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[先天性巨细胞病毒感染——包括产前诊断在内的临床特征]

[Congenital cytomegalovirus infection--clinical characteristics including prenatal diagnosis].

作者信息

Milewska-Bobula Bogumiła

机构信息

Klinika Niemowleca Instytutu "Pomnik - Centrum, Zdrowia Dziecka" w Warszawie.

出版信息

Med Wieku Rozwoj. 2003 Jul-Sep;7(3 Suppl 1):123-7.

Abstract

Congenital infections are the important cause of morbidity and mortality of newborn infants. Among them, cytomegalovirus (CMV) infection is the frequent congenital injection worldwide with the incidence 0.3-2.2% of live births. The virus can be transmitted to the foetus through primary (in 30 to 40%) or secondary (rare) maternal infection. 90% of infants with congenital infection have no signs or symptoms at birth. The other 10% will be symptomatic and about half of the will have the classic stigmata of CMV inclusion disease. Ten to thirty percent of the severely affected infants will die, more then 90% of survivors will have neurological handicaps, sensorineural hearing loss, chorioretinitis. Ten to 15% of children asymptomatic at birth have a risk of abnormal development and 10% develop hearing loss during the first years of life. Prenatal detection of congenital disease by ultrasound examination is not sufficient, but prenatal diagnosis can be confirmed by amniocentesis (culture of amniotic fluid and detection of virus DNA by quantitative polymerase chain reactions). However, the number of mothers who underwent amniocentesis and the broad case definition used to define symptomatic disease is still not adequate. Because there is currently no treatment for prenatal infection, early diagnosis of congenital infection during neonatal period is important (the possibility of antiviral treatment of children with symptomatic congenital disease and long-term follow-up). The best hope for eliminating congenital CMV infection is to prevent prenatal infection: with no vaccine, good hygiene and handwashing should be promoted.

摘要

先天性感染是新生儿发病和死亡的重要原因。其中,巨细胞病毒(CMV)感染是全球常见的先天性感染,活产儿发病率为0.3%-2.2%。该病毒可通过原发性(30%至40%)或继发性(罕见)母体感染传播给胎儿。90%的先天性感染婴儿出生时无体征或症状。另外10%会出现症状,其中约一半会有CMV包涵体病的典型体征。10%至30%的重症感染婴儿会死亡,超过90%的幸存者会有神经功能障碍、感音神经性听力损失、脉络膜视网膜炎。10%至15%出生时无症状的儿童有发育异常风险,10%在生命的头几年会出现听力损失。通过超声检查对先天性疾病进行产前检测并不充分,但可通过羊膜穿刺术(羊水培养和定量聚合酶链反应检测病毒DNA)确诊产前诊断。然而,接受羊膜穿刺术的母亲数量以及用于定义症状性疾病的宽泛病例定义仍然不够。由于目前尚无针对产前感染的治疗方法,新生儿期先天性感染的早期诊断很重要(对有症状的先天性疾病儿童进行抗病毒治疗和长期随访的可能性)。消除先天性CMV感染的最大希望是预防产前感染:由于没有疫苗,应提倡良好的卫生习惯和洗手。

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