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目的探讨逆转录聚合酶链反应(RT-PCR)技术用于产前诊断人巨细胞病毒(HCMV)宫内活动性感染的临床价值。方法应用酶联免疫吸附试验(ELISA)、RT-PCR及血浆套式聚合酶链反应(N-PCR)法,检测311例孕妇外周血HCMV mRNA、HCMV IgM及HCMV DNA,其中任意2项阳性为HCMV活动性感染(119例,观察组)、任意2项均阴性为非活动性感染(192例,对照组)。应用RT-PCR和N-PCR技术,检测两组孕妇从宫内采集的孕早期绒毛共108例、孕中期脐血和羊水共203例,并追踪胎儿生长发育及出生后情况。结果 (1)观察组绒毛、脐血HCMV感染率分别为55%(22/40)、48.1%(38/79);对照组分别为10.3%(7/68)、11.3%(14/124),两组比较,差异有极显著性(P<0.001)。观察组绒毛、脐血HCMV活动性感染率分别为32.5%(13/40)和30.4%(24/79);显著高于对照组的5.8%(4/68)和6.45%(8/124),两组比较,差异有极显著性(P<0.001)。(2)HCMV DNA阳性胎儿中,HCMVmRNA阳性胎儿的流(早)产率为42.9%(21/49),显著高于HCMV mRNA阴性胎儿的12.5%(4/32)。HCMV活动性感染胎儿中,有12例因胎儿生长发育异常而行终止妊娠术。结论应用RT-PCR技术产前诊断HCMV宫内活动性感染安全可靠,对于活动性感染孕妇的胎儿取舍具有临床指导价值。
Objective To investigate the clinical value of reverse transcription-polymerase chain reaction (RT-PCR) in prenatal diagnosis of human cytomegalovirus (HCMV) intrauterine infection. Methods The HCMV mRNA, HCMV IgM and HCMV DNA in peripheral blood of 311 pregnant women were detected by ELISA, RT-PCR and N-PCR, and any two of them were positive HCMV active infection (119 cases, observation group), any two were negative for non-active infection (192 cases, control group). Using RT-PCR and N-PCR technology, we detected 108 cases of first trimester villus collected from the uterus in the two groups and 203 cases of second trimester umbilical cord blood and amniotic fluid, and traced fetal growth and development after birth. Results (1) HCMV infection rates in villus and cord blood of observation group were 55% (22/40) and 48.1% (38/79) respectively, while those in control group were 10.3% (7/68) and 11.3% (14/124) There was significant difference between the two groups (P <0.001). The infection rate of HCMV in observation group was 32.5% (13/40) and 30.4% (24/79) respectively, significantly higher than those in control group (5.8% (4/68) and 6.45% (8/124) There was significant difference between the two groups (P <0.001). (2) HCMV mRNA-positive fetuses had HCMV mRNA-positive fetuses with a flow (early) yield of 42.9% (21/49), significantly higher than 12.5% (4/32) of HCMV mRNA-negative fetuses. HCMV activity of infected fetus, 12 cases of fetal growth and development due to abnormal termination of pregnancy. Conclusion The prenatal diagnosis of active intrauterine infection of HCMV by RT-PCR technique is safe and reliable, and has clinical value in the fetus selection of pregnant women with active infection.