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中国循证儿科杂志

中国循证儿科杂志 ›› 2024, Vol. 19 ›› Issue (6): 460-463.DOI: 10.3969/j.issn.1673-5501.2024.06.010

• 论著 • 上一篇    下一篇

新生儿生后14和21天内检测B19病毒IgM阳性与先天性心脏病关联性分析的回顾性队列研究

赵琦1a，沈军1b，曹凌峰1c，王佳钰1d, 2，孙淑娜1a   

  1. 1 复旦大学附属儿科医院上海，201102，a 心血管中心，b 感染传染科，c 临床检验中心，d 儿科研究院；2 国家卫生健康委员会新生儿疾病重点实验室（复旦大学）上海，201102
  • 收稿日期:2024-08-15 修回日期:2024-12-02 出版日期:2024-12-25 发布日期:2024-12-25
  • 通讯作者: 孙淑娜

The association between B19 virus IgM positivity within 14 and 21 days after birth and congenital heart disease: A retrospective cohort study

ZHAO Qi1a, SHEN Jun1b, CAO Lingfeng1c, WANG Jiayu1d, 2, SUN Shuna1a   

  1. 1 Children’s Hospital of Fudan University, Shanghai 201102, China, a Cardiovascular Center, b Infectious Disease Deparment, c Clinical Laboratory Center, d Institute of Pediatrics; 2 National Health Commission Key Laboratory of Neonatal Diseases (Fudan University), Shanghai 201102, China
  • Received:2024-08-15 Revised:2024-12-02 Online:2024-12-25 Published:2024-12-25
  • Contact: SUN Shuna

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摘要： 背景 目前关于宫内感染B19病毒与先天性心脏病（CHD）发生的关联性尚不明确。 目的 探讨宫内感染B19病毒的新生儿的临床特征，分析B19病毒感染与 CHD的关联性，以及关联性临床指标。 设计 回顾性队列研究。 方法 纳入2017年9月至2023年4月在复旦大学附属儿科医院住院且在生后21 d内进行血清B19病毒IgM检测的新生儿。将生后0~21 d检测B19病毒IgM阳性病例（以下简称：21 d内阳性组）中分出0~14 d检测B19病毒IgM阳性病例（以下简称：14 d内阳性组）；按照性别、同一季节出生按1∶ 3随机分别匹配21 d内阳性组的对照组（对照1组）和14 d内阳性组的对照组（对照2组）病例。从病历系统中采集与B19病毒感染和CHD诊断相关的信息，以及其他临床资料。 主要结局指标 新生儿B19病毒IgM检测阳性与CHD的关联性。 结果 21 d内阳性组83例，其中CHD18例；14 d内阳性组30例，其中CHD 9例；对照1组249例，其中CHD 31例；对照2组112例，其中CHD 16例。CHD、合并胸腔/腹腔/其他腔隙积液、Hb 降低伴Ret不升高的比例、白蛋白降低、ALT升高在21 d内阳性组高于对照1组，差异均有统计学意义；除ALT升高外，14 d内阳性组与对照2组比较结果同21 d内阳性组与对照1组。多因素Logistic回归分析显示，21 d内阳性组（OR=2. 695, 95%CI: 1. 058~7. 545, P=0. 049）和14 d内阳性组（OR=5. 166, 95%CI: 1. 034~25. 814, P=0. 045）皆与CHD存在关联。21 d内阳性组和14 d内阳性组中，均发现合并胸腔/腹腔/其他腔隙积液与发生CHD关联。 结论 B19病毒宫内感染与CHD发生存在关联。生后0~14 d或生后0~21 d B19病毒IgM阳性患儿，出现水肿征象（胸腔/腹腔/其他腔隙积液）进一步提示发生CHD的风险，需及时进行心血管相关检查。

关键词: B19病毒, 先天性心脏病, IgM阳性, 新生儿

Abstract: Background The association between intrauterine infection with B19 virus and the development of congenital heart disease (CHD) are still unclear. Objective To investigate the clinical characteristics of neonates with intrauterine B19 virus infection and the association between B19 virus infection and CHD. Design Retrospective cohort study. Methods Neonates who were hospitalized in the Children's Hospital of Fudan University from September 2017 to April 2023 and underwent serum B19 virus IgM testing within 21 d after birth were included. B19 virus IgM-positive cases detected at 0-14 d postnatal (hereinafter referred to as: positive group within 14 d) were seperated from 0-21 d B19 virus IgM-positive cases detected at 0-21 d (hereinafter referred to as: positive group within 21 d). The control groups were randomly matched with the positive group within 21 d (control group 1) and with the positive group within 14 d (control group 2) according to gender and the same season of the birth rows 1: 3. Clinical information including B19 virus infection and CHD were collected from the medical record system. Main outcome measures The association of neonatal positive B19 virus IgM and CHD. Results There were 83 cases in the positive group within 21 d, including 18 cases of CHD, 30 cases in the positive group within 14 d, including 9 cases of CHD, 249 cases in the control group 1, including 31 cases of CHD, and 112 cases in the control group 2, including 16 cases of CHD. The proportions of CHD, combined thoracic/abdominal/other cavity effusion , decreased Hb with no increase in Ret, decreased albumin, increased ALT were higher in the positive group within 21 d than in the control group, and the differences were statistically significant. Except for ALT, the results of the positive group within 14 d with the control group were the same as those of the positive group within 21 d with the control group. Multifactorial logistic regression analysis showed that both positive group within 21 d and positive group within 14 d were associated with CHD（OR21 d positive=2. 695, 95%CI: 1. 058~7. 545, P=0. 049, OR14 d positive=5. 166, 95%CI: 1. 034~25. 814, P=0. 045） Combined thoracic/abdominal/other cavity effusion were associated with the development of CHD both in positive group within 21 d and positive group within 14 d. Conclusion There was an association between intrauterine infection with B19 virus and the development of CHD. Newborns whose B19 virus IgM positive within 0-14 d or 0-21 d after birth, signs of edema (thoracic/abdominal/other cavity effusion) further indicate the risk of CHD, and cardiovascular examinations need to be carried out in time.

Key words: Parvovirus B19, CHD, Positive IgM, Neonate