白血病患儿巨细胞病毒感染的PCR与抗原检测方法比较

Cytomegalovirus infection in children with leukemia: PCR assay for detecting CMV-DNA and CMV antigenemia assay

目的 对不同种类标本应用PCR检测巨细胞病毒(cytomegalovirus,CMV)DNA,并与外周血白细胞CMV抗原检测比较,以了解PCR方法在诊断白血病患儿活动性CMV感染时的意义。方法 实验组为31例白血病患儿,对照组为31例免疫功能正常儿童,两组儿童的年龄、性别无差异。应用PCR方法检测血清、尿液和脑脊液CMVDNA,间接免疫荧光方法检测外周血白细胞CMV抗原,ELISA方法检测血清抗CMVIgG。结果 实验组CMV感染率为100%(31/31例CMVIgG阳性),对照组CMV感染率为839%(26/31例CMVIgG阳性),两者之间无差异(P=1)。实验组检测CMV抗原,有9例阳性且均发生了活动性CMV感染,活动性感染率为291%,对照组活动性感染率为0%,两者之间差异有非常显著性(P=0002)。与CMV抗原检测相比,PCR方法检测尿、血清和脑脊液CMVDNA诊断白血病儿童活动性CMV感染的敏感性为(889～100)%,特异性为(682～818)%。结论 白血病患儿易发生活动性CMV感染。在诊断CMV感染时,应用PCR