孕前干预预防巨细胞病毒、弓形虫和风疹病毒宫内感染  

Prevention of Cytomegalovirus,Toxoplasma and Rubivirus Intrauterine Infection by Intervention before Pregnancy

作　　者：陈素华[1] 闻良珍[1] 邢玮[1] 曾万江[1] 凌霞珍[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院妇产科,武汉430030

出　　处：《华中科技大学学报（医学版）》2003年第2期197-199,共3页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：国家"九五"科技攻关基金资助项目(No.96 - 90 4 - 0 6 -0 8)

摘　　要：目的　探讨孕前干预预防巨细胞病毒 (CMV)、弓形虫 (TO)和风疹病毒 (Ru)宫内感染的效果。方法　采用前瞻性随机对照临床研究 ,从 310 5例有异常妊娠史的育龄妇女中 ,筛查 CMV和 TO活动性感染者以及 Ru易感者 ,分别采用中西医方法进行干预 ,追踪至再次妊娠结束。结果　中药金叶败毒颗粒可使育龄妇女 CMV Ig M和 m RNA转阴率从 5 2 .4 4 % (43/ 82 )提高到 77.91% (6 7/ 86 ) (χ2 =12 .0 5 P=0 .0 0 1) ,螺旋霉素可使育龄妇女 TO Ig M转阴率从 4 2 .86 % (36 / 84 )提高到 6 7.0 1% (6 5 / 97) (χ2 =17.94 P=0 .0 0 1) ;CMV和 TO治疗转阴后再次妊娠分别有 34例和 2 8例 ,均足月分娩 ,无宫内感染。接种 Ru疫苗后 Ig G阳转率 95 % (76 / 80 ) ,38例再次妊娠后对 Ru具有免疫效应 ;而 2 3例未接种疫苗受孕者中 2例发生孕期感染并宫内传播 ,分别表现为自然流产和心脏畸形。结论　孕前干预具有减少妊娠期感染。Objective To study the prevention of cytomegalovirus (CMV), toxoplasma (TO) and rubivirus (Ru) intrauterine infection by intervention before pregnancy.Methods The prospectively randomized controlled clinical trials were done. The women subject to active infection of CMV or TO or susceptible to Ru were screened from 3105 women of childbearing age who had abnormal pregnant history, interfered by means of combination of Chinese traditional and Western Medicine, and followed up to the end of next pregnancy. Results Jinyebaidu granules could significantly increase the trans negative rate of CMV IgM and CMV late mRNA of women from 52 44 % (43/82) to 77 91 % (67/86)(χ 2 =12 05, P =0 001). Spiramycin could increase the trans netative rate of TO IgM from 42 86 % (36/84) to 67 01 % (65/97) (χ 2 =17 94, P =0 001). After conversion to negative of CMV and TO 34 and 28 women became pregnant again without reinfection in gestational period and delivered healthy infants termly. After inoculation of Ru vaccine, IgG trans positive rate was 95 %(76/80). 38 women whose Ru IgG was induced had pregnancy again without infection in gestational period and delivered healthy infants termly. However, 2 of 23 women who had been susceptibal to Ru without inoculation of Ru vaccine got Ru infection during pregnant period, therefore intrauterine transmission and abnormal pregnancy outcomes. Conclusion Intervention before pregnancy can decrease the infection during pregnant period and prevent the intrauterine infection.

关 键 词：巨细胞病毒 弓形虫 风疹病毒 宫内感染 孕前干预 金叶败毒颗粒 螺旋霉素 Ru疫苗 

分 类 号：R714.251[医药卫生—妇产科学] R715.3[医药卫生—临床医学]