단일 기관에서 경험한 선천성 거대세포바이러스 감염 환자의 임상 양상 및 신경발달학적 추적 관찰
Clinical Features and Neurodevelopmental Outcomes of Infants with Congenital Cytomegalovirus Infection: Single NICU Experience
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목적 : 단일 기관의 신생아중환자실에서 경험한 선천성 거대세포바이러스 감염으로 진단된 환자의 임상 양상과 청력손상 및 발달 장애 여부를 알아보았다. 방법 : 2002년부터 2012년까지 신생아 중환자실로 입원한 신생아 중 선천성 거대세포바이러스 감염이 의심되어 생후 2주 이내 시행한 소변 배양 검사 상 거대세포바이러스가 분리된 31명의 환자를 대상으로 이들의 임상 양상, 청력손상, 발달 경과에 대하여 조사하였다. 결과 : 총 연구 대상은 31명으로 남녀비는 1.1:1이었고 평균 재태 연령은 36.3±3.2주, 평균 출생 체중은 2,395±715 g,37주미만 미숙아는 10명(32.2%)이었다. 자궁 내 발육 지연은 9명(29%), 저체중 출생아는 13명(41.9%), 극소 저체중 출생아는 2명(6.5%)이었다. 임상 소견으로는 소두증 3명(9.7%)이었고 점상 출혈, 간비종대, CMV로 인한폐렴이 각각 1명(3.2%)이었다. 혈액 검사상 혈소판 감소증 11명(35.5%), 백혈구 감소증 4명(12.9%)이었다. 혈청CMV IgM 검사는 검사를 시행한 26명의 환아 중 15명(57.7%)에서 양성 소견을 보였다. 퇴원 시 시행한 청각 유발 전위 검사 결과 사망한 1명의 환자를 제외하고 비정상인 경우는 8명 (26.7%)이었고 평균 36.4개월 추적 관찰한 결과 이 중 6명(75.0%)에서 감각 신경성 청력 소실을 보였다. 12개월 미만인 3명과 사망한 환자를 제외하고베일리 영유아 발달 검사와 한국형 영유아 발달 검사, 웩슬러 지능 검사를 시행한 27명의 환자 중 6명(22.2%)은발달 장애 소견을 보였다. 뇌 자기 공명 영상 검사 상 뇌실확장증, 뇌실 주위 석회화, 다소뇌회증, 소뇌증, 소뇌형성 부전의 비정상적인 소견과 발달 장애간에는 통계학적으로 유의한 상관성을 보였고(P<0.05), 뇌실 주위 낭종, 뇌백질병변 과는 유의한 상관성을 보이지 않았다. 결론 : 선천성 거대세포바이러스 감염은 자궁 내 바이러스성 태아 감염의 가장 흔한 원인으로서 선천성 감염이 의심되는 경우 반드시 감별해야 할 질환이며 추적관찰 상 청력소실이 20%에서 관찰되었고 특히 뇌 자기 공명 영상에비정상적인 소견을 보이는 경우 장기적인 신경 발달학적 추적 관찰이 요구된다.
Abstract
Purpose: To assess the clinical features, hearing loss and neurodevelopmental outcomes of infants with congenital cytomegalovirus (CMV) infection and to discover significant brain magnetic resonance imaging (MRI) findings that predict poor neurodevelopmental outcomes. Methods: The medical records of 31 infants who were diagnosed with congenital CMV infection at the Neonatal Intensive Care Unit of Asan Medical Center between 2002 and 2012 after CMV was isolated from their urine within the second week of their life were retrospectively reviewed. The long-term neurodevelopmental outcomes of the infants were monitored using the Bayley Scale of Infant Development II, the Korean Infants’ Development Screening Test and the Wechsler Scale of Intelligence, as appropriate. Results: The infants’ mean gestational age was 36.3±3.2 weeks and their mean birth weight was 2,395±715 g. Microcephaly were detected in three of them (9.7%), and petechiae and hepatosplenomegaly were detected in one (3.2%). Ten infants (32.2%) and nine infants (29.0%) showed preterm and intrauterine growth retardation, respectively. Of the 27 infants with whom long-term follow-up was possible, six (22.2%) showed developmental disabilities. The brain MRI findings, which included ventriculomegaly, periventricular calcification, polymicrogyria, microcephaly and cerebellar hypoplasia, were correlated with the poor neurodevelopmental outcomes, but no correlation was found between the presence of periventricular cysts and that of white matter disease. Of the infants who survived, six (20.0%) had sensorineural hearing loss at the median age of 30.6 months. Conclusion: Congenital cytomegalovirus infection is one of the most frequent causes of intrauterine viral fetal infection and need to be distinguished if congenital infection is suspected. On the follow up observation, the hearing loss was observed in 20% of the patients. A long term neurological observation is required for the patients who had unusual impression on MRI.
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