【摘要】 目的　探讨外周血白细胞巨细胞病毒(cytomegalovirus, CMV)抗原(即刻早期抗原和早期抗原)检测、唾液聚合酶链反应(PCR)检测CMV DNA和血清学检测CMV IgM三种实验方法在诊断和监测新生儿先天性CMV感染中的作用。　方法　对98 例患儿之母在孕期血CMV IgM阳性的高危新生儿出生后14 d 内检查血CMV IgM、外周血白细胞CMV抗原和唾液PCR CMV DNA,比较三种方法的检测结果,并对新生儿进行临床观察和随访。　结果　(1)98 例中,48 例诊断先天性CMV感染。症状性感染7 例,无症状性感染41 例;无一例CMV IgM阳性。症状性感染组CMV抗原、PCR阳性检出率分别为7/7、5/7;无症状性感染组阳性检出率分别为71%(29/41)、46%(19/41)。CMV抗原检测法、PCR检测法的诊断敏感性分别为75%、54%。症状性感染儿每5 万白细胞中CMV阳性细胞数16~52个,无症状性感染儿3~31个,症状性感染儿CMV抗原指数水平显著高于无症状感染儿(P<0.05)。(2)随访10例患儿,2 例症状性感染儿CMV抗原和PCR转阴,症状消失;1例CMV肝炎治疗后CMV抗原和PCR检测仍阳性,最后发展为肝硬化。7 例无症状性感染儿,CMV抗原在6个月内转阴或减少至低水平;2 例伴唾液PCR阳性,复查时1 例转阴,1 例仍阳性。　结论　CMV抗原检测法具有早期、敏感、量化的特点,PCR法能发现潜伏性感染更多还原

【Abstract】 Objective To evaluate the feasibility and utility of three different assays on early diagnosis and monitoring of neonatal congenital cytomegalovirus infection. Methods Ninety-eight neonates whose mother was CMV-IgM positive during pregnancy were examined on the 14th days after birth for CMV antigen in blood and PCR-CMV-DNA in the saliva. Three different methods were applied including CMV antigenemia assay, PCR for CMV-DNA and ELISA for serum CMV-IgM. Neonates were followed up for six months. Results (1) Forty-eight of the 98 neonates were diagnosed as congenital CMV infection including 7 symptomatic infection and 41 asymptomatic. None of the 98 subjects was CMV-IgM positive. Among the 7 symptomatic cases, the positive rates of CMV antigen and PCR-CMV-DNA were 100%(7), 71.4%(5), and 70.7%(29/41), 46.3%(19/41) in the asymptomatic group, respectively. The sensitivity of CMV antigenemia assay and PCR was 75.0% and 54.2%, respectively. The CMV antigenemia index of the symptomatic cases was significantly higher than that of asymptomatic ones [(16-52)/50 000 vs (3-31)/50 000 white blood cells, P<0.05]. (2) Ten cases were followed up. The CMV antigen and PCR result were negative in 2 symptomatic infected cases and remained positive in 1 case after treatment of CMV hepatitis. The last case finally progressed to hepatic cirrhosis. For the 7 asymptomatic cases, the CMV antigenemia decreased to a lower level or became negative within 6 months. One of the two positive PCR-CMV-DNA cases became negative, while another still remained positive. Conclusions The combination of CMV antigenemia assay with PCR for CMV-DNA seemed to be a better method for the early diagnosis and monitoring of neonatal congenital CMV infection. But serum CMV-IgM is less sensitive in early diagnosis of neonatal congenital CMV infection.更多还原