孕前和孕期风疹病毒、巨细胞病毒、弓形虫抗体动态定量检测的意义和作用  

Significance and role of dynamic quantitative detection of rubella virus,cytomegalovirus and toxoplasma antibody before and during pregnancy

作　　者：张宁 崔鑫 魏威 刘星池 于月新 Zhang Ning;Cui Xin;Wei Wei;Liu Xingchi;Yu Yuexin(Department of Reproductive Medicine,General Hospital of PLA Northern Theater Command,Liaoning,Shenyang 110001,China)

机构地区：[1]解放军北部战区总医院生殖医学科,辽宁沈阳110003

出　　处：《发育医学电子杂志》2021年第3期233-237,共5页Journal of Developmental Medicine (Electronic Version)

基　　金：军队计生专业科研课题项目(16JS014)。

摘　　要：目的探讨妊娠期风疹病毒(rubella virus,RV)、巨细胞病毒(cytomegalovirus,CMV)、弓形虫(toxoplasma,TOX)抗体动态定量检测在孕前和孕期中的意义和作用。方法2013年8月1日至2016年1月1日,在解放军北部战区总医院做孕前和孕期RV-IgG、CMV和TOX-IgG筛查者分别为14852、14190和12951例,RV、CMV和TOX-IgM筛查者分别为16527、16339、15366例。采用间接三明治化学发光免疫分析法检测RV-IgG、CMV-IgG、CMV-IgM、TOX-IgG和TOX-IgM,采用捕获化学发光免疫分析法检测RV-IgM。选择2个时间(T1、T2)定量检测IgG或IgM浓度(C1、C2),计算一段时间内(10~20 d)浓度变化倍数。RV、CMV或TOX筛查抗体IgG和IgM同时阳性者92例,其中孕前22例,孕期70例。对其采用动态定量分析方法进行,结合病毒抗体IgM阳性后续判读流程,对其进行妊娠指导。结果孕期70例有随访结果者66例,失访4例。其中RV-IgG和IgM同时阳性者44例,33例胎儿出生正常,6例胎儿受传统解释方法的影响要求行人工流产手术,1例胎儿染色体异常,1例胎儿发育不良早产、3例胎儿失访;CMV-IgG和IgM同时阳性者4例,1例胎儿失访,其他胎儿出生均正常;TOX-IgG和IgM同时阳性者3例,胎儿出生均正常。19例单纯TOX-IgM阳性者经动态定量分析判为假阳性,继续妊娠产后婴儿未见异常。孕前22例因抗体IgG和IgM同时阳性未尝试妊娠的妇女中,经指导后5例正常妊娠,17例仍受传统解释方法的影响未尝试妊娠。结论动态定量检测RV、CMV、TOX抗体可以提供可靠的结果,结合判定流程可消除错误的临床干预,提供有效的孕前和孕期预防和治疗原则。Objective To discuss the significance and role of dynamic quantitative detection of rubella virus(RV),cytomegalovirus(CMV)and toxoplasma(TOX)antibodies before and during pregnancy.Methods There were 14852 cases of RV-IgG,14190 cases of CMV-IgG,12951 cases of TOXIgG,16527 cases of RV-IgM,16339 cases of CMV-IgM,15366 cases of TOX-IgM,which were screened before pregnancy and during pregnancy respectively in the General Hospital of PLA Northern Theater Command from 1st August 2013 to 1st January 2016.The RV-IgG,CMV-IgG,CMV-IgM,TOX-IgG and TOX-IgM were detected by indirect chemiluminescence immunoassay.The RV-IgM was detected by capture chemiluminescence immunoassay.We chose two times(T1,T2)to quantitatively detect the IgG or IgM concentration(C1,C2),and calculate the fold of the concentration change within a period of time(10-20 d).There were 92 patients with antibody IgG and IgM positive of RV,CMV or TOX,22 cases were detected before pregnancy,70 cases were detected in pregency.Their RV,CMV and TOX antibody were observed dynamicly by dynamic quantitative analysis.Combined with the follow-up interpretation process for viral antibody IgM positive,pregnancy guidance was given.Results In 70 cases in pregnancy,66 cases were followed up,and 4 cases were lost to follow-up.There were 44 cases with RV IgG and IgM positive,of which 33 fetuses were completely normal after birth,6 fetuses were aborted due to traditional explanation,1 fetus was born with chromosome abnormality,1 fetus was with fetal dysplasia,3 fetuses were lost to follow-up.Among 4 cases with CMV IgG and IgM positive,3 fetuses were completely normal after birth,1 fetus was lost to follow-up.TOX-IgG and IgM positive were 3 cases,the fetuses were all normal after birth.19 patients with only TOX-IgM positive were proved to be false positive by dynamic quantitative analysis,they continued their pregnancy and fetuses were born with no abnormality.22 patients who feared to pregnant due to IgG and IgM positive before pregnancy,after provided by guidance,5 cases chose

关 键 词：定量分析 妊娠 风疹病毒 巨细胞病毒 弓形虫 

分 类 号：R511[医药卫生—内科学] R446.6[医药卫生—临床医学] R53