人巨细胞病毒在乳汁中的载量变化及其传播风险  

Loads change of HCMV in breast milk and the risk of transmission via breast milk

作　　者：王婷[1] 崔会玲[1] 段歌红[1] 陈茂才[1] 冀恒涛[1] 

机构地区：[1]郑州大学第二附属医院检验科,河南郑州450014

出　　处：《中国医药导报》2015年第21期63-65,74,共4页China Medical Herald

基　　金：河南省医学科技攻关计划项目(201403085)

摘　　要：目的 探讨人巨细胞病毒（HCMV）DNA在乳汁中的载量变化以揭示其通过母乳喂养将病毒传播给婴儿的风险。方法 选择2013年9月~2014年10月于郑州大学第二附属医院产科住院的305名产妇（哺乳期母亲）及其婴儿作为实验对象,选择同期103名奶粉喂养婴儿为对照,用实时荧光定量PCR方法检测其乳汁、尿液和外周血白细胞中的HCMV病毒DNA载量,数据进行统计学分析比较各组差异。结果 产后第6周乳汁病毒DNA总阳性率为44.92%,其中有73名母亲将病毒传播给了婴儿,72名是非传播者。传播者的DNA载量为（4.70±1.26）（lg）而非传播者为（3.08±0.88）（lg）,差异有高度统计学意义（P〈0.01）。病毒DNA阳性乳汁喂养的婴儿感染率（50.68%）显著高于阴性乳汁喂养的婴儿（3.70%）和奶粉喂养的婴儿（9.71%）,差异均有高度统计学意义（P〈0.01）。而且母乳喂养及奶粉喂养的早产儿的尿液HCMV-DNA阳性率（83.33%、37.50%）均高于足月儿（47.76%、7.37%）,差异均有统计学意义（P〈0.05）。乳汁病毒DNA载量高于3.42者,84%将病毒传播给婴儿,而低于3.42者75%没有传播病。因此,2600 copies/m L（lg2600=3.42）为传播者的临界值。结论 含有病毒的乳汁是HCMV的重要传染源,而且建议乳汁HCMV DNA载量2600 copies/m L作为传播者的临界值。早产儿对HCMV更为易感,尿液病毒DNA检测用来诊断HCMV具有很好的敏感性。Objective To discuss the loads change of HCMV in breast milk and to reveal the risk of transmission to in- fants via breast-feeding. Methods From September 2013 to October 2014, 305 lactating mothers admitted to Obstetric Department of the Second Affiliated Hospital, and their 308 infants were screened for HCMV, with 103 formula-fed in- fants in the same period were selected as control. HCMV DNA isolated from breast milk, urine and peripheral blood mononuclear cells （PBMC） was detected by real-time PCR. Results The accumulative DNAlactia（＋） was 44.92% during the first 6 weeks postpartum, including 73 transmitters and 72 non-transmitters. But transmitters had significantly higher DNA load than non-transmitters [（4.70±1.26） vs （3.08±0.88）], the difference was statistically significant （P 〈 0.01）. Breast-fed infants with DNAlactia＋ milk were found more DNAuria （＋） （50.68%） than breast-fed infants with DNAlae- tia- milk （3.70%） and formula-fed babies （9.71%）, the difference was statistically significant （P 〈 0.01）. And preterm babies breast-fed and formula fed had significant higher DNAuria （＋） （83.33%, 37.50%） than term ones （47.76%, 7.37%）, the differences were statistically significant （P 〈 0.05）. 84% puerpera with milk viral DNA loads 〈 3.42 spread the virus to infants, and 75% puerpera with milk viral DNA loads 〈 3.42 had not spread the virus to infants, so 2600 copies/mL （lg2600=3.42） was the cut-off viral DNA load. Conclusion Breast milk is a main source for transmission and a proposal cut-off viral DNA load is defined as 2600 copies/mL in milk for potential maternal virus transmitters. Preterm infants seem more vulnerable to HCMV infection and the analysis of urine from children for the presence of DNA is more valuable for the diagnosis of HCMV.

关 键 词：人巨细胞病毒 母婴传播 乳汁 病毒DNA 

分 类 号：R511[医药卫生—内科学]