Zika Virus Infection in Pregnant Women in Rio de Janeiro.
Zika Virus Infection in Pregnant Women in Rio de Janeiro.
复制标题
DOI：
10.1056/nejmoa1602412
复制
发表时间：
2016-12-15
期刊：
影响因子：
--
通讯作者：
Nielsen-Saines K
中科院分区：
文献类型：
--
作者：
Brasil P;Pereira JP Jr;Moreira ME;Ribeiro Nogueira RM;Damasceno L;Wakimoto M;Rabello RS;Valderramos SG;Halai UA;Salles TS;Zin AA;Horovitz D;Daltro P;Boechat M;Raja Gabaglia C;Carvalho de Sequeira P;Pilotto JH;Medialdea-Carrera R;Cotrim da Cunha D;Abreu de Carvalho LM;Pone M;Machado Siqueira A;Calvet GA;Rodrigues Baião AE;Neves ES;Nassar de Carvalho PR;Hasue RH;Marschik PB;Einspieler C;Janzen C;Cherry JD;Bispo de Filippis AM;Nielsen-Saines K
寨卡病毒（ZIKV）与胎儿的中枢神经系统畸形有关。为了描述孕妇和婴儿感染寨卡病毒疾病的症状范围，我们对里约热内卢的患者进行了跟踪，以阐述母亲的临床表现以及婴儿急性寨卡病毒感染的影响。
我们招募了在过去5天内出现皮疹的孕妇，并通过逆转录聚合酶链反应检测血液和尿液样本中的寨卡病毒。我们对这些女性进行前瞻性随访，以获取有关妊娠和婴儿结局的数据。
2015年9月至2016年5月期间，共有345名女性入组；其中，182名女性（53%）在血液、尿液或两者中寨卡病毒检测呈阳性。急性寨卡病毒感染的时间从妊娠6周延伸至39周。主要的母体临床特征包括瘙痒性下行性斑疹或斑丘疹、关节痛、结膜充血和头痛；27%的人有发热（短期且低热）。到2016年7月，共有134例受寨卡病毒影响的妊娠和73例未受寨卡病毒影响的妊娠完成，其中125例受寨卡病毒影响的妊娠和61例未受寨卡病毒影响的妊娠结局已知。在未感染寨卡病毒的女性中，42%被确定感染基孔肯雅病毒，而在感染寨卡病毒的女性中这一比例为3%（P<0.001）。两组的胎儿死亡率均为7%；寨卡病毒阳性女性的后代总体不良结局发生率为46%，而寨卡病毒阴性女性的后代为11.5%（P<0.001）。在116名寨卡病毒阳性女性所生的117名活产婴儿中，42%被发现有明显异常的临床或脑部影像学表现，或两者皆有，其中包括4名小头畸形婴儿。无论女性在妊娠哪个阶段感染寨卡病毒，都注意到了不良结局（55%的妊娠在母亲妊娠早期感染后出现不良结局，妊娠中期感染后为52%，妊娠晚期感染后为29%）。
尽管母亲的临床症状较轻，但孕期感染寨卡病毒对胎儿有害，并与胎儿死亡、胎儿生长受限以及一系列中枢神经系统异常有关。（由巴西卫生部等资助）
Zika virus (ZIKV) has been linked to central nervous system malformations in fetuses. To characterize the spectrum of ZIKV disease in pregnant women and infants, we followed patients in Rio de Janeiro to describe clinical manifestations in mothers and repercussions of acute ZIKV infection in infants. We enrolled pregnant women in whom a rash had developed within the previous 5 days and tested blood and urine specimens for ZIKV by reverse-transcriptase–polymerase-chain-reaction assays. We followed women prospectively to obtain data on pregnancy and infant outcomes. A total of 345 women were enrolled from September 2015 through May 2016; of these, 182 women (53%) tested positive for ZIKV in blood, urine, or both. The timing of acute ZIKV infection ranged from 6 to 39 weeks of gestation. Predominant maternal clinical features included a pruritic descending macular or maculopapular rash, arthralgias, conjunctival injection, and headache; 27% had fever (short-term and low-grade). By July 2016, a total of 134 ZIKV-affected pregnancies and 73 ZIKV-unaffected pregnancies had reached completion, with outcomes known for 125 ZIKV-affected and 61 ZIKV-unaffected pregnancies. Infection with chikungunya virus was identified in 42% of women without ZIKV infection versus 3% of women with ZIKV infection (P<0.001). Rates of fetal death were 7% in both groups; overall adverse outcomes were 46% among offspring of ZIKV-positive women versus 11.5% among offspring of ZIKV-negative women (P<0.001). Among 117 live infants born to 116 ZIKV-positive women, 42% were found to have grossly abnormal clinical or brain imaging findings or both, including 4 infants with microcephaly. Adverse outcomes were noted regardless of the trimester during which the women were infected with ZIKV (55% of pregnancies had adverse outcomes after maternal infection in the first trimester, 52% after infection in the second trimester, and 29% after infection in the third trimester). Despite mild clinical symptoms in the mother, ZIKV infection during pregnancy is deleterious to the fetus and is associated with fetal death, fetal growth restriction, and a spectrum of central nervous system abnormalities. (Funded by Ministério da Saúde do Brasil and others.)