Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain; Fetal Medicine Service, Obstetrics Department, Hospital "Santo Tomás", University of Panama, Panama City, Panamá in behalf of the Iberoamerican Research Network in Translational, Molecular and Maternal Fetal Medicine.
Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain; Centre for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain.
J Clin Virol. 2019 Oct;119:37-43. doi: 10.1016/j.jcv.2019.08.008. Epub 2019 Aug 20.
Cytomegalovirus (CMV) remains a major cause of congenital infection and disease. During pregnancy, symptomatic cases can be detected through ultrasound (US) features, nevertheless, prognostic assessment is difficult. The aim of this study was to assess the predictive value of specific blood parameters in CMV infected fetuses.
Twenty-eight CMV-infected fetuses in which a cordocentesis had been performed were included. Fetuses were considered severely or mildly affected according to prenatal US/MRI brain damage. Fetal blood parameters were assessed for the prediction of severe brain abnormalities, and compared according to the trimester of pregnancy. Logistic regression and receiver operating curve analysis were performed.
Thrombocytopenia (≤100,000/mm; p:0.03) and high levels of gamma-glutamyl transpeptidase (GGT) (≥151 IU/L; p:0.02) signaled severity. For the prediction of brain damage, GGT levels ≥ 183 UI/l achieved 71% sensitivity, 83% specificity (AUC: 0.78), and OR of 2.05 (95% CI: 1.22-3.43) per 100 IU/l increase, adjusted for gestational age. However, thrombocytopenia (91% vs 50%; p: 0.04), β microglobulin >10.4 mg/l (60% vs 0% p: 0.03), CMV-DNA >50,000 copies/ml (80% vs 25%; p: 0.02), and positive IgM (70% vs 17%; p: 0.04) were observed significantly more often in severely damaged fetuses sampled ≤28 weeks than thereafter.
In CMV infected fetuses, thrombocytopenia and high levels of GGT are associated with severe US/MRI brain abnormalities. Nevertheless, among severely affected fetuses, blood parameters, with exception of GGT, change according to gestational age. Fetal blood could be less predictive of brain damage in the third trimester.
巨细胞病毒（CMV）仍然是先天性感染和疾病的主要原因。在怀孕期间，可以通过超声（US）特征检测到有症状的病例，但预后评估较为困难。本研究旨在评估 CMV 感染胎儿特定血液参数的预测价值。
共纳入 28 例进行脐带穿刺术的 CMV 感染胎儿。根据产前 US/MRI 脑损伤情况，将胎儿分为严重或轻度受累。评估胎儿血液参数以预测严重脑异常，并根据妊娠 trimester 进行比较。进行逻辑回归和接收者操作曲线分析。
血小板计数（≤100,000/mm；p：0.03）和谷氨酰转肽酶（GGT）水平升高（≥151 IU/L；p：0.02）提示病情严重。对于脑损伤的预测，GGT 水平≥183 UI/l 可达到 71%的灵敏度、83%的特异性（AUC：0.78），每增加 100 IU/l 的 OR 为 2.05（95%CI：1.22-3.43），调整了胎龄因素。然而，血小板计数（91%比 50%；p：0.04）、β微球蛋白>10.4mg/l（60%比 0%；p：0.03）、CMV-DNA>50,000 拷贝/ml（80%比 25%；p：0.02）和阳性 IgM（70%比 17%；p：0.04）在≤28 周时严重受损胎儿中更为常见，而在 28 周后则较少见。
在 CMV 感染胎儿中，血小板计数减少和 GGT 水平升高与严重的 US/MRI 脑异常相关。然而，在严重受累的胎儿中，除 GGT 外，血液参数随胎龄而变化。在孕晚期，胎儿血液对脑损伤的预测价值可能降低。
