93.2%/1.4%, 88.6%/1.1%, 93.2%/1.3%) in pregnant women, 0/0(96.7%/0, 87.1%/0, 88.0%/0,) in pregnant women with embryo standstills and 1.04%/0(98.6%/0, 91.2%/0, 94.6%/0) in women with habitual abortion, respectively. Only one serum sample was found to be true positive with rubella virus-IgM antibody in 31 Torch-IgM antibodies positive serum samples tested by other hospitals. Conclusion The necessity to screen toxoplasma antibodies in pregnant women should be evaluated due to the low incidence. It is important to determine immune status to rubella virus prior pregnancy for prenatal screening.Further studies are needed before the scheme to diagnose CMV infection during pregnancy can be decided. Serum samples tested with Torch-IgM antibodies should be re-tested with kits from other manufactures or by reference labs to avoid false positive. There are no relationships being found between Torch infection and pregnant women with embryo standstills as well as women with habitual abortion.