1、CMV宮內感染的研討現狀.先天性感染新生兒感染也稱為先天性感染congenital infection) ，主要包括宮內感染、產程感染和產后感染，其中宮內感染預后嚴重。其病原體主要包括：細菌，如李氏桿菌、軍團菌、結核菌；寄生蟲，如弓形蟲Toxoplasma, TOX；病毒： 風疹 (Rubella virus, RUV), 巨細胞病毒(Cytomegilic virus, CMV), 單純皰疹病毒(Herpessimplex virus, HSV) 乙型肝炎 HBV愛滋病 HIV-1其他病原體，如衣原體、支原體、梅毒；等所致的感染在新生兒期均有共同特點，故國外簡稱TORCH 綜合癥。.“T代表

2、弓形蟲Toxoplasma “O代表其他柯薩其病毒，衣原體等Other “R代表風疹病毒Rubella ViruS “C代表巨細胞病毒Cytomegalo ViruS “H代表單純皰疹病毒HerpesStmplex Virus， ToRCH 綜合癥一組優生優育挑選常用檢測對象TORCH綜合癥：是指可導致先天性宮內感染及圍產期感染而引起圍產兒畸形的病原體，它是一組病原微生物的英文稱號縮寫： .宮內感染的途徑宮內感染有以下幾種途徑：病原體由母體血運經胎盤而進入胎兒血循環中，或因胎盤炎癥進入羊水中。病原體經陰道、宮頸上行性感染。胎膜已破者病原體可直接進入羊水；假設未破，那么可經胎膜或蛻膜而污染羊水。

3、病原體經輸卵管下行性感染，由于絨毛膜、羊膜炎或蛻膜炎進入羊水。胎兒感染可由胎兒吞咽羊水至胃腸道內或吸入呼吸道內而感染。.宮內感染的發病機制1. 受孕前感染：病原體在孕前即進入卵細胞或精子，受精時產生先天轉錄 其病原體轉入受精卵，使胚胎發育受阻。2. 著床前感染：病原體依賴于生殖細胞進展增殖，導致胚胎畸變，殘疾或流產。3. 著床后感染：感染發生于妊娠1-3個月，導致重要器官系統發育缺陷。.宮內感染嚴重性的影響要素1. 病原體的數量與毒力2. 母體的免疫形狀：初感時宿主免疫低下，感染后長期埋伏于體內，當宿主免疫力再度下降病原體激活 增殖再染 受感染器官系統損害加重。3. 胎兒成熟度。.巨細胞病毒

4、(cytomegalovirus, CMV ) .巨細胞病毒構造模擬圖.CMV感染的根本特征CMV infects not only the fibroblasts, but also the majority of body cells.The immune response is focused on two human-CMV proteins, the envelope glycoprotein gB and the phosphoprotein pp65.The virus lacks the enzyme thymidine kinase, therefore it is resi

5、stant to antiviral agents that use this enzyme for their action.Receptor: GEF-Receptor and alpha V integrin; .CMV infects 60% of women of childbearing age in developed countries and 90% in developing countries (Griffiths, P.D. 2002).CMV Infection leaves the patients without symptoms and CMV establis

6、hes latency, except for cases where the hosts immune systemis compromised (AIDS, transplant patients and fetuses).congenital CMV infection can lead to sensorineural hearing loss, mental retardation, and neurologic deficits.CMV感染的流行病學.CMV感染對胎嬰兒生長發育的影響一近期影響：流產、死胎、新生兒死亡，死亡率50%80%；二遠期：5%出現發育異常. 表1 PCR檢測

7、27例畸形及死亡新生兒CMV感染的臟器分布 臟器 受檢數 陽性數 陽性率% 胸腺 11 6 54.6 腦 13 7 53.9 肝 26 13 50.0 肺 26 6 23.1 脾 15 3 20.0 腎 25 7 28.0 心 25 2 8.0 淋巴腺 1 0 0 唾液腺 1 1 1/1 合 計 141 45 31.91 .CMV的傳播途徑血行傳播：輸注血液或血制品 母-嬰間垂直傳播 臟器或組織移植唾液腺傳播：人-人，程度傳播乳汁傳播：哺乳期傳播精液傳播：性接觸傳播.Mother-to-child transmission is mainly the result of primary mat

