Gunkel J, Wolfs T F W, Nijman J, Schuurman R, Verboon-Maciolek M A, de Vries L S, Murk J L
Department of Neonatology, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands.
Department of Pediatric Infectious Diseases, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands.
J Clin Virol. 2014 Sep;61(1):61-4. doi: 10.1016/j.jcv.2014.06.002. Epub 2014 Jun 8.
Cytomegalovirus (CMV) is the most frequently contracted virus in preterm infants. Postnatal infection is mostly asymptomatic but is sometimes associated with severe disease. To diagnose an infection, urine or saliva samples can be tested for CMV-DNA by real-time polymerase chain reaction (rtPCR). Although the diagnostic accuracy of testing saliva samples has not been determined in preterm infants, saliva is widely used because it is easier to obtain than urine.
To determine whether screening of saliva is equivalent to urine to detect a postnatal CMV infection in preterm infants.
Between 2010 and 2013 saliva and urine samples were collected from infants admitted to the Neonatal Intensive Care Unit of the University Medical Center Utrecht and born with a gestational age (GA) below 32 weeks. Urine samples were obtained within three weeks after birth and urine and saliva samples at term equivalent age (40 weeks GA) and tested for CMV-DNA by rtPCR. Infants with a congenital CMV infection were excluded.
Of 261 preterm infants included in the study, CMV-DNA was detected in urine of 47 and in saliva of 43 children. Of 47 infants with postnatal CMV infection, CMV was detected in 42 saliva samples (sensitivity 89.4%; CI 76.9-96.5). Of 214 children without postnatal CMV infection, one saliva sample tested positive for CMV (specificity 99.5%; CI 97.4-99.9).
Screening saliva for CMV-DNA by rtPCR is inferior to urine to diagnose postnatal CMV infections in preterm infants.
巨细胞病毒（CMV）是早产儿中最常感染的病毒。产后感染大多无症状，但有时与严重疾病有关。为诊断感染，可通过实时聚合酶链反应（rtPCR）检测尿液或唾液样本中的CMV-DNA。尽管尚未确定检测唾液样本在早产儿中的诊断准确性，但由于唾液比尿液更容易获取，因此被广泛使用。
确定检测唾液是否等同于检测尿液以发现早产儿的产后CMV感染。
在2010年至2013年期间，收集了乌得勒支大学医学中心新生儿重症监护病房收治的、胎龄（GA）低于32周的婴儿的唾液和尿液样本。出生后三周内获取尿液样本，在足月等效年龄（40周GA）时获取尿液和唾液样本，并通过rtPCR检测CMV-DNA。排除先天性CMV感染的婴儿。
在纳入研究的261名早产儿中，47名儿童的尿液中检测到CMV-DNA，43名儿童的唾液中检测到CMV-DNA。在47名产后CMV感染的婴儿中，42份唾液样本检测到CMV（敏感性89.4%；可信区间76.9-96.5）。在214名无产后CMV感染的儿童中，1份唾液样本CMV检测呈阳性（特异性99.5%；可信区间97.4-99.9）。
通过rtPCR检测唾液中的CMV-DNA在诊断早产儿产后CMV感染方面不如检测尿液。
