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[极早产儿或极低出生体重儿出生后巨细胞病毒感染的临床特征分析]

[Analysis of the clinical features of postnatal cytomegalovirus infection in very preterm infants or very low birth weight infants].

作者信息

Jiang M T, Liu T X, Xu S S, Mei H F, Xie T, Ma X L, Chen Z, Xu Y P

机构信息

Department of Respiratory Medicine, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China.

Department of Neonatal Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China.

出版信息

Zhonghua Er Ke Za Zhi. 2025 Mar 2;63(3):259-265. doi: 10.3760/cma.j.cn112140-20241115-00832.

DOI:10.3760/cma.j.cn112140-20241115-00832
PMID:39979101
Abstract

To analyze the clinical features of postnatal cytomegalovirus (pCMV) infection in very preterm infants or very low birth weight infants. This was a case-control study. A total of 50 very preterm or very low birth weight infants who were hospitalized and diagnosed with pCMV infection in the Neonatal Intensive Care Unit of Children's Hospital, Zhejiang University School of Medicine from January 2019 to June 2024, were enrolled as the pCMV group. Meanwhile, through propensity score matching, each infant in the pCMV group was paired with a very preterm or very low birth weight infant without cytomegalovirus infection during the same period, constituting the control group, also consisting of 50 cases. Subsequently, the pCMV group was divided into a treated subgroup and an untreated subgroup according to antiviral treatment. Clinical data of all enrolled infants, including clinical features, laboratory test results, and clinical outcomes were collected. Differences in relevant parameters were analyzed using with test or continuity-corrected test or Fisher's exact test, independent-samples test, Mann-Whitney test as appropriate. Logistic regression was employed to analyze the risk factors, and Spearman correlation analysis was applied for non-normal distribution data or ordinal data. There were no significant differences between the pCMV group and the control group in terms of gestational age, birth weight, proportion of male infants, Apgar score at the 1 minute and 5 minute and days of breastfeeding during the first 3 weeks of life (all >0.05). Compared with the control group, the duration of hospital stay and invasive mechanical ventilation were both longer in the pCMV group (both <0.05). The risks of bronchopulmonary dysplasia, retinopathy of prematurity, and hearing impairment were all higher in the pCMV group when compared with the control group(all <0.05). The body weight and body length of the infants in the pCMV group were both lower than those of in the control group at the corrected gestational age of 36 weeks (both <0.05). pCMV infections were associated with the increased incidence of both necrotizing enterocolitis (=11.50, 95% 1.94-68.30, =0.007) and severe intraventricular hemorrhage (=6.82, 95% 1.19-38.97, =0.031) in very preterm infants or very low birth weight infants. In the treated group, the platelet count was significantly improved after 6-8 weeks of antiviral treatment compared with that before treatment ((245±19)×10/L (119±14)×10/L,=5.37,<0.001). Very preterm infants or very low birth weight infants with postnatal cytomegalovirus infection have longer hospital stay and duration of invasive mechanical ventilation, and are highly susceptible to bronchopulmonary dysplasia, retinopathy of prematurity, hearing impairment, and growth restriction. Antiviral treatment can effectively ameliorate thrombocytopenia in these infants.

摘要

分析极早产儿或极低出生体重儿出生后巨细胞病毒(pCMV)感染的临床特征。这是一项病例对照研究。选取2019年1月至2024年6月在浙江大学医学院附属儿童医院新生儿重症监护病房住院并诊断为pCMV感染的50例极早产儿或极低出生体重儿作为pCMV组。同时,通过倾向得分匹配,将pCMV组中的每例婴儿与同期未感染巨细胞病毒的极早产儿或极低出生体重儿配对,构成对照组,对照组也有50例。随后,根据抗病毒治疗情况将pCMV组分为治疗亚组和未治疗亚组。收集所有纳入婴儿的临床资料,包括临床特征、实验室检查结果和临床结局。根据情况使用t检验或连续性校正t检验或Fisher确切检验、独立样本t检验、Mann-Whitney U检验分析相关参数的差异。采用Logistic回归分析危险因素,对非正态分布数据或有序数据应用Spearman相关性分析。pCMV组与对照组在胎龄、出生体重、男婴比例、1分钟和5分钟Apgar评分以及生后前3周母乳喂养天数方面均无显著差异(均>0.05)。与对照组相比,pCMV组的住院时间和有创机械通气时间均更长(均<0.05)。与对照组相比,pCMV组支气管肺发育不良、早产儿视网膜病变和听力障碍的风险均更高(均<0.05)。在矫正胎龄36周时,pCMV组婴儿的体重和身长均低于对照组(均<0.05)。pCMV感染与极早产儿或极低出生体重儿坏死性小肠结肠炎(=11.50,95%可信区间1.94 - 68.30,=0.007)和重度脑室内出血(=6.82,95%可信区间1.19 - 38.97,=0.031)的发生率增加相关。在治疗组中,抗病毒治疗6 - 8周后血小板计数较治疗前显著改善((245±19)×10⁹/L 比(119±14)×10⁹/L,=5.37,<0.001)。出生后感染巨细胞病毒的极早产儿或极低出生体重儿住院时间和有创机械通气时间更长,且极易发生支气管肺发育不良、早产儿视网膜病变、听力障碍和生长受限。抗病毒治疗可有效改善这些婴儿的血小板减少症。

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