新生儿人巨细胞病毒感染头颅影像学改变与临床指标的相关性分析  

Correlation analysis between cranial imaging changes and clinical indicators in newborns infected with human cytomegalovirus

作　　者：王爽[1] 邹飞[2] 孙峥嵘[1] Wang Shuang;Zou Fei;Sun Zhengrong(Department of Human Genetic Resource Biobank,Shengjing Hospital of China Medical University,Shenyang 110004,China;Department of Pediatrics,The First Hospital of Jilin University,Changchun 130021,China)

机构地区：[1]中国医科大学附属盛京医院人类遗传资源库,沈阳110004 [2]吉林大学第一医院儿科,长春130021

出　　处：《国际儿科学杂志》2024年第9期628-633,共6页International Journal of Pediatrics

基　　金：国家自然科学基金(81171581);辽宁省科技厅应用基础研究计划(2022JH2/101500045)。

摘　　要：目的探讨新生儿人巨细胞病毒(human cytomegalovirus,HCMV)感染头颅影像学改变与临床检测指标的相关性,为临床HCMV感染的病情评估和监测提供依据。方法选取中国医科大学附属盛京医院2016年8月至2017年12月收治的HCMV感染新生儿87例,根据头颅影像学检查结果分为异常组(25例)和正常组(62例)。应用荧光定量PCR方法检测外周血单个核细胞(peripheral blood mononuclear cell,PBMC)HCMV-DNA拷贝数,比较两组新生儿临床资料。采用Logistic回归分析并绘制受试者工作特征(receiver operating characteristic,ROC)曲线评价各指标对头颅影像学检查结果的预测价值。结果与正常组相比,头颅影像学异常组胎龄更小[29.29(28.29,32.71)周vs 33.00(30.00,37.86)周,P=0.004]、出生体重更低[1393.00(1047.00,1960.00)g vs 1835.00(1490.00,2850.00)g,P=0.003]、血红蛋白更低[87.00(83.00,104.00)g/L vs 98.00(90.00,138.00)g/L,P=0.025]、PBMC HCMV-DNA拷贝数显著升高(80.00%vs 51.61%,P=0.015),差异均有统计学意义。PBMC HCMV-DNA定量检测对头颅影像学结果预测价值的ROC曲线下面积为0.671(P=0.016),与HCMV-IgM抗体及尿HCMV-DNA定量相比,有较高敏感度和特异度。Logistic回归分析显示,PBMC HCMV-DNA定量、性别和总胆红素与HCMV感染新生儿头颅影像学异常具有一定的相关性(P<0.05)。三项联合预测头颅影像学检查结果异常的ROC曲线下面积为0.860(95%CI:0.743~0.976)。结论PBMC HCMV-DNA定量检测与症状性HCMV感染的新生儿头颅影像学改变具有一定的相关性,可为神经系统损伤的风险评估提供参考。Objective To investigate the correlation between cranial imaging changes and clinical detection indicators in newborns infected with human cytomegalovirus(HCMV),and to provide a basis for the assessment and monitoring of clinical HCMV infection.Methods A total of 87 newborns with HCMV infection treated in Shengjing Hospital of China Medical University from August 2016 to December 2017 were selected.According to the cranial imaging examination results,they were divided into an abnormal group(25 cases)and a normal group(62 cases).The HCMV-DNA copy number of peripheral blood mononuclear cell(PBMC)was detected by real time PCR,and the clinical data of two groups of newborns were analyzed.Logistic regression was used for multivariate analysis,and drawed receiver operating characteristic(ROC)curve to evaluate the predictive value of each indicator for cranial imaging examination results.Results Compared with the normal group,the newborns in abnormal cranial imaging group had smaller gestational age(29.29w vs 33.00w,P=0.004),lower birth weight(1393.00g vs 1835.00g,P=0.003),lower hemoglobin levels(87.00 g/L vs 98.00 g/L,P=0.025),and significantly higher PBMC HCMV-DNA copy number(80.00%vs 51.61%,P=0.015),with statistically significant differences.The area under the ROC curve of the predictive value of PBMC HCMV-DNA quantitative detection for cranial imaging results was 0.671(P=0.016),with high sensitivity compared with HCMV-IgM antibody and urinary HCMV-DNA quantification.Logistic regression analysis showed that there was a certain correlation between PBMC HCMV-DNA quantification,gender,and total bilirubin levels and changes in cranial imaging(P<0.05).Three indicators combined to predict the area under ROC curve of abnormal cranial imaging results was 0.860(95%CI:0.743~0.976).Conclusion PBMC HCMV-DNA quantitative detection has a certain correlation with the cranial imaging changes of newborns with symptomatic HCMV infection,which can provide a reference for risk assessment of nervous system injury.

关 键 词：人巨细胞病毒 新生儿 外周血单个核细胞 影像学 中枢神经系统损伤 

分 类 号：R722.1[医药卫生—儿科]