Adler Stuart P, Nigro Giovanni, Pereira Lenore
Department of Pediatrics, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA 23298, USA.
Semin Perinatol. 2007 Feb;31(1):10-8. doi: 10.1053/j.semperi.2007.01.002.
Continued but slow progress has led to recent advances in our understanding that congenital cytomegalovirus (CMV) infection has occurred. We understand that the most severe congenital disease occurs following a primary maternal infection during pregnancy. We now have the ability to accurately diagnosis a primary maternal infection using serologic studies of single serum sample. For pregnant women with young children, we know that child-to-mother CMV transmission can probably be prevented by hygienic intervention, and that for pregnant women who have acquired a primary CMV infection, mother-to-fetal transmission is probably preventable using CMV hyperimmune globulin. Although additional studies are needed, treatment of congenitally infected fetuses or newborns should be possible using either CMV hyperimmune globulin or antiviral agents such as ganciclovir or its derivates. Finally, recent evidence indicates that CMV replicates in the placenta, impairs development, and causes inflammation and dysfunction. This plus the reversibility of many manifestations of congenital infection in the fetus and newborn indicate that congenital CMV disease is in part a syndrome of placental insufficiency.
持续但缓慢的进展已使我们对先天性巨细胞病毒（CMV）感染的认识取得了最新进展。我们了解到，最严重的先天性疾病发生在孕期母亲初次感染之后。我们现在有能力通过对单一血清样本进行血清学研究来准确诊断母亲的初次感染。对于家中有幼儿的孕妇，我们知道通过卫生干预或许可以预防儿童向母亲的CMV传播，而且对于已发生初次CMV感染的孕妇，使用CMV高效价免疫球蛋白或许可以预防母亲向胎儿的传播。尽管还需要更多研究，但使用CMV高效价免疫球蛋白或抗病毒药物（如更昔洛韦或其衍生物）对先天性感染的胎儿或新生儿进行治疗应该是可行的。最后，最近的证据表明，CMV在胎盘中复制，损害发育，并引起炎症和功能障碍。这一点加上胎儿和新生儿先天性感染的许多表现具有可逆性，表明先天性CMV疾病部分是一种胎盘功能不全综合征。
