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目的探讨早产儿宫内巨细胞病毒(CMV)感染CMV-DNA定量测定与早产儿脑损伤的关系及可能的炎症机制。方法选择2008—2009年本研究中3家医院产科分娩、确诊脑损伤的早产儿为观察组,1∶1配对选择B超确诊无脑损伤的早产儿为对照组,分别用酶联免疫吸附试验法检测脐血白细胞介素-1β(IL-1β)、IL-6、肿瘤坏死因子-α(TNF-α)、IL-10水平,荧光定量PCR测定脐血CMV-DNA水平,比较两组各指标的差异,分析早产儿脑损伤发病影响因素,评价CMV-DNA负载量对早产儿脑损伤发病风险的影响。结果共493例早产儿生后3～7天完成了头颅B超检查,其中脑损伤120例,脑损伤发生率24.3%,对照组配对入选120例无脑损伤早产儿。观察组脐血CMV-DNA阳性率、IL-1β、IL-6、TNF-α水平均高于对照组,IL-10水平低于对照组[阳性率:63.3%比17.5%,IL-1β:(11.4±3.2)μg/L比(5.5±2.1)μg/L,IL-6:(7.8±1.4)μg/L比(3.7±0.8)μg/L,TNF-α:(6.9±1.7)μg/L比(3.5±1.1)μg/L,IL-10:(5.8±1.4)μg/L比(12.7±2.9)μg/L,P均<0.05]。观察组患儿脐血CMV-DNA拷贝数(经对数lg转换)水平高于对照组[(6.8±1.1)比(4.9±0.8),P<0.05]。DNA拷贝数(经对数lg转换)为6～7以及>7是早产儿脑损伤的独立危险因素,其优势比分别为2.344(95%CI:1.117～3.579)和2.679(95%CI:2.018～4.417)。结论早产儿早期CMV感染程度与生后脑损伤的发病风险密切相关,CMV导致的早期脑损伤可能与细胞免疫因子失调相关。
Objective To investigate the relationship between CMV-DNA in preterm infants with intrauterine cytomegalovirus (CMV) infection and premature infants with brain injury and possible inflammatory mechanisms. Methods The obstetric delivery and diagnosis of brain injury in 3 hospitals in our hospital from 2008 to 2009 were selected as the observation group. The preterm infants diagnosed without brain injury in the 1: 1 matched group were selected as the control group. Enzyme-linked immunosorbent assay The levels of IL-1β, IL-6, TNF-α and IL-10 in umbilical cord blood were detected by radioimmunoassay. The levels of CMV-DNA in umbilical cord blood were detected by real-time quantitative PCR. Indicators of differences in the analysis of preterm infants with brain injury factors affecting the evaluation of CMV-DNA load on the risk of brain injury in preterm infants. Results A total of 493 preterm infants were examined by B-ultrasound 3 to 7 days after birth. Among them, 120 were brain injury and 24.3% were brain injury. The control group was matched to 120 premature infants without brain injury. The positive rate of CMV-DNA, the level of IL-1β, IL-6 and TNF-α in cord blood of observation group were higher than that of control group, and the level of IL-10 in control group was lower than that of control group [positive rate: 63.3% (11.4 ± 3.2) μg / L (5.5 ± 2.1) μg / L and IL-6: (7.8 ± 1.4) μg / L and / L ratio (3.5 ± 1.1) μg / L, IL-10: (5.8 ± 1.4) μg / L vs (12.7 ± 2.9) μg / L, P all <0.05]. The level of CMV-DNA copy number (log lg conversion) in cord blood of observation group was higher than that of control group [(6.8 ± 1.1) vs (4.9 ± 0.8), P <0.05]. DNA copy numbers (log lg conversion) of 6-7 and> 7 were independent risk factors for brain injury in preterm infants, with odds ratios of 2.344 (95% CI: 1.117-3.579) and 2.679 (95% CI: 2.018 ~ 4.417). Conclusion The incidence of early CMV infection is closely related to the risk of developing brain injury. The early brain injury induced by CMV may be related to the imbalance of cellular immune factors.