[Correlation between serum IgM antibody and viral load with clinical symptoms in neonates infected with cytomegalovirus].

To investigate the correlation between serum cytomegalovirus (CMV) IgM antibody/viral load and infection-related clinical symptoms in neonates infected with CMV, and provide basis for clinical assessment and monitoring of neonatal CMV infection. A total of 70 neonates with CMV infection admitted to neonatology in Women's Hospital, School of Medicine Zhejiang University, from January 2014 to December 2020 were included in this study. Using real-time quantitative PCR as the diagnostic criteria, congenital cytomegalovirus-infected neonates (n=29) was diagnosed within the first 3 weeks of life, otherwise, it was postnatally acquired cytomegalovirus infection (n=41). The differences in general information and clinical indicators between IgM antibody positive and negative patients were analyzed, combined with the PCR result, the correlation between the IgM/viral load and the occurrence of symptoms were analyzed. T-test and non-parametric test were used to compare the differences of indicators between groups, logistic regression was used for multivariate analysis, and ROC curve was used to evaluate the auxiliary diagnostic value of relevant indicators. In the congenital CMV infection group and the postnatally acquired CMV infection group, viral load and the proportion of symptomatic patients in IgM positive group were significantly higher than IgM negative group (Z=-2.616, P=0.008; 80% vs. 21%, P=0.005) (Z=-2.405, P=0.016; 56% vs. 19%, P=0.025). Logistic regression analysis of the included population showed the risk factors of CMV infection-related symptoms were IgM positive (OR 4.562, 95%CI:1.461-14.246,P=0.009) and viral load (OR 1.728, 95%CI:1.068-2.798,P=0.026). Regressive analysis for single symptom with correction showed IgM antibody positive was associated with hearing dysfunction(OR 3.954, 95%CI:1.066-14.677,P=0.040),the CMV viral load was associated with thrombocytopenia (OR 2.228, 95%CI:1.124-4.413,P=0.022), and brain imaging abnormalities (OR 3.956, 95%CI:1.421-11.011, P=0.008). Receiver operating characteristic (ROC) analysis showed the area under ROC curve of CMV viral load for brain imaging abnormalities was 0.883 (P<0.001), with a sensitivity of 75.0% and specificity of 90.3%. For neonates infected with CMV, the risk of infection-related clinical symptoms and hearing dysfunction may be increased when IgM antibody was positive. Meanwhile, the higher the CMV viral load at diagnosis, the higher the risk of thrombocytopenia and abnormal brain imaging.探讨巨细胞病毒（CMV）感染新生儿的血清CMV-IgM抗体和病毒载量与其出现临床症状的相关性，为临床新生儿CMV感染的病情评估和监测提供参考。本研究回顾性分析2014年1月至2020年12月浙江大学附属妇产科医院新生儿科收治的70例CMV感染新生儿，以荧光定量PCR法为诊断标准方法，出生3周为界分为先天性CMV感染组（n=29）和后天性CMV感染组（n=41），根据血清CMV IgM抗体结果，分析IgM抗体阳性者与阴性者之间一般资料和临床指标之间的差异，并结合确诊时CMV病毒载量，分析两者与出现CMV感染相关症状的相关性。采用T检验及非参数检验比较各组间指标差异，Logistic回归进行多因素分析，ROC曲线评估相关指标的辅助诊断价值。结果显示先天性CMV感染组和后天性CMV感染组中IgM抗体阳性者确诊时病毒载量和有症状者比例均显著高于IgM阴性者（先天CMV感染组：Z=-2.616，P=0.008；80%比21%，P=0.005；后天CMV感染组：Z=-2.405，P=0.016；56%比19%，P=0.025）。对纳入人群的logistic回归分析显示，IgM抗体阳性和确诊时病毒载量对有症状者的校正OR值分别为4.562（95%CI：1.461~14.246，P=0.009）和1.728（95%CI：1.068~2.798，P=0.026）。对单一症状的回归分析显示，IgM抗体阳性校正确诊时病毒载量影响后对听力功能障碍的OR值为3.954（95%CI：1.066~14.677，P=0.040）；确诊时病毒载量在校正IgM抗体影响后对出现血小板减少、脑成像异常的OR值分别为2.228（95%CI：1.124~4.413，P=0.022）；3.956（95%CI：1.421~11.011，P=0.008）。ROC曲线分析显示，确诊时病毒载量对脑成像异常的ROC曲线下面积为0.883（P<0.001），截断值为5.97，敏感度为75.0%，特异度为90.3%。综上，对于CMV感染新生儿，IgM抗体阳性可能增加了其出现临床症状和听力功能障碍的风险。确诊时CMV病毒载量越高，出现血小板减少、脑成像异常的风险可能也越高。.