先天性巨细胞病毒感染胎儿7例的临床与尸检特征分析  

Analysis of seven autopsied fetuses with congenital cytomegalovirus infection

作　　者：王景美 余慧萍[2] 林晓倩[3] 陈玲[2] 吴鸿雁[2] 茹彤[3] 胡娅莉[3] 孟凡青[2] WANG Jingmei;YU Huiping;LIN Xiaoqian;CHEN Ling;WU Hongyan;RU Tong;HU Yali;MENG Fanqing(Department of Pathology,Jiangsu Provincial Hospital of Chinese Medicine/Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,China;Department of Pathology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Obstetrics and Gynecology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]江苏省中医院/南京中医药大学附属医院病理科,南京210029 [2]南京大学医学院附属鼓楼医院病理科,南京210008 [3]南京大学医学院附属鼓楼医院妇产科,南京210008

出　　处：《临床与实验病理学杂志》2023年第9期1073-1079,共7页Chinese Journal of Clinical and Experimental Pathology

摘　　要：目的 探讨围产儿宫内巨细胞病毒(cytomegalovirus, CMV)感染的临床及尸检病理学特征。方法 收集7例先天性CMV感染的尸体解剖胎儿及胎盘,对体表、内部脏器进行大体观察,对各脏器及胎盘进行组织病理学观察,检测胎儿肾脏CMV DNA拷贝数,收集孕母相关临床资料,对胎儿的生长发育状态及病理学特征进行评估及回顾性分析。结果 1例为胎死宫内胎儿,6例为孕期检查显示明显发育异常引产胎儿。男女性胎儿分别为3、4例,孕龄24周至37+5周。孕期影像学检查显示6例胎儿脑发育畸形,其中5例大体检查显示脑发育畸形,镜下病理学特征包括缺血缺氧性脑病、局灶脑坏死、钙化、炎症、出血等。5例胎儿肾脏CMV DNA检测呈阳性。5例胎儿大体外观无明显异常,2例多发外观畸形。6例胎儿肾脏见CMV包涵体,其他脏器偶可见病毒包涵体。6例胎盘出现慢性绒毛炎,5例胎盘见CMV包涵体。结论 先天性CMV感染胎儿的影像学主要表现为脑发育异常,脑组织可能出现显著的病理改变;孕期影像学检查及病毒监测是必要的;肾脏中出现CMV包涵体最常见且具有特异性,其次为胎盘的浆细胞性慢性绒毛炎。Purpose To investigate the clinical and autopsy pathological features of congenital cytomegalovirus(CMV)infection in perinatal infants.Methods Seven autopsy cases of fetuses with congenital CMV infection,along with their placentas were collected.Gross observations were made on the external surface and internal organs of the fetuses,and on the placentas.Histopathological examinations were performed on fetuses organs and placentas.CMV DNA copies were detected in the kidneys of 5 cases.The clinical data of the mothers were collected during the pregnancy.The growth and developmental status of the fetus and its pathological characteristics were assessed retrospectively.Result One case was intrauterine fetal death,and 6 cases were stillbirths due to significant developmental abnormalities detected during prenatal imaging examinations.Of these,3 were male and 4 were female,with gestational ages ranging from 24 weeks to 37+5 weeks.Prenatal imaging examinations revealed brain developmental anomalies in 6 fetuses.Gross examination of the brain showed developmental abnormalities in 5 cases,and microscopic pathological features included ischemic hypoxic encephalopathy,focal cerebral necrosis,calcification,inflammation and hemorrhage.CMV DNA testing in renal tissues showed positive results in all 5 cases.External observation revealed no obvious abnormalities in 5 cases and multiple external malformations in 2 cases.CMV inclusions were observed in the kidney of 6 cases,and occasionally in other organs.Chronic villitis was present in the placenta of 6 cases and CMV inclusions were seen in 5 placentas.Conclusion The imaging manifestations of congenital CMV infection in fetuses are mainly brain abnormalities,and significant pathological changes may occur.Imaging and viral surveillance are necessary during pregnancy.The presence of CMV inclusions in the kidney is the most common and specific,followed by chronic villitis with plasma cells in the placenta.

关 键 词：巨细胞病毒 先天性感染 尸检 胎盘 

分 类 号：R361.1[医药卫生—病理学]