胎儿人巨细胞病毒宫内感染4例临床病理分析  

Intrauterine infection with fetal human cytomegalovirus:a clinicopathological analysis of four cases

作　　者：孙笑非[1] 顾依群[1] 孙云飞[1] 孟然[1] 张慧[1] 王岩 SUN Xiao-fei;GU Yi-qun;SUN Yun-fei;MENG Ran;ZHANG Hui;WANG Yan(Department of Pathology,Haidian Maternal and Child Health Hospital,Beijing 100080,China)

机构地区：[1]北京市海淀区妇幼保健院病理科,北京100080

出　　处：《诊断病理学杂志》2022年第6期537-541,共5页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨宫内感染人巨细胞病毒(HCMV)的病理解剖特征、病因、发病机制及产前超声诊断特点及预后,提高对此类疾病诊断的精准性。方法收集2003-01—2020-10经北京市海淀区妇幼保健院尸体解剖的4例HCMV感染的胎儿,回顾胎儿尸解资料、产前超声及临床情况,并复习相关的文献。结果产前超声诊断胎儿生长受限(FGR)2例、双侧侧脑室增宽2例、大脑皮质发育不良1例、肝脏增大2例、颅内钙化灶1例。3例母血HCMV IgM阴性,IgG阳性,其中1例脐血及孕妇外周血病原体核酸检测HCMV DNA均阴性,仅羊水HCMV DNA阳性。病理光镜肺脏3例、肾脏3例、胸腺2例、肝脾2例、胰腺1例均观察到HCMV包涵体。胎盘均呈弥漫性淋巴浆细胞性绒毛炎,仅2例检查到HCMV包涵体。4例均为巨细胞病毒早期、晚期蛋白免疫组织化学染色阳性。结论产前超声表现为颅内钙化灶、脑室增宽、肝脾大、FGR等特征。典型的病理学表现为枭眼状核内包涵体。巨细胞病毒早期、晚期蛋白免疫组化可以作为诊断的辅助手段。胎儿感染HCMV不代表胎儿受损,当出现严重畸形时,应遗传咨询是否知情同意后终止妊娠。Objective To investigate the pathological and anatomical features,etiology,pathogenesis and prenatal ultrasound diagnostic features and prognosis of human cytomegalovirus(HCMV)intrauterine infection,in order to improve the accuracy of diagnosis of such diseases.Methods Four HCMV-infected fetuses autopsied by the Beijing Haidian District Maternal and Child Health Hospital between January 2003 and October 2020 were collected,and the fetal autopsy data,prenatal ultrasound and clinical conditions as well as the relevant literature were reviewed.Results Prenatal ultrasound of 4 fetal autopsies was diagnosed as fetal growth restriction(FGR)in 2 cases,bilateral lateral ventricular widening in 2 cases,cortical dysplasia in 1 case,liver enlargement in 2 cases,and intracranial calcified foci in 1 case.3 cases were HCMV IgM negative and IgG positive in maternal blood,among which 1 case had cord blood and maternal peripheral blood pathogenic nucleic acid test for HCMV DNA that was negative,and only the amniotic fluid was positive for HCMV DNA.HCMV inclusion bodies were observed in the lungs of 3 cases by pathological light microscopy,and that in kidneys of 3 cases,thymuses of 2 cases,livers and spleens of 2 cases,and pancreas of 1 case.All placentas showed diffuse lymphoplasmacytic chorioamnionitis and HCMV inclusion bodies were examined in only 1 case.All the 4 cases were positive for cytomegalovirus early and late protein immunohistochemical staining.Conclusion Prenatal ultrasound shows features such as intracranial calcified foci,ventricular widening,hepatosplenomegaly,and FGR.The typical pathology is a“lord’s eye”-like intranuclear inclusion.Cytomegalovirus early and late protein immunohistochemistry can be used as a diagnostic aid.Fetal infection with HCMV does not mean that the fetus is impaired,and when severe malformations are present,the pregnancy should be terminated after genetic counseling for informed consent.

关 键 词：人巨细胞病毒 感染 胎儿 尸体解剖 产前 

分 类 号：R373[医药卫生—病原生物学]