人巨细胞病毒（HCMV）原发性感染与妊娠
Primary Human Cytomegalovirus (HCMV) Infection in Pregnancy.
机构信息
Department of Pediatric and Adolescent Medicine, Division for Neonatology at the University Hospital Frankfurt, Frankfurt am Main, Germany; Institute of Medical Virology and Epidemiology of Viral Diseases, University Hospital Tübingen, Tübingen, Germany; Department of Gynecology and Obstetrics at the Health Center Rheine, Mathias Spital, Rheine, Germany; Em. Director of Department of Gynecology and Obstetrics, Campus Innenstadt and Campus Großhadern of the Ludwig-Maximilians University, Munich, Germany.
出版信息
Dtsch Arztebl Int. 2017 Jan 27;114(4):45-52. doi: 10.3238/arztebl.2017.0045.
BACKGROUND
In 0.5-4% of pregnancies, the prospective mother sustains a primary infection with human cytomegalovirus (HCMV). An HCMV infection of the fetus in the first or second trimester can cause complex post-encephalitic impairment of the infant brain, leading to motor and mental retardation, cerebral palsy, epilepsy, retinal defects, and progressive hearing loss.
METHODS
This review is based on pertinent publications from January 2000 to October 2016 that were retrieved by a selective search in PubMed employing the terms "cytomegalovirus and pregnancy" and "congenital cytomegalovirus."
RESULTS
85-90% of all neonates with HCMV infection are asymptomatic at birth. The main long-term sequela is hearing impairment, which develops in 8-15% of these affected children. Hygienic measures can lower the risk of primary HCMV infection in pregnancy by 50-85%. The first randomized and controlled trial (RCT) of passive immunization with an HCMV-specific hyper - immune globulin (HIG) preparation revealed a trend toward a lower risk of congenital transmission of the virus (30% versus 44% with placebo, p = 0.13). The effect of HIG was more marked in the initial non-randomized trial (15% versus 40%, p = 0.02). The RCT also showed HIG to be associated with a higher frequency of fetal growth retardation and premature birth (13% versus 2%, p = 0.06). Valaciclovir is a further, non-approved treatment option.
CONCLUSION
In the absence of an active vaccine against HCMV, counseling about hygienic measures may currently be the single most effective way to prevent congenital HCMV infection. Moreover, HCMV serologic testing is recommended in the guideline of the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF). Further randomized trials of treatment with HIG and with valaciclovir are urgently needed so that the options for the prevention and treatment of congenital HCMV infection can be assessed.
背景
在 0.5-4%的妊娠中，孕妇会初次感染人巨细胞病毒（HCMV）。妊娠 1 或 2 个月时胎儿感染 HCMV 可能导致婴儿大脑出现复杂的脑炎后损伤，导致运动和精神发育迟缓、脑瘫、癫痫、视网膜缺陷和进行性听力损失。
方法
本综述基于 2000 年 1 月至 2016 年 10 月期间的相关出版物，采用选择性搜索在 PubMed 中检索了使用“巨细胞病毒和妊娠”和“先天性巨细胞病毒”这两个术语的文章。
结果
所有 HCMV 感染新生儿中，85-90%在出生时无症状。主要的长期后遗症是听力损伤，这些受影响儿童中有 8-15%会发展为听力损伤。卫生措施可将妊娠期间初次 HCMV 感染的风险降低 50-85%。首例针对 HCMV 特异性高免疫球蛋白（HIG）制剂的被动免疫的随机对照试验（RCT）显示，病毒先天性传播的风险呈降低趋势（用 HIG 治疗组为 30%，安慰剂组为 44%，p=0.13）。最初的非随机试验中 HIG 的效果更为显著（用 HIG 治疗组为 15%，安慰剂组为 40%，p=0.02）。RCT 还表明 HIG 与胎儿生长迟缓及早产的发生频率较高有关（用 HIG 治疗组为 13%，安慰剂组为 2%，p=0.06）。伐昔洛韦是另一种未经批准的治疗选择。
结论
在缺乏针对 HCMV 的活性疫苗的情况下，关于卫生措施的咨询可能是目前预防先天性 HCMV 感染的唯一最有效方法。此外，德国科学医学专业协会联合会（Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften，AWMF）的指南建议进行 HCMV 血清学检测。迫切需要进一步开展 HIG 和伐昔洛韦治疗的随机试验，以便评估预防和治疗先天性 HCMV 感染的选择。
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