寨卡病毒病爆发导致新生儿出生缺陷增加

作者：王韵壹、李英、熊慧卿

本期文章：《新英格兰医学杂志》：Vol.383 No.6

美国疾病控制和预防中心Van T. Tong分析了哥伦比亚寨卡病毒与妊娠结局之间的相关性。2020年8月6日，《新英格兰医学杂志》发表了该成果。

2015和2016年，哥伦比亚爆发了寨卡病毒。两个基于人口的关于症状性寨卡病毒病（ZVD）和先天缺陷的国家监测系统数据提供了寨卡病毒爆发对孕妇和婴儿结局的影响的补充信息。

研究组收集了2015年6月至2016年7月报告的ZVD孕妇病例的国家监测数据。通过实时逆转录酶-聚合酶链反应（rRT-PCR）分析，在这些女性的亚组中鉴定寨卡病毒RNA的存在。在实验室确诊的ZVD女性中鉴定婴儿和胎儿的脑或眼缺陷以及其他不良妊娠结局。

在18117名ZVD孕妇中，有5926名通过rRT-PCR（33%）证实了寨卡病毒的存在。在5673例经实验室确诊为ZVD的孕妇中，有93例婴儿或胎儿（占2％）患有脑或眼缺陷。孕妇在孕早期出现ZVD症状，其婴儿脑或眼缺陷的发生率为3%，显著高于孕中期或孕晚期（1%）。5673例孕妇中有172例（3％）流产。排除受出生缺陷影响的孕妇后，5426例孕妇中有409例（8％）早产，333例婴儿出生体重低（6%）。寨卡病毒爆发期间婴儿脑或眼缺陷的患病率为每10000例活产中有13例，疫情爆发前为8例，疫情爆发后为11例。

总之，在实验室确诊的ZVD孕妇中，寨卡病毒爆发期间婴儿或胎儿的脑部或眼睛缺陷比爆发之前和之后更为普遍。孕早期出现症状的女性缺陷发生率有所增加。

附：英文原文

Title: Zika Virus Disease and Pregnancy Outcomes in Colombia

Author: Martha L. Ospina, M.D.,, Van T. Tong, M.P.H.,, Maritza Gonzalez, M.D.,, Diana Valencia, M.S.,, Marcela Mercado, M.S.,, Suzanne M. Gilboa, Ph.D.,, Andrea J. Rodriguez, B.S.,, Sarah C. Tinker, Ph.D.,, Angelica Rico, M.S.,, Christina M. Winfield, M.P.H.,, Lissethe Pardo, B.S.,, Jennifer D. Thomas, Ph.D.,, Greace Avila, M.S.,, Julie M. Villanueva, Ph.D.,, Sara Gomez, B.S.,, Denise J. Jamieson, M.D.,, Franklyn Prieto, M.D.,, Dana Meaney-Delman, M.D.,, Oscar Pacheco, M.D.,, and Margaret A. Honein, Ph.D.

Issue&Volume: 2020-08-05

Abstract: BACKGROUND

In 2015 and 2016, Colombia had a widespread outbreak of Zika virus. Data from two national population-based surveillance systems for symptomatic Zika virus disease (ZVD) and birth defects provided complementary information on the effect of the Zika virus outbreak on pregnancies and infant outcomes.

METHODS

We collected national surveillance data regarding cases of pregnant women with ZVD that were reported during the period from June 2015 through July 2016. The presence of Zika virus RNA was identified in a subgroup of these women on real-time reverse-transcriptase–polymerase-chain-reaction (rRT-PCR) assay. Brain or eye defects in infants and fetuses and other adverse pregnancy outcomes were identified among the women who had laboratory-confirmed ZVD and for whom data were available regarding pregnancy outcomes. We compared the nationwide prevalence of brain and eye defects during the outbreak with the prevalence both before and after the outbreak period.

RESULTS

Of 18,117 pregnant women with ZVD, the presence of Zika virus was confirmed in 5926 (33%) on rRT-PCR. Of the 5673 pregnancies with laboratory-confirmed ZVD for which outcomes had been reported, 93 infants or fetuses (2%) had brain or eye defects. The incidence of brain or eye defects was higher among pregnancies in which the mother had an onset of ZVD symptoms in the first trimester than in those with an onset during the second or third trimester (3% vs. 1%). A total of 172 of 5673 pregnancies (3%) resulted in pregnancy loss; after the exclusion of pregnancies affected by birth defects, 409 of 5426 (8%) resulted in preterm birth and 333 of 5426 (6%) in low birth weight. The prevalence of brain or eye defects during the outbreak was 13 per 10,000 live births, as compared with a prevalence of 8 per 10,000 live births before the outbreak and 11 per 10,000 live births after the outbreak.

CONCLUSIONS

In pregnant women with laboratory-confirmed ZVD, brain or eye defects in infants or fetuses were more common during the Zika virus outbreak than during the periods immediately before and after the outbreak. The frequency of such defects was increased among women with a symptom onset early in pregnancy.

DOI: 10.1056/NEJMoa1911023

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa1911023

期刊信息

The New England Journal of Medicine：《新英格兰医学杂志》，创刊于1812年。隶属于美国麻省医学协会，最新IF：70.67
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