Maternal and neonatal screening methods for congenital cytomegalovirus infection
Maternal and neonatal screening methods for congenital cytomegalovirus infection
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DOI：
10.1111/jog.13889
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发表时间：
2019-03-01
影响因子：
1.6
通讯作者：
Yamada, Hideto
中科院分区：
文献类型：
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作者：
Tanimura, Kenji;Yamada, Hideto
人类巨细胞病毒(CMV)是一种常见的先天性感染原因，可导致严重的长期后遗症。由于没有既定的疫苗、胎儿干预或新生儿治疗，因此既不建议进行孕产妇筛查，也不建议进行新生儿筛查。然而，最近的研究表明，早期抗病毒治疗可能会改善有症状的先天性感染婴儿的神经预后。因此，产前检测对于感染这种疾病的高危新生儿可能很重要。羊水中巨细胞病毒DNA的聚合酶链式反应被认为是诊断宫内感染的金标准，但由于羊水穿刺术是一种侵入性操作，其应用受到限制。在一项前瞻性队列研究中，我们已经报道，在高危人群中，母亲宫颈分泌物中CMV DNA的存在预示着先天性感染。然而，我们最近也证明，用特异性免疫球蛋白G、免疫球蛋白G亲和力指数或特异性免疫球蛋白M进行母体CMV感染的血清学筛查可能会忽略许多病例。先前的研究表明，通过普遍筛查新生儿尿液CMV DNA的早期检测与早期抗病毒治疗相结合，可以改善有症状的先天性感染婴儿的预后。在本文中，我们回顾了母亲和新生儿先天性巨细胞病毒感染筛查的现状。
Human cytomegalovirus (CMV) is a common cause of congenital infection that may lead to severe long-term sequelae. Because there are no established vaccines, fetal interventions or neonatal treatments, neither maternal nor neonatal screening is recommended. However, recent studies have indicated that early antiviral treatment may improve neurological outcomes in symptomatic infants with congenital infection. Therefore, prenatal detection may be important in newborns at high risk of such infection. Polymerase chain reaction for CMV DNA in the amniotic fluid is considered the gold standard for diagnosis of intrauterine infection, but its use is limited because amniocentesis is an invasive procedure. In a prospective cohort study, we have reported that the presence of CMV DNA in secretions of the maternal uterine cervix were predictive of congenital infection in groups at high risk. However, we also recently demonstrated that maternal serological screening for primary CMV infection using specific immunoglobulin G, the immunoglobulin G avidity index or specific immunoglobulin M can overlook many cases. Previous research has indicated that the combination of early detection by universal neonatal screening of urinary CMV DNA combined with early antiviral therapy can improve outcomes in infants with symptomatic congenital infection. In this article, we review the current state of maternal and neonatal screening for congenital CMV infection.