8、ernal CMV infection which carries a risk of transmission varying from 24% to 75% (mean value 40%) ; Cases of CMV transmission due to non-primary infection have been reported in 12.2% of cases, i.e. at a much lower rate than those resulting from primary infection; (Fowler et al., 1992 CMV的母-嬰傳播途徑.孕婦C

9、MV 感染的診斷；胎兒CMV 宮內感染的診斷；CMV 宮內感染的診斷.1、病原學診斷：目前從血、分泌物、體液等標本中分別培育出病毒仍是診斷HCMV 感染的金規范。 PCR法； 病毒培育法; 2、孕婦血清抗體程度的檢測；血清CMV特異性抗體的亞類鑒定；IgG與IgM血清抗體的親和力測定；孕婦CMV 感染的診斷.CMV特異性細胞免疫功能測定.胎兒超聲學檢查：胎兒CMV 感染后可有超聲學異常表現,如胎兒生長受限、腦室腫大、腹水、顱內鈣化和羊水量異常(通常為羊水過少) 等；羊膜腔穿刺：CMV 宮內感染時,病毒?？衫奂疤耗I臟并在其中復制,含有CMV 的零落細胞可隨胎兒尿液進入羊水中,故羊水中檢出CMV

10、 或其基因片段；臍靜脈穿刺：孕20 周后可在超聲引導下行臍靜脈穿刺，所得胎血除可做病原體分別、基因擴增、特異性IgM抗體檢測外,還可進展病毒定量和其它非特異目的的分析,包括血紅蛋白、血小板、嗜酸性細胞數等血液學目的、轉氨酶等生化目的；胎兒CMV 宮內感染的診斷.固相膜免疫檢測.CMV的防治現狀-Vaccine; Vaccine; Active vaccines have included live attenuated virus, killed virus vaccine, and recombinant vaccines；There are currently twoCMVvaccines

11、 in phase II studies.One is the CMV gB/MF59 vaccine which is disulfide-linked glycoprotein complex (gB) with 130 and 55 kDa components；The other vaccine in human trials is the Towne strain. It is a live attenuated vaccine used extensively in clinical trials and is safe；.Passive Immunization during P

12、regnancy for Congenital Cytomegalovirus Infection;Passive immunization which includes both hyperimmune sera and sera raised against the gB glycoprotein ofgpCMV has also been effective at reducing pup mortality and/or preventing congenital infection；CMV的防治現狀-被動免疫治療; .The end.CMV引起的細胞病變.HCMV感染的免疫學檢測HC

13、MV抗原血癥pp65、IE、p150.Ekaterina Maidji J Virol. 2007. .CMV的埋伏感染與再次激活宿主情況(安康或正常) 病毒埋伏(無臨床病癥)- 平衡形狀 (突破平衡) 生物的 物理的 | 化學的 | 等等 埋伏的病毒 -激活(復制) .A 64 year old woman had taken oral corticosteroids for 2 years, in treatment of polymyalgia rheumatica. She now presents with abdominal pain and rectal bleeding. En

14、doscopic examination of the colon showed cecal ulcerations, and a partial bowel resection was ultimately undertaken. .HSV-1型所致唇皰疹.水痘-帶狀皰疹病毒感染所致的帶狀皰疹.結核病的病原體-結核分枝桿菌.弓形體-蟲卵囊.傳播途徑的表示圖.皰疹病毒(herps virus) 皰疹病毒的電鏡照片.風疹病毒感染.梅毒(syphilis)慘白密螺旋體鏡下形狀暗視野)一種性傳播性疾病梅毒螺旋體梅毒亞種感染所致人是獨一宿主梅毒分先天/獲得性梅毒診治的參考目的: 血清挑選實驗 血清學確診實驗.胎盤粘住頭部 內臟外翻畸形斜視、腦癱.孕婦CMV 感染的診斷.免疫球蛋白抗體的種類.用ELISA法檢測外周血特異性抗體 CMV-IgM、IgG，判別結果： I