摘要目的:分析极早产儿或极低出生体重儿获得性巨细胞病毒（pCMV）感染的临床特征。方法:病例-对照研究，纳入2019年1月至2024年6月收住浙江大学医学院附属儿童医院新生儿重症监护病房并诊断pCMV感染的极早产儿或极低出生体重儿共50例作为pCMV组，采用倾向性评分1∶1匹配同时期非巨细胞病毒感染的50例极早产儿或极低出生体重儿作为对照组。pCMV组根据抗病毒治疗情况分为治疗组和未治疗组。收集各组患儿的临床特征、实验室检查结果、临床结局等资料，组间比较采用 χ2检验或连续校正 χ2检验或Fisher确切概率法、独立样本 t检验及Mann-Whitney U检验，采用二元Logistic回归分析危险因素，相关性采用Spearman相关性分析。 结果:pCMV组与对照组出生胎龄、出生体重、男性比例、第1及5分钟Apgar评分、生后前3周母乳喂养天数等差异均无统计学意义（均 P>0.05）。与对照组相比，pCMV组住院时间及接受有创机械通气时间均更长，发生支气管肺发育不良、早产儿视网膜病、听力损伤的比例均更高（均 P<0.05）。pCMV组校正胎龄36周龄时的体重、身长均低于对照组（均 P<0.05）。pCMV感染与早产儿坏死性小肠结肠炎及严重脑室内出血的发生率增加均相关［ OR=11.50（95% CI 1.94~68.30）、6.82（95% CI 1.19~38.97），均 P<0.05］。治疗组经抗病毒治疗6~8周后血小板计数较未治疗前明显升高［（245±19）×10 9比（119±14）×10 9/L， t=5.37， P<0.001］。 结论:pCMV感染的极早产儿或极低出生体重儿住院时间和接受有创机械通气时间明显更长，更容易发生支气管肺发育不良、早产儿视网膜病、听力损伤及生长受限。抗病毒治疗可改善血小板减少。

abstractsObjective:To analyze the clinical features of postnatal cytomegalovirus (pCMV) infection in very preterm infants or very low birth weight infants.Methods:This was a case-control study. A total of 50 very preterm or very low birth weight infants who were hospitalized and diagnosed with pCMV infection in the Neonatal Intensive Care Unit of Children′s Hospital, Zhejiang University School of Medicine from January 2019 to June 2024, were enrolled as the pCMV group. Meanwhile, through propensity score matching, each infant in the pCMV group was paired with a very preterm or very low birth weight infant without cytomegalovirus infection during the same period, constituting the control group, also consisting of 50 cases. Subsequently, the pCMV group was divided into a treated subgroup and an untreated subgroup according to antiviral treatment. Clinical data of all enrolled infants, including clinical features, laboratory test results, and clinical outcomes were collected. Differences in relevant parameters were analyzed using with χ2 test or continuity-corrected χ2 test or Fisher′s exact test, independent-samples t test, Mann-Whitney U test as appropriate. Logistic regression was employed to analyze the risk factors, and Spearman correlation analysis was applied for non-normal distribution data or ordinal data. Results:There were no significant differences between the pCMV group and the control group in terms of gestational age, birth weight, proportion of male infants, Apgar score at the 1 st minute and 5 th minute and days of breastfeeding during the first 3 weeks of life (all P>0.05). Compared with the control group, the duration of hospital stay and invasive mechanical ventilation were both longer in the pCMV group (both P<0.05). The risks of bronchopulmonary dysplasia, retinopathy of prematurity, and hearing impairment were all higher in the pCMV group when compared with the control group(all P<0.05). The body weight and body length of the infants in the pCMV group were both lower than those of in the control group at the corrected gestational age of 36 weeks (both P<0.05). pCMV infections were associated with the increased incidence of both necrotizing enterocolitis ( OR=11.50, 95% CI 1.94-68.30, P=0.007) and severe intraventricular hemorrhage ( OR=6.82, 95% CI 1.19-38.97, P=0.031) in very preterm infants or very low birth weight infants. In the treated group, the platelet count was significantly improved after 6-8 weeks of antiviral treatment compared with that before treatment ((245±19)×10 9/L vs. (119±14)×10 9/L, t=5.37, P<0.001). Conclusions:Very preterm infants or very low birth weight infants with postnatal cytomegalovirus infection have longer hospital stay and duration of invasive mechanical ventilation, and are highly susceptible to bronchopulmonary dysplasia, retinopathy of prematurity, hearing impairment, and growth restriction. Antiviral treatment can effectively ameliorate thrombocytopenia in these infants.