Article record

先天性巨细胞病毒的流行病学、早期治疗及后遗症预测因素：一项全国性队列研究

Epidemiology, Early Therapy and Sequelae Predictors in Congenital CMV: A Nationwide Cohort Study.

临床研究耳科IF 2.1Q2

文献信息

PMID	42764414
原文	在 PubMed 查看原文 ↗
发表日期	2026
作者	Renato Gualtieri 查看其他 15 位作者 Aimilia Tzani；Sebastien Papis；Hélène Cao Van；Manon Jaboyedoff；Yves Fougère；Eric Giannoni；Marie Ballester；Abdelaziz Zemmouri；Michael Russo；Michael Buettcher；Lisa Kottanattu；Petra Zimmermann；Laure F Pittet；Klara M Posfay-Barbe；Arnaud G L'Huillier
作者单位	From the Department of Pediatrics, Gynecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland. 查看其他 11 条单位信息 Division of Pediatrics, Department of Women-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.；Division of General Pediatrics, Department of Women, Child and Adolescent Health, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.；Pediatric Otolaryngology Unit, Department of Otorhinolaryngology, Head and Neck Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.；Department of Pediatrics, Hôpital de Morges, Ensemble Hospitalier de la Côte, Morges, Switzerland.；Department of Pediatrics, Sion Hospital, Centre Hospitalier du Valais Romand, Sion, Switzerland.；Pediatric Infectious Diseases Unit, Children's Hospital of Central Switzerland (KidZ), Lucerne, Switzerland.；Faculty of Health Sciences and Medicine, Department of Pediatrics, Children's Hospital of Central Switzerland, University of Lucerne, Lucerne, Switzerland.；Paediatric Pharmacology and Pharmacometrics Research Unit, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland.；Institute of Pediatrics of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.；Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.；Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland.
期刊	The Pediatric infectious disease journal
SCI 分区	Q2
IF	2.1
研究类型	临床研究 · 临床
所属专科	耳科

中文摘要

背景： 先天性巨细胞病毒（cCMV）是最常见的先天性感染，约17%-20%的感染新生儿会发展为永久性后遗症。早期风险分层仍然具有挑战性，但对治疗决策至关重要。我们旨在描述全国流行病学特征，识别后遗症的早期预测因素，并评估早期抗病毒治疗对cCMV婴儿结局的影响。
方法： 我们在2017年至2024年间开展了一项全国性前瞻性观察研究，分析了瑞士确诊cCMV婴儿的出生及1年随访数据。
结果： 共纳入209名cCMV感染儿童。出生时最常见的发现是小头畸形（35%）、宫内生长受限（34%）和神经影像学异常（36%）。36%（75/209）的患者接受了抗病毒治疗，其中75%（56/75）在出生后第一个月内开始治疗。多变量分析确定肝脾肿大（比值比13.2，95%置信区间2.3-75.2）和出生时肌张力低下（比值比6.6，95%置信区间1.1-41.1）是迟发性感音神经性听力损失（SNHL）的独立预测因素。在1年随访评估时，与延迟开始治疗相比，早期开始治疗与神经发育障碍发生率显著降低相关（23% vs. 50%，P = 0.004）。
结论： 这项瑞士全国性研究证实了既往报道的出生时肝脾肿大与迟发性SNHL之间的关联，并确定肌张力低下是迟发性SNHL的新独立预测因素。数据还证实了早期抗病毒治疗的关键作用，尤其是对神经发育障碍，强调了在有指征时及时诊断和治疗cCMV的重要性。

英文摘要

BACKGROUND: Congenital cytomegalovirus (cCMV) is the most common congenital infection, with approximately 17%-20% of infected neonates developing permanent sequelae. Early risk stratification remains challenging yet crucial for therapeutic decision-making. We aimed to characterize national epidemiology, identify early predictors of sequelae, and assess the impact of early antiviral treatment on outcomes in infants with cCMV.
METHODS: We conducted a nationwide prospective observational study between 2017 and 2024, analyzing birth and 1-year follow-up data of infants with confirmed cCMV in Switzerland.
RESULTS: Two hundred and nine cCMV-infected children were included. The most common findings at birth were microcephaly (35%), intrauterine growth restriction (34%) and neuroimaging abnormalities (36%). Antiviral treatment was administered to 36% (75/209) of patients, among whom 75% (56/75) had treatment initiation within the first month of life. Multivariate analysis identified hepatosplenomegaly (odds ratio 13.2, 95% confidence interval, 2.3-75.2) and hypotonia at birth (odds ratio 6.6, 95% confidence interval, 1.1-41.1) as independent predictors of late-onset sensorineural hearing loss (SNHL). At the 1-year follow-up assessment, early treatment initiation was associated with significantly lower rates of neurodevelopmental disorders compared with delayed treatment initiation (23% vs. 50%, P = 0.004).
CONCLUSIONS: This Swiss nationwide study confirms the previously reported association between hepatosplenomegaly at birth and late-onset SNHL and identifies hypotonia as a new independent predictor of late-onset SNHL. The data also confirm the crucial role of early antiviral treatment, particularly for neurodevelopmental disorders, emphasizing the importance of prompt cCMV diagnosis and treatment when indicated.