Lazzarotto T, Guerra B, Spezzacatena P, Varani S, Gabrielli L, Pradelli P, Rumpianesi F, Banzi C, Bovicelli L, Landini M P
Department of Clinical and Experimental Medicine, Section of Microbiology, Medical School, University of Bologna, Bologna, Italy.
J Clin Microbiol. 1998 Dec;36(12):3540-4. doi: 10.1128/JCM.36.12.3540-3544.1998.
We report here the results of a study on the prenatal diagnosis of congenital cytomegalovirus (CMV) infection. The study was carried out by both PCR and virus isolation from amniotic fluid (AF) for 82 pregnant women at risk of transmitting CMV for the detection of (i) seroconversion to CMV immunoglobulin G (IgG) positivity during the first trimester of pregnancy, (ii) symptomatic CMV infection in the mother during the first trimester of pregnancy or intrauterine growth retardation detected by ultrasound or abnormal ultrasonographic findings suggestive of fetal infections, and (iii) seropositivity for CMV-specific IgM. For 50 women, fetal blood (FB) was also obtained and tests for antigenemia and PCR were performed. The results indicate that AF is better than FB for the prenatal diagnosis of CMV infection. PCR with AF has a sensitivity (SNS) of 100%, a specificity (SPE) of 83.3%, a positive predictive value (PPV) of 40%, and a negative predictive value (NPV) of 100%; rapid virus isolation with the same material has an SNS of 50%, an SPE of 100%, a PPV of 100%, and an NPV of 94.7%. Fewer than 10% of the women positive for IgM by enzyme immunoassay (EIA) had a congenitally infected fetus or newborn infant. When EIA IgM positivity was confirmed by Western blotting (WB) and the WB profile was considered, the percent transmission detected among women with an "at-risk" profile was higher than that observed among IgM-positive women and was the same as that among women who seroconverted during the first trimester of pregnancy (transmission rates of 29 and 25%, respectively).
我们在此报告一项关于先天性巨细胞病毒（CMV）感染产前诊断的研究结果。该研究对82名有CMV传播风险的孕妇进行了羊水（AF）的聚合酶链反应（PCR）和病毒分离，以检测：（i）妊娠早期CMV免疫球蛋白G（IgG）血清转化为阳性；（ii）妊娠早期母亲出现症状性CMV感染，或超声检测到胎儿宫内生长受限或提示胎儿感染的异常超声检查结果；（iii）CMV特异性IgM血清阳性。对于50名女性，还采集了胎儿血液（FB）并进行了抗原血症检测和PCR检测。结果表明，羊水在CMV感染的产前诊断方面优于胎儿血液。羊水PCR的敏感性（SNS）为100%，特异性（SPE）为83.3%，阳性预测值（PPV）为40%，阴性预测值（NPV）为100%；用相同材料进行快速病毒分离时，SNS为50%，SPE为100%，PPV为100%，NPV为94.7%。酶免疫测定（EIA）检测IgM阳性的女性中，先天性感染胎儿或新生儿的比例不到10%。当通过蛋白质印迹法（WB）确认EIA IgM阳性并考虑WB图谱时，“高危”图谱女性中的传播率高于IgM阳性女性，且与妊娠早期血清转化女性中的传播率相同（分别为29%和25%）。
