Prediction of Congenital Cytomegalovirus Infection in High-Risk Pregnant Women
Prediction of Congenital Cytomegalovirus Infection in High-Risk Pregnant Women
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高危孕妇先天性巨细胞病毒感染的预测
DOI：
10.1093/cid/ciw707
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发表时间：
2017
影响因子：
11.8
通讯作者：
Hideto Yamada
中科院分区：
文献类型：
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作者：
Kenji Tanimura;Shinya Tairaku;Yasuhiko Ebina;Ichiro Morioka;Satoshi Nagamata;Kana Deguchi;Mayumi Morizane;Masashi Deguchi;Toshio Minematsu;Hideto Yamada
BackgroundThis前瞻性研究的目的是确定产妇的临床，实验室和超声检查结果，有效地预测先天性巨细胞病毒（CMV）感染（CCI）的发生在高危孕妇。MethodsThree百CMV免疫球蛋白（IG）M阳性孕妇参加。对孕妇的临床和实验室检查结果进行评价，包括血清CMV IgM和IgG; IgG亲合力指数（AI）;抗原血症测定（C7-HRP）;聚合酶链反应（PCR）检测孕妇血清、尿液和宫颈分泌物中的CMV DNA;产前超声检查结果。为了确定CCI发生的预测因素，Logistic回归分析performed.ResultsIn 22的300名妇女，CCI证实使用PCR新生儿尿液中的CMV-DNA。单因素分析显示，母亲有流感样症状、胎儿超声异常、血清CMV IgM滴度、C7-HRP阳性、CMV IgG AI <40%、宫颈分泌物PCR阳性与CCI的发生有统计学意义。多变量分析显示，超声胎儿异常的存在，（比值比[OR]，31.9; 95%可信区间[CI]，8.5-120.3;P<0.001）和宫颈分泌物PCR阳性结果（OR，16.4; 95% CI，5.0-54.1; P< .001）是CMV IgM阳性妇女CCI的独立预测因素。孕妇宫颈分泌物DNA及胎儿超声异常是高危孕妇发生先天性CMV感染的预测指标。
BackgroundThis prospective study aimed to determine maternal clinical, laboratory, and ultrasound findings that effectively predict the occurrence of congenital cytomegalovirus (CMV) infection (CCI) in high-risk pregnant women.MethodsThree hundred CMV immunoglobulin (Ig) M–positive pregnant women were enrolled. The maternal clinical and laboratory findings, including serum CMV IgM and IgG; IgG avidity index (AI); antigenemia assay (C7-HRP); polymerase chain reaction (PCR) for the detection of CMV-DNA in the maternal serum, urine, and uterine cervical secretion; and prenatal ultrasound findings, were evaluated. To determine predictive factors for the occurrence of CCI, logistic regression analyses were performed.ResultsIn 22 of the 300 women, CCI was confirmed using PCR for CMV-DNA in newborn urine. Univariate analyses demonstrated that the presence of maternal flu-like symptoms, presence of ultrasound fetal abnormalities, serum titers of CMV IgM, positive results for C7-HRP, CMV IgG AI <40%, and positive PCR results in the uterine cervical secretion were statistically associated with the occurrence of CCI. Multivariable analysis revealed that the presence of ultrasound fetal abnormalities (odds ratio [OR], 31.9; 95% confidence interval [CI], 8.5–120.3;P< .001) and positive PCR results in the uterine cervical secretion (OR, 16.4; 95% CI, 5.0–54.1;P< .001) were independent predictive factors of CCI in CMV IgM-positive women.ConclusionsThis is the first prospective cohort study to suggest that the presence of CMV-DNA in the maternal uterine cervical secretion and ultrasound fetal abnormalities are predictive of the occurrence of congenital CMV infection in high-risk pregnant women.