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[母婴先天性巨细胞病毒感染的防治综述]

[A review on the prevention and treatment of congenital cytomegalovirus infection in mothers and infants].

作者信息

Xu Wen-Fang, Yuan Tian-Ming

机构信息

Department of Neonatology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China.

出版信息

Zhongguo Dang Dai Er Ke Za Zhi. 2018 Oct;20(10):870-875. doi: 10.7499/j.issn.1008-8830.2018.10.018.

Abstract

Human cytomegalovirus (HCMV) has a high infection rate worldwide, and 85%-90% of congenital cytomegalovirus (CMV) infections are asymptomatic at birth, with the clinical manifestations of hearing loss, psychomotor retardation, and learning disabilities, while 10%-15% are symptomatic infections. Some preterm infants develop CMV infection after birth, which can cause sepsis-like syndrome, thrombocytopenia, neutropenia, liver injury, and lung injury. However at present, women of childbearing age have a lack of awareness of CMV. CMV education and hygiene precautions for pregnant women can prevent CMV infections in themselves and congenital CMV infections in their infants. No definite results have been obtained from the studies on the effect of CMV vaccine and high-titer immunoglobulin in preventing congenital CMV infection in fetuses. Recent studies have confirmed that the specificity and sensitivity of urinary or salivary CMV-DNA detection have reached more than 98%, which contributes to the early diagnosis of congenital CMV infection. In addition to short-term treatment with ganciclovir, long-term treatment with oral valganciclovir is safe for symptomatic congenital CMV infection and appears to have a better clinical effect than the short-term treatment. In the future, it is necessary to strengthen the health education for pregnant women, enhance the mother-to-child management of CMV infection, conduct the research on CMV vaccine, and further standardize treatment regimens.

摘要

人巨细胞病毒(HCMV)在全球感染率很高,85%-90%的先天性巨细胞病毒(CMV)感染在出生时无症状,临床表现为听力丧失、精神运动发育迟缓及学习障碍,而10%-15%为有症状感染。一些早产儿出生后发生CMV感染,可导致败血症样综合征、血小板减少、中性粒细胞减少、肝损伤及肺损伤。然而目前育龄女性对CMV缺乏认识。对孕妇进行CMV教育及采取卫生预防措施可预防自身CMV感染及婴儿先天性CMV感染。关于CMV疫苗及高滴度免疫球蛋白预防胎儿先天性CMV感染效果的研究尚未取得确切结果。近期研究证实,尿液或唾液CMV-DNA检测的特异性和敏感性均达到98%以上,有助于先天性CMV感染的早期诊断。除了更昔洛韦短期治疗外,口服缬更昔洛韦长期治疗对有症状的先天性CMV感染是安全的,且似乎比短期治疗有更好的临床效果。未来有必要加强对孕妇的健康教育,强化CMV感染的母婴管理,开展CMV疫苗研究,并进一步规范治疗方案。

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