中台灣孕婦TORCH感染盛行率之調查與臨床探討

懷孕婦女造成新生兒缺陷的原因除了藥物、輻射汙染、基因突變、遺傳等因素之外，母親在妊娠期間感染了各種致病微生物，並經由母體垂直傳染給胎兒，也可使胎兒造成各種畸形。子宮內的感染尤以病毒感染為主，由於胎盤的屏障作用，使得一些大分子物質不容易通過，而分子量較小的病毒及部分寄生蟲，則可以通過胎盤傳染給胚胎或胎兒，比較常見且危害較劇的有德國麻疹病毒(Rubella Virus)、巨細胞病毒(Cytomegalovirus)、單純疱疹I型和II型病毒（Herpes Simplex Virus I and II）等，寄生蟲中以弓漿蟲（Toxoplasma gondii）感染最為多見，醫學上將以上幾種病原體稱為“TORCH”。胎兒典型的TORCH 感染或是在婦產醫學中稱之為“TORCH綜合症”，是一組以胎兒中樞神經系統受損為主，多器官受累的症候群，這組微生物感染有一共同的臨床特徵，那就是可以造成母嬰感染，主要通過對胎兒細胞的直接損害，使大、小血管發生炎症並梗塞；特別是在懷孕的第一期(一 ~ 三個月)，胚胎處於器官形成期，此時如果受到病毒的感染，胎兒可能被破壞細胞或抑制細胞的分裂和增殖。器官形成期以後感染病毒，胎兒可能被破壞組織和器官結構，合併引起臟器缺氧相關的病變，致使臟器發育不全，以及免疫功能和染色體的異常，造成感染胎兒的先天性缺陷、畸形、死胎等，並可形成持續感染，出生後繼續破壞。故"TORCH"的感染對於人口素質有著深切的影響，並且與優生、優育實有相當重要密切的關係。目前，已經受到全世界醫學界尤其是婦產科和兒科醫生的高度重視。

關鍵字

TORCH綜合症；德國麻疹病毒；巨細胞病毒；單純庖疹I型和II型病毒；弓漿蟲

並列摘要

Infection during the pregnancy is one of the most common birth defects apart from the drug-, radiation-, pollution-, and genetic-related causes. A variety of pathogens are found capably to transmit vertically to the fetus during the pregnancy. In fact, most of pathogens are difficulty penetrate and successfully colonize onto fetus due to the barrier of placenta. However, some small viral particles and parasites are able to establish infections. For examples, the so-called “TORCH” including Rubella Virus, Cytomegalovirus, Herpes Simplex Virus I & II, Toxoplasma gondii are among those commonly found in pregnancy. Fetal TORCH infections usually associate with central nervous system damaged, as well as multiple-organ failures. Most severe TORCH infections occur at the early pregnancy when fetal cells developments are likely affected. Infections at a later pregnancy stage resulted in an organ developmental problem and organ failure are frequently found. Therefore, TORCH are among the important tests for pre-natal diagnosis to secure healthy babies are born. In Taiwan, there is no solid data regarding the prevalence of TORCH infection. In this study, we collected sera and investigate TORCH antibodies from 2,760 pregnant individuals between January 2011 and December 2013 in two counties in central Taiwan region. Among these results, we found 7 Toxoplasma gondii IgM(+) (0.25%), 24 Rubella Virus IgM(+) (0.87%), and 18 Cytomegalovirus IgM(+) (0.65%). Since there are roughly 210,000 newborns annually, 2 to 3 thousands infections are very likely expected based on our results. In order to prevent medical waste due to the ignorance of these infections occurred in the early pregnancy, we propose to execute sera TORCH assays for every pregnant woman.

並列關鍵字

TORCH Syndrome ； Rubella Virus ； Cytomegalovirus ； Herpes Simplex Virus I and II ； Toxoplasma gondii

參考文獻

detection of Antibodies to Toxoplasma gondii. – Eur. J. Clin.

1.(1996). Induction of changes in human behaviour by the parasitic protozoan Toxoplasma gondii. Parasitology113, 49–54.

2.Montoya JG (2002) Laboratory diagnosis of Toxoplasma gondii infection and

toxoplasmosis. J. Infect. Dis. 185 Suppl 1, p S73-S82.

3.(2007). Adaptive-filtering of trisomy 21: risk of Down syndrome depends on family size and age of previous child. Naturwissenschaften94, 117–121.

國際替代計量

中台灣孕婦TORCH感染盛行率之調查與臨床探討

全文下載

主題瀏覽