Value Of Serum Specific Antibody CMV-IgG In The Diagnosis Of Congenital CMV Infection In Neonates

Background and objectives Cytomegalovirus(CMV)is recognized as the most common congenital viral infection in humans.Congenital cytomegalovirus infection can lead to se vere congenital malformation,delayed nerve development and other serious sequelae.It is the main non-genetic factor of sensorineural hearing loss i n children,and has a great influence on the healthy development of child ren.Most congenital CMV infections have no obvious clinical symptoms,and about 10%-15% of congenital cytomegalovirus infants have symptoms at birth,which is called symptomatic congenital CMV infection.There is no standard definition of symptomatic cytomegalovirus infection,and mos t studies have use the presence of one or more of the following symptom atic diseases to define symptomatic diseases:developmental retardation,live r damage(jaundice,hepatomegaly,splenomegaly,liver function damage,e tc.),blood system damage(anemia,thrombocytopenia,punctate cell decre ase,etc.),central nervous system involvement(such as intracranial calcifi cation,microcephaly,convulsion,mental retardation,etc.),and myocardit is,choroidal retinitis,and other lesions.At present,the diagnosis of cytomegalovirus infection is mainly based on clear laboratory evidence: virus isolation and culture,virus antigens(such as PP65 antigens,blood specific antibodies CMV-Ig M and CMV-DN A in serum and / or urine),any of which can be used to diagnose CMV infection.In clinical,when distinguishing the etiology of the newborns with li ver injury and / or cholestasis,most doctors often give priority to ten terms o f eugenics or whole sets of virus,more often than not,further virological exa mination(e.g.,urine CMV-DNA)were performed only if the result of cytomegal ovirus specific antibody CMV-Ig M was positive,ignored the children who wer e CMV-Ig M negative and CMV-Ig G positive.However,the positive rate of seru m antibody Ig M was low,and there was a risk of missed diagnosis.In this paper,193 cases of the First Affiliated Hospital of Zhengzhou Uni versity from June 2015 to June 2017 in neonatal pediatrics were retrospectivel y analyzed,these neonates were hospitalized for liver injury and / or cholesta sis,and the specific antibody CMV-Ig G was positive in eugenic screening or v irus full examination.to compare and analyse the difference of various detectio n methods for CMV infection,and to investigate the clinical significance of se rum specific antibody CMV-Ig G in cytomegalovirus infection.Methods In this study,we selected 193 cases from in the neonatal department of t he First Affiliated Hospital of Zhengzhou University during June 2015 and Jun e 2017,these neonates were hospitalized for liver injury and / or cholestasis,and the specific antibody Ig G was positive in eugenic screening or virus full e xamination.collected and recorded the basic information of age,sex,gestational age,birth weight and related laboratory examination results(including CMV s erum specific antibody Ig M and Ig G,CMV-DNA quantitative in blood and uri neand liver enzyme and bilirubin levels),and do statistical analysis with SPSS 21.0 Software.Results 1 Comparison of common diagnostic methods for CMV infection 1.1 Comparison of Serum CMV-Ig M Antibody and urine CMV-DNA Of the 193 cases,51 cases of specific antibody Ig M were positive,accou nting for 26.4%.92 cases of positive urine CMV-DNA were positive,the posit ive rate was 47.7%.There was significant difference between the two methods(p<0.05).Consistency strength index Kappa was 0.46,in the range of 0.4 and 0.7,the degree of agreement is general.1.2 Comparison of serum and urine CMV-DNA In this study,92 cases(47.7%)were CMV-DNA positive in urine.Serum CMV-DNA was positive in 14 cases,the positive rate was 7.3%.There was a significant difference in the detection rate between the two methods(P < 0.05).The Kappa value of the consistency strength index was 0.158,less than 0.4,and the two detection methods were in poor anastomosis.1.3 Comparison of related Indexes in 92 patients with CMV infection Among the 92 cases of CMV infection,the specific antibody CMV-Ig M was positive in 46 cases(50%),92 cases(100%)of CMV-DNA positive in u rine and 14 cases of CMV-DNA positive in serum(15.2%),and the difference s among the three groups were statistically significant(p<0.05).2 Related Laboratory Indexes of simple CMV-Ig G positive Children Of the 193 cases,CMV-DNA was positive in serum and/or urine in 92 cas es(47.7%),and of the 92 cases with positive CMV-DNA,46 cases were nega tive for Ig M(50.0%).In 46 cases of CMV infection with Ig G antibody positi ve and Ig M negative,there were 12 cases with elevated ALT and 11 cases wi th elevated AST,and direct bilirubin was increased in 22 cases(47.8%),the d ifference among the three is statistically significant(p<0.05).Conclusion 1.The positive rate of urine CMV-DNA is higher than that of serum CM V-DNA and serum antibody Ig M,which is more suitable for clinical diagnosis of CMV infection.2.For the children with liver injury and cholestasis,especially the patient s with elevated direct bilirubin,there is still a certain proportion of CMV infe ction in the patients with CMV-Ig G positive serum specific antibody,and furth er quantitative detection of the virus is needed.