早产儿经母乳获得性巨细胞病毒感染状况及影响因素分析  

Analysis of the Status and Factors of Breast Milk-Acquired Cytomegalovirus Infection in Preterm Infants

作　　者：范忠祥 刘欣 高晓珊 黄群 吴强 Fan Zhongxiang;Liu Xin;Gao Xiaoshan(Department of Pediatrics,Women and Children's Health Care Hospital of Wenjiang District,Chengdu,Sichuan 611130;Department of Operation and Management,Traditional Chinese Medicine Hospital of Wenjiang District,Chengdu,Sichuan 611130,China)

机构地区：[1]成都市温江区妇幼保健院儿科,四川成都611130 [2]成都市温江区中医医院运营管理科,四川成都611130

出　　处：《四川医学》2025年第3期248-253,共6页Sichuan Medical Journal

基　　金：成都市医学科研课题资助(编号:2022624)。

摘　　要：目的探讨早产儿经母乳获得性巨细胞病毒(CMV)感染发生情况及影响因素。方法选取2022年2月至2023年10月我院新生儿病房收治的126例新鲜母乳喂养的早产儿为研究对象,根据母亲CMV血清结果分为母CMV-IgG阳性组(n=109)和母CMV-IgG阴性组(n=17),前者根据是否出现CMV感染分为感染组(n=46)和对照组(n=63),感染组再根据是否出现CMV相关症状分为有症状感染组(n=14)和无症状感染组(n=32)。收集各组早产儿胎龄、出生体质量、分娩方式等临床资料,监测早产儿母乳CMV DNA载量变化,明确早产儿CMV感染的发病率、相关临床表现及听力损伤情况,并分析其影响因素。结果母血清CMV-IgG阳性率为86.5%(109/126),早产儿经新鲜母乳喂养后获得性CMV感染率为36.5%(46/126),30.4%(14/46)为症状性感染。感染组早产儿出生胎龄、出生体质量低于对照组[(32.0±1.2)w vs.(35.1±1.4)w,(2347.3±270.6)g vs.(3060.0±96.6)g,P<0.05],有症状感染组早产儿出生胎龄、出生体质量低于无症状感染组[(31.3±1.1)w vs.(33.2±1.7)w,(2272.3±303.9)g vs.(2936.0±237.2)g,P<0.05]。感染组早产儿母乳CMV DNA载量高于对照组,有症状感染组早产儿母乳CMV DNA载量高于无症状感染组。感染组早产儿血小板减少症、胆汁淤积症及肝脾肿大的发生率高于对照组(15.2%vs.3.2%,30.4%vs.7.9%,6.5%vs.0,P<0.05)。感染组早产儿听力TEOAE及AABR未通过率高于对照组(17.4%vs.1.6%,8.7%vs.0,P<0.05)。结论新鲜母乳喂养的早产儿经母乳获得性CMV感染率高,感染CMV的早产儿更易出现血小板减少、胆汁淤积症、肝脾肿大、听力损伤,出生胎龄、出生体质量及母乳CMV DNA载量是影响其是否感染及严重程度的重要因素。Objective To investigate the occurrence and factors of cytomegalovirus(CMV)infection acquired through breast milk in preterm infants.Methods 126 freshly breast fed preterm infants admitted to the neonatal ward of our hospital from February 2022 to October 2023 were selected,and were divided into the CMV-IgG positive group(n=109)and the CMV-IgG negative group(n=17)based on their mothers CMV serologic results,and the former group was divided into the infected group(n=46)and the control group(n=63)based on the presence or absence of CMV infection,and the infected group was further divided into symptomatic infection group(n=14)and asymptomatic infection group(n=32)according to whether CMV-related symptoms appeared or not.Clinical data such as gestational age,birth weight and mode of delivery were collected from preterm infants in each group,and changes in CMV DNA load in breast milk of preterm infants were monitored.To clarify the incidence of CMV infection,related clinical manifestations and hearing damage were investigated,and their influencing factors in preterm infants were analyzed.Results Maternal serum CMV-IgG positivity was 86.5%(109/126),and the rate of acquired CMV infection in preterm infants after fresh breastfeeding was 36.5%(46/126),and 30.4%(14/46)was symptomatic.The gestational age and birth weight were lower in the infected group than those in the control group[(32.0±1.2)w vs.(35.1±1.4)w,(2347.3±270.6)g vs.(3060.0±96.6)g,P<0.05],and were lower in the symptomatically infected group than those in the asymptomatically infected group[(31.3±1.1)w vs.(33.2±1.7)w,(2272.3±303.9)g vs.(2936.0±237.2)g,P<0.05].Breast milk CMV DNA load was higher in the infected group than that in the control group,and was higher in the symptomatic infection group than that in the asymptomatic infection group.The incidence of thrombocytopenia,cholestasis and hepatosplenomegaly was higher in the infected group than in the control group(15.2%vs.3.2%,30.4%vs.7.9%,6.5%vs.0,P<0.05).The rate of TEOAE and AABR failure was higher

关 键 词：早产儿 巨细胞病毒 获得性感染 母乳喂养 

分 类 号：R722.13[医药卫生—儿科]