标题：融冻与巴氏消毒法对母乳巨细胞病毒感染性的影响

      作者：周文姬 1，沈永珍 1，周紫光 2，张春一 1，钟志成 3    广东省妇幼保健院新生儿科 1、手术室 2、产前诊断实验室 3，广东 广州 511400

      卷次： 2023年34卷6期

      【摘要】 目的 比较融冻与巴氏消毒法对母乳巨细胞病毒(HCMV)的灭活效果。方法 选取2021年3~6月期间在广东省妇幼保健院住院的20例早产儿母亲作为研究对象，收集其新鲜母乳。经过母乳初筛后，有4例母亲母乳HCMV-DNA阳性。4例母乳HCMV-DNA阳性母亲留取新鲜母乳后各分为3份，每份10 mL，然后各取1份新鲜母乳作为对照组，其余2份分别经融冻(融冻组)和巴氏水浴消毒(巴氏消毒组)。记录三组母乳HCMV-DNA载量情况、融冻组与巴氏消毒组母乳HCMV-DNA清除率、4例阳性母亲对应的三组早产儿(对照组、融冻组和巴氏消毒组)获得性HCMV感染情况。结果 三组母乳HCMV-DNA平均载量比较差异具有统计学意义(P<0.05)，其中巴氏消毒组和融冻组HCMV-DNA平均载量分别为(3.21±0.57) mL、(3.74±0.68) mL，明显低于对照组的(4.12±0.79) mL，而巴氏消毒组的HCMV-DNA平均载量又明显低于融冻组，差异均有统计学意义(P<0.05)；巴氏消毒组的HCMV-DNA清除率为100.0%，明显高于融冻组的25.0%，差异具有统计学意义(P<0.05)；三组早产儿获得性HCMV感染率比较差异具有统计学意义(P<0.05)，其中巴氏消毒组早产儿HCMV感染率为 0，明显低于对照组的 75.0%和融冻组的50.0%，而融冻组明显低于对照组的75.0%，差异均具有统计学意义(P<0.05)。结论 普通水浴巴氏消毒能完全消除母乳中HCMV的感染性，融冻法则无法完全消除。对于极低出生体质量早产儿或免疫缺陷患儿，如母亲感染HCMV，乳汁筛查出HCMV阳性，母乳应使用巴氏消毒处理后再喂养更为安全。
      【关键词】 母乳；巨细胞病毒感染；融冻；巴氏消毒；早产儿
      【中图分类号】 R714.61 【文献标识码】 A 【文章编号】 1003—6350（2023）06—0832—04

Effect of thawing and pasteurization on human cytomegalovirus infection through breast milk.
ZHOU Wen-ji 1,SHEN Yong-zhen 1, ZHOU Zi-guang 2, ZHANG Chun-yi 1, ZHONG Zhi-cheng 3. Department of Neonatology 1, OperationRoom 2, Department of Prenatal Diagnosis 3, Guangdong Women and Children Hospital, Guangzhou 511400, Guangdong,CHINA
【Abstract】 Objective To compare the inactivation effect of thawing and pasteurization on human cytomegalo-virus (HCMV).Methods Twenty mothers of premature infants hospitalized in Guangdong Women and Children Hospi-tal from March to June 2021 were selected as the study subjects to collect their fresh breast milk. After the preliminaryscreening of breast milk, 4 mothers with HCMV-DNA positive breast milk were found, and their fresh breast milk werecollected and divided into 3 samples each, with each sample of 10 mL. Then, 1 sample of fresh breast milk was taken asthe control group, 1 was taken as the thawing group (treated with thawing), and 1 as pasteurization group (treated withpasteurization). HCMV-DNA load of breast milk in three groups, HCMV-DNA clearance rate of breast milk in thawinggroup and pasteurization group, and acquired HCMV infection of premature infants in three groups corresponding tofour positive mothers were recorded. Results The mean HCMV-DNA load of breast milk had statistically significantdifferences among the three groups (P<0.05); the load of pasteurization group and thawing group were (3.21±0.57) mLand (3.74±0.68) mL, which were significantly lower than (4.12±0.79) mL of the control group; the load of pasteurizationgroup was significantly lower than that of thawing group (P<0.05). The clearance rate of HCMV-DNA in pasteurizationgroup was 100.0%, which was significantly higher than 25.0% in thawing group (P<0.05). The acquired HCMV infec-tion rate of premature infants showed statistically significant differences among the three groups (P<0.05). The infectionrate in the pasteurization group was 0, which was significantly lower than 75.0% in the control group and 50.0% in thethawing group, and that in the thawing group was significantly lower than that in the control group, with statistically sig-nificant differences (P<0.05). Conclusion The general water bath pasteurization can completely eliminate the infectivi-ty of HCMV in breast milk, but the thawing method cannot completely eliminate the infectivity. For very low birthweight preterm infants or children with immune deficiency, if the mother is infected with HCMV and the milk isscreened positive for HCMV, it is safer to feed the breast milk after pasteurization.
      【Key words】 Breast milk; Cytomegalovirus infection; Thawing; Pasteurization; Premature infant