人巨细胞病毒感染及母婴传播阻断临床研究进展

doi:10.3877/cma.j.issn.1674-1358.2017.06.002

人巨细胞病毒（HCMV）为dsDNA病毒，其囊膜糖蛋白和基质蛋白诱导人体产生免疫反应。HCMV通过直接损伤和免疫病理损伤，导致多器官损害。人感染HCMV以潜伏性和再次激活为特征，临床症状与免疫力状态有关。本文旨在对HCMV感染的流行病学、临床表现及母婴感染特点、实验室检查手段及评价、抗HCMV治疗及母婴阻断措施作一综述。我国育龄妇女HCMV血清学阳性率为95%以上，妊娠期原发感染率为1%～4%，其中24%～75%通过垂直传播引发宫内胎儿感染，导致其发育畸形、流产、死胎或新生儿出生缺陷甚至死亡，建议实施规范感染控制措施预防孕期CMV感染。先天性CMV感染可累及多脏器，常见于神经系统和网状内皮系统损害。HCMV检测包括分子技术与非分子技术，抗-HCMV亲和力的测定有助于原发感染的诊断。目前不能将抗病毒治疗和超免疫球蛋白作为预防孕期先天性CMV感染常规手段。抗病毒药阿昔洛韦、伐昔洛韦、泛昔洛韦无致畸作用，但仍有必要评价其孕期治疗的安全性和有效性。巨细胞病毒免疫球蛋白是防治HCMV感染的有效制剂，单克隆抗体的研制是防治HCMV感染的研究热点之一。

关键词: 人巨细胞病毒, 母婴传播阻断, 新生儿, 孕妇

Human cytomegalovirus (HCMV), a double-stranded DNA virus, whose envelope glycoproteins and matrix proteins may induce immune responses in humans. HCMV caused multiple organs damage through direct injury and pathological damage. Latency and reactivation are defining characteristics of HCMV. Clinical symptoms of HCMV infection are related to immune status of the host. This review summarized the epidemiology, clinical manifestations, characteristics of vertical transmission, laboratory test and evaluation, anti-HCMV treatment and mother-to-child blocking methods of HCMV infection. The positive rate with serology in women of childbearing age was over 95%. The rates of primary HCMV infection during pregnancy was 1% to 4%, and 24% to 75% of them could cause intrauterine fetal infection through vertical transmission, resulting in malformations, miscarriages, stillbirths, birth defects or even death. Therefore, it is suggested that standard control measures should be taken to prevent CMV infection during pregnancy. Congenital CMV infection involves multiple organs, most common in nervous system or reticuloendothelial system. HCMV detection included both molecular and non-molecular techniques. The determination of avidity of HCMV antibodies is helpful in the diagnosis of primary infection. Antiviral therapy and immunoglobulin may not be routinely used to prevent congenital CMV infection during pregnancy at this stage. Although there was no teratogenic effect of the following antiviral drugs, acyclovir, valaciclovir and famciclovir, it was still needed to evaluate the safety and efficacy of them used in pregnancy. Cytomegalovirus immunoglobulin is an effective preparation for the prevention and treatment of HCMV infection. The development of monoclonal antibody to HCMV is one of research hotspots in prevention and treatment filed.

Key words: Human cytomegalovirus, Maternal-infant interruption, Newborn, Pregnant women

表1 先天性CMV感染胎儿异常产前超声表现

产前超声表现	概率（%）
脑钙化	0.6～17.4
小头畸形	14.5
肠管回声增强	4.5～13.0
宫内生长受限	1.9～13.0
室管膜下囊肿	11.6
脑室扩大	4.5～11.6
腹水	8.7
心包积液	7.2
高回声肾	4.3
肝肿大	4.3
胎盘肿大或胎盘钙化	4.3
肝钙化	1.4
胎儿水肿	0.6

表1 先天性CMV感染胎儿异常产前超声表现

产前超声表现	概率（%）
脑钙化	0.6～17.4
小头畸形	14.5
肠管回声增强	4.5～13.0
宫内生长受限	1.9～13.0
室管膜下囊肿	11.6
脑室扩大	4.5～11.6
腹水	8.7
心包积液	7.2
高回声肾	4.3
肝肿大	4.3
胎盘肿大或胎盘钙化	4.3
肝钙化	1.4
胎儿水肿	0.6

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