先天性巨细胞病毒感染的免疫球蛋白 G 亲和性的通用筛查。

Universal Screening With Use of Immunoglobulin G Avidity for Congenital Cytomegalovirus Infection.

机构信息

Departments of Obstetrics and Gynecology.

Pediatrics, Kobe University Graduate School of Medicine.

出版信息

Clin Infect Dis. 2017 Oct 30;65(10):1652-1658. doi: 10.1093/cid/cix621.

DOI:10.1093/cid/cix621

PMID:29020153

Abstract

BACKGROUND

The aim of this prospective cohort study was to evaluate the efficacy of maternal screening for congenital cytomegalovirus infection (CCI) using cytomegalovirus (CMV) immunoglobulin G (IgG) and the IgG avidity index (AI).

METHODS

Pregnant women underwent screening of CMV IgG and AI measurements. IgG-negative women underwent remeasurement of IgG after educational intervention. Women with an AI ≤45% received further examinations, including measurement of CMV IgM. All newborns received polymerase chain reaction analyses of the urine, and CCI was diagnosed by the detection of CMV-DNA in the urine. Primary infection was defined as an AI <35% and/or positive IgM (>1.20 index). Serum samples from women with an AI >45% were stored, and the IgM levels were measured after delivery. The efficacy of AI and IgM for CCI screening was compared.

RESULTS

A total of 1562 (71.2%) women tested positive for IgG. In this study, 10 newborns with CCI were detected. The presence of infection in 3 newborns from mothers with primary infection was predicted by screening of IgG and AI <35%. However, infection in 7 newborns from women with nonprimary infection could not be predicted by screening of CMV IgG, AI <35%, or IgM. The application of an AI <35% for CCI screening yielded 22.2% sensitivity, 95.0% specificity, 2.5% positive predictive value, and 99.5% negative predictive value and was similar to that of IgM (11.1% sensitivity, 93.2% specificity, 0.9% positive predictive value, and 92.7% negative predictive value).

CONCLUSIONS

Maternal screening using CMV IgG and AI can identify pregnancies with CCI from primary infection, but overlooks a number of those from nonprimary infection.

摘要

背景

本前瞻性队列研究旨在评估使用巨细胞病毒（CMV）免疫球蛋白 G（IgG）和 IgG 亲和指数（AI）对先天性巨细胞病毒感染（CCI）进行母体筛查的效果。

方法

对孕妇进行 CMV IgG 和 AI 测量筛查。IgG 阴性的孕妇在接受教育干预后重新测量 IgG。AI≤45%的女性接受进一步检查，包括 CMV IgM 测量。所有新生儿均接受尿液聚合酶链反应分析，通过检测尿液中的 CMV-DNA 诊断 CCI。将 AI<35%和/或 IgM 阳性（>1.20 指数）定义为原发性感染。AI>45%的女性的血清样本被储存，产后测量 IgM 水平。比较 AI 和 IgM 对 CCI 筛查的效果。

结果

共有 1562 名（71.2%）女性 IgG 检测呈阳性。本研究共检测到 10 例 CCI 新生儿。3 例来自原发性感染母亲的感染新生儿通过 IgG 和 AI<35%的筛查得到预测。然而，7 例来自非原发性感染母亲的感染新生儿不能通过 CMV IgG、AI<35%或 IgM 的筛查来预测。应用 AI<35%进行 CCI 筛查的灵敏度为 22.2%，特异性为 95.0%，阳性预测值为 2.5%，阴性预测值为 99.5%，与 IgM 相似（灵敏度为 11.1%，特异性为 93.2%，阳性预测值为 0.9%，阴性预测值为 92.7%）。