PCR tests for uterine cervical secretion are promising noninvasive methods for predicting congenital cytomegalovirus infection
PCR tests for uterine cervical secretion are promising noninvasive methods for predicting congenital cytomegalovirus infection
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宫颈分泌物 PCR 检测是预测先天性巨细胞病毒感染的有前景的无创方法
DOI：
10.1080/14737159.2017.1318068
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发表时间：
2017
影响因子：
5.1
通讯作者：
Hideto Yamada
中科院分区：
文献类型：
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作者：
Kenji Tanimura;Yasuhiko Ebina;Hideto Yamada
病原体在分娩期间传播给新生儿可通过新生儿暴露于生殖器分泌物或通过血源性感染发生。B族链球菌（GBS）、单纯疱疹病毒（HSV）、人乳头瘤病毒（HPV）、沙眼衣原体、淋病奈瑟菌和巨细胞病毒（CMV）可通过新生儿接触生殖器分泌物传播。事实上，GBS培养和检测生殖器分泌物中沙眼衣原体的聚合酶链反应（PCR）测试被广泛用作孕产妇筛查工具，以防止分娩期间这些病原体的母婴传播。在既往研究中，有报道称，母体宫颈分泌物或阴道分泌物中存在病毒DNA，包括B型肝炎病毒、人类免疫缺陷病毒（HIV）和HPV，可能是病毒母婴传播的危险因素[1-3]。然而，还没有研究评估PCR检测宫颈分泌物中CMV-DNA作为出生前预测先天性CMV感染的工具的可用性。人类CMV是人类先天性病毒感染的最常见原因。10%至15%的感染胎儿在出生时具有先天性CMV感染的临床症状，包括胎儿生长受限、中枢神经系统和多器官受累。大约90%的存活婴儿有明显的先天性CMV感染症状，有严重的长期神经系统后遗症。此外，即使在出生时没有明显的先天性CMV感染症状的婴儿中，也有10-15%的婴儿会出现长期后遗症，包括进行性或迟发性感音神经性听力困难。另一方面，有研究表明，使用新生儿尿液样本中CMV-DNA的PCR检测进行早期诊断和早期抗病毒治疗可能会改善有症状的先天性CMV感染婴儿的神经系统结局[4-7]。因此，产前检测的母亲和新生儿在先天性CMV感染的高风险是重要的。然而，仍然不推荐对新生儿进行先天性CMV感染的普遍筛查。因此，我们试图确定预测先天性CMV感染的非侵入性方法，包括高危孕妇宫颈分泌物中CMV-DNA的PCR检测[8]。
Intrapartum transmission of pathogens to newborns can occur by exposure of genital secretions to newborns or by hematogenous infection. Group B streptococci (GBS), herpes simplex virus (HSV), human papilloma virus (HPV), Chlamydia trachomatis, Neisseria gonorrhea, and cytomegalovirus (CMV) can be transmitted by newbornsL exposure to genital secretions. Indeed, culture of GBS and polymerase chain reaction (PCR) tests for the detection of Chlamydia trachomatis in the genital secretions are widely used as maternal screening tools to prevent intrapartum mother-to-infant transmission of these pathogens. In previous studies, it was reported that the presence of viral DNA, including hepatitis B virus, human immunodeficiency virus (HIV), and HPV, in the maternal uterine cervical secretion or vaginal secretion may be a risk factor for mother-to-child transmission of viruses [1-3]. However, there have been no studies that evaluate the usability of PCR tests for CMV-DNA in the uterine cervical secretion as a tool for predicting congenital CMV infection before birth. Human CMV is the most common cause of congenital viral infection in humans. Ten to fifteen percent of infected fetuses have the clinical symptoms of congenital CMV infection, including fetal growth restriction, and central nervous system and multiple organ involvement, at birth. Approximately 90% of the surviving infants who have obvious symptoms of congenital CMV infection have severe long-term neurological sequelae. In addition, even in the infants who have no obvious symptoms of congenital CMV infection at birth, 10-15% of them develop long-term sequelae, including progressive or late-onset sensorineural hearing difficulty. On the other hand, it has been suggested that early diagnosis using PCR assay for CMV-DNA in newborn urine samples and early antiviral therapy may improve neurological outcomes of infants with symptomatic congenital CMV infection [4-7]. Therefore, the prenatal detection of mothers and newborns at high risk for congenital CMV infection is important. However, universal screening of newborns for congenital CMV infection is still not recommended. Hence, we tried to determine noninvasive methods for predicting congenital CMV infection, including PCR tests for CMV-DNA in the uterine cervical secretion, among high-risk pregnant women [8].