胎儿宫内人巨细胞病毒感染的产前诊断及宫内感染胎儿妊娠结局  

Prenatal diagnosis and pregnancy outcomes of fetal intrauterine human cytomegalovirus infection

作　　者：罗茗月 林海英 沈楷 严泽浩 麦光兴 蓝慧娟 熊礼宽 LUO Ming-yue;LIN Hai-ying;SHEN Kai;YAN Ze-hao;MAI Guang-xing;LAN Hui-juan;XIONG Li-huan(Department of Center Laboratory,Shenzhen Baoan Women's and Children's Hospital,Jinan University,Shenzhen 518100,Guangdong,China;不详)

机构地区：[1]暨南大学附属深圳市宝安区妇幼保健院中心实验室,广东深圳518100 [2]暨南大学附属深圳市宝安区妇幼保健院产前诊断科,广东深圳518100

出　　处：《广东医学》2024年第8期1048-1052,共5页Guangdong Medical Journal

基　　金：深圳市科技计划项目(ZDSYS201504301707152)。

摘　　要：目的探讨2016-2021年深圳市宝安区妇幼保健院人巨细胞病毒(HCMV)胎儿宫内感染率,以及宫内感染胎儿的超声表现和妊娠结局。方法对4685例行羊水穿刺孕妇的羊水标本进行HCMVDNA检测,并回顾性分析部分病例的HCMV-IgG和IgM检测结果,对11例DNA阳性病例进行染色体核型分析、超声检查并追踪妊娠结局。结果4685例羊水标本中4674例HCMV-DNA阴性,其中2076例孕妇中26例血清HCMVIgM阳性,1482例中IgG阳性1454例。11例孕妇羊水HCMV-DNA阳性,对11例孕妇进行血清HCMV-IgM、IgG和DNA检测,并对尿液进行HCMV-DNA检测,其中HCMV-IgM阳性3例,阴性8例;HCMV-IgG阳性8例,未检测3例;孕妇尿液HCMV-DNA阳性2例,阴性7例,未检测2例;血清HCMV-DNA阴性9例,未检测2例。11例HCMV宫内感染的孕妇中,有2例穿刺前HCMV-IgM阳性,9例穿刺原因为胎儿超声异常或唐氏筛查高风险;7例超声检查结果有HCMV感染相关表现,其中6例引产,1例出生后未发现异常,4例超声未提示感染相关表现,正常分娩后未发现异常。结论羊水HCMV-DNA检测可准确诊断先天性CMV感染,孕妇血清Ig和DNA检测对诊断参考价值不大。胎儿宫内HCMV感染后,部分会出现超声异常,但部分感染胎儿出生后未致病。Objective To investigate the intrauterine infection rate of human cytomegalovirus(HCMV)in fetuses and analyze the ultrasound findings and pregnancy outcomes of fetuses with intrauterine HCMV infection from 2016 to 2021 at Shenzhen Baoan Woman's and Children's Hospital.Methods Amniotic fluid samples from 4685 pregnant women who underwent amniocentesis at our hospital were tested for HCMV-DNA.A retrospective analysis was conducted on HCMV-IgG and IgM test results in a subset of cases.Chromosomal karyotyping,ultrasound examinations,and pregnancy outcomes were tracked for 11 cases with positive HCMV-DNA.Results Among the 4685 amniotic fluid samples,4674 were HCMV-DNA negative.Of 2076 pregnant women,26 had positive serum HCMV-IgM,and among 1482 tested,1454 were positive for HCMV-IgG.For the 11 pregnant women with positive amniotic fluid HCMV-DNA,the following results were observed:serum HCMV-IgM positive in 3 cases and negative in 8 cases;HCMV-IgG positive in 8 cases,with 3 cases not tested;HCMV-DNA in urine was positive in 2 cases,negative in 7 cases,and not tested in 2 cases;serum HCMV-DNA was negative in 9 cases,with 2 cases not tested.Of the 11 cases with intrauterine HCMV infection,2 had positive HCMV-IgM before amniocentesis.The remaining 9 underwent amniocentesis due to abnormal fetal ultrasound findings or high-risk Down syndrome screening.Ultrasound results related to HCMV infection were observed in 7 cases:6 resulted in termination,and 1 newborn was without abnormalities.Four cases showed no infection-related findings on ultrasound,and all had normal deliveries with no abnormalities detected postpartum.Conclusion Amniotic fluid HCMV-DNA testing provides accurate diagnosis of congenital CMV infection.Serum Ig and DNA tests in pregnant women have limited diagnostic value.Some fetuses with intrauterine HCMV infection may present ultrasound abnormalities,while others may be asymptomatic at birth.

关 键 词：人巨细胞病毒 宫内感染 妊娠结局 

分 类 号：R715.7[医药卫生—妇产科学] R714.4[医药卫生—临床医学]