先天性无症状性巨细胞病毒感染对婴儿期发育的影响  

Influence of congenital asymptomatic cytomegalovirus infection on development of infants

作　　者：单若冰[1] 王晓亮[3] 傅平[2] 

机构地区：[1]青岛市妇女儿童医疗保健中心新生儿科,266011 [2]青岛市妇女儿童医疗保健中心儿童保健科,266011 [3]青岛大学医学院儿科教研室

出　　处：《中华儿科杂志》2008年第9期658-661,共4页Chinese Journal of Pediatrics

基　　金：山东省自然科学基金（Y2006C25）

摘　　要：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月符合入选条件感染病例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（Amiel-Tison法）和体格发育检查、一般状况检查。结果（1）两组新生儿12—14d时20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21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。Objective Human cytomegalovirus （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 are at risk for audiologic, neurologic, and developmental sequelae. The aim of this study was to evaluate the outcome of children with asymptomatic congenital human cytomegalovirus infection identified from a cohort of newborn infants screened for congenital HCMV infection compared with matched uninfected control subjects. Methods Between July 2003 and July 2005, eligible hospitalized infants were recruited into the cohort. Serum was collected within two weeks of birth and transported to the laboratory within 24 hours, and stored at - 20 ℃. Then Real-time fluorescent quantitative polymerase chain reaction（FQ-PCR） for the presence of HCMV DNA was used as a screening tool for the detection of congenital cytomegalovirus infection. Asymptomatic congenital HCMV infection （ACCMV） was defined as detection of HCMV during the first 2 weeks of hfe 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 neonatal 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 standardised 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-Tison to evaluate the general movements for neurological development. Hearing screening were completed

关 键 词：巨细胞病毒感染 婴儿 新生 病毒 

分 类 号：R686[医药卫生—骨科学]