Department of Cell and Tissue Biology, School of Dentistry, University of California San Francisco, San Francisco, California.
J Infect Dis. 2014 May 15;209(10):1573-84. doi: 10.1093/infdis/jiu019. Epub 2014 Jan 7.
Human cytomegalovirus (HCMV) is the major viral etiology of congenital infection and birth defects. Fetal transmission is high (30%-40%) in primary maternal infection, and symptomatic babies have permanent neurological, hearing, and vision defects. Recurrent infection is infrequently transmitted (2%) and largely asymptomatic. Congenital infection is also associated with intrauterine growth restriction (IUGR).
To investigate possible underlying HCMV infection in cases of idiopathic IUGR, we studied maternal and cord sera and placentas from 19 pregnancies. Anti-HCMV antibodies, hypoxia-related factors, and cmvIL-10 were measured in sera. Placental biopsy specimens were examined for viral DNA, expression of infected cell proteins, and pathology.
Among 7 IUGR cases, we identified 2 primary and 3 recurrent HCMV infections. Virus replicated in glandular epithelium and lymphatic endothelium in the decidua, cytotrophoblasts, and smooth muscle cells in blood vessels of floating villi and the chorion. Large fibrinoids with avascular villi, edema, and inflammation were significantly increased. Detection of viral proteins in the amniotic epithelium indicated transmission in 2 cases of IUGR with primary infection and 3 asymptomatic recurrent infections.
Congenital HCMV infection impairs placental development and functions and should be considered as an underlying cause of IUGR, regardless of virus transmission to the fetus.
人巨细胞病毒（HCMV）是先天性感染和出生缺陷的主要病毒病因。在原发性母体感染中，胎儿传播率很高（30%-40%），症状性婴儿有永久性神经、听力和视力缺陷。复发性感染的传播率较低（2%），且大多无症状。先天性感染也与宫内生长受限（IUGR）有关。
为了研究特发性 IUGR 病例中可能存在的 HCMV 感染，我们研究了 19 例妊娠的母血和脐血清及胎盘。在血清中测量了抗 HCMV 抗体、缺氧相关因素和 cmvIL-10。对胎盘活检标本进行了病毒 DNA、受感染细胞蛋白和病理学检查。
在 7 例 IUGR 病例中，我们发现了 2 例原发性和 3 例复发性 HCMV 感染。病毒在蜕膜的腺上皮和淋巴管内皮、绒毛的滋养层细胞和血管的平滑肌细胞中复制。大的纤维蛋白原伴无血管绒毛、水肿和炎症明显增加。在 2 例原发性感染和 3 例无症状复发性感染的 IUGR 中，在羊膜上皮中检测到病毒蛋白，表明有病毒传播。
先天性 HCMV 感染会损害胎盘的发育和功能，应被视为 IUGR 的潜在病因，无论病毒是否传播给胎儿。
