摘要目的 初步探讨早产儿(出生体重≤1500 g)经母乳获得性巨细胞病毒(cytomegalovirus,CMV)感染的发生情况.方法 研究对象为2015年10月至2016年7月收住复旦大学附属儿科医院新生儿重症监护病房(neonatal intensive care unit,NICU)的出生体重≤1500 g、母体CMV DNA阳性的、行母乳喂养的早产儿.收集这些早产儿的母乳及尿标本.采用荧光定量聚合酶链反应检测CMV DNA,并收集和分析这些早产儿的临床资料.采用χ2检验(或Fisher精确概率法)、两独立样本t检验及秩和检验等统计学方法对数据进行统计学分析.结果 (1)共60例母乳CMV DNA阳性的早产儿纳入本研究.其中19例(31.7%)发生经母乳获得性CMV感染(感染组),41例(68.3%)未发生(非感染组).感染组母乳平均CMV病毒载量、出生胎龄、出生体重均高于非感染组[病毒载量:3.76(3.18~4.50)与3.47(3.00~4.88)Log10拷贝/ml,Z=-2.042;出生胎龄:(30.4±2.1)与(28.4±2.3)周,t=3.175;出生体重:1290(750~1500)与1110(575~1480)g,Z=-2.837],接受输血的病例数少于非感染组[5/19与56.1%(23/41),χ2=4.627],差异均有统计学意义(P值均<0.05).19例患儿发生感染的中位时间为92(28~164)d.(2)感染组中,6例症状性感染患儿的感染日龄显现出小于无症状患儿(13例)的趋势,但该差异未见统计学意义[(72±34)与(97±28)d,t=-1.710,P>0.05].(3)感染组19例患儿中,4例(21.1%,4/19)存在明显靶器官损害和(或)血IgM阳性,给予缬更昔洛韦抗病毒治疗;2例临床表现为轻度肝功能损害或中性粒细胞减少的患儿未予抗病毒治疗.对这6例患儿随访1~6个月,发现他们的血常规、生化及眼底检查结果均恢复正常.结论本研究CMV DNA阳性母乳喂养的早产儿(出生体重≤1500 g)经母乳获得性CMV感染发生率为31.7%(19/60),未见严重感染病例.

abstractsObjective To investigate the incidence and clinical presentation of breast milk transmitted cytomegalovirus (CMV) infection among preterm infants with birth weight≤1500 g.Methods Preterm infants enrolled in this study met the following inclusion criteria: birth weight≤1500 g, fed with CMV-positive breast milk and admitted into Neonatal Intensive Care Unit of Children's Hospital of Fudan University within 72 hours after birth from October 2015 to July 2016. And those with congenital digestive tract malformation or congenital CMV infection were excluded. Breast milk and infants' urine samples were regularly screened for CMV DNA by fluorescent quantitative polymerase chain reaction. Symptoms and laboratory findings in infants with CMV infection transmitted via breast milk were documented and analyzed. Differences in relevant parameters were analyzed usingChi-square test, Fisher's exact test,t test or Mann-WhitneyU test where appropriately.Results Sixty preterm infants breastfed with CMV DAN-positive milk were recruited. Among them, 19 (31.7%) developed breast milk-acquired CMV infection as their urine samples were positive for CMV DNA, while the others were negative for CMV DNA (infected group:n=19; non-infected group:n=41). The average CMV copies in breast milk, gestational age and birth weight of the infected group were all significantly higher than those of the non-infected group [3.76 (3.18-4.50) vs 3.47 (3.00-4.88) Log10 copies/ml,Z=-2.042;(30.4±2.1) vs (28.4±2.3) weeks,t=3.175; 1290 (750-1500) vs 1110 (575-1480) g,Z=-2.837; all P<0.05). Fewer infants in the infected group than in the non-infected group received blood transfusion [5/19 vs 56.1%(23/41),χ2=4.627,P<0.05]. Ages of the infants with CMV infection ranged from 26 to 164 days (median age of 92 days). Six out of the 19 infants had clinical symptoms concurrent with viral excretion in urine and the ages of these symptomatic infants of infection were earlier than those of the asymptomatic ones without significance [(72±34) vs (97±28) days,t=-1.710,P>0.05]. Four infants (21.1%, 4/19) had severe organ damage and/or positive IgM antibodies to CMV in serum, and were treated with antiviral therapy. Two had mild symptoms and were not given antiviral therapy. All of the six symptomatic infants were followed-up for one to six months, during which time the complete blood cell count and results of biochemical test and fundus examination were back to normal.Conclusions The incidence of breast milk-acquired CMV infection among preterm infants with birth weight≤ 1500 g was 31.7%, and no severe symptoms were reported in this study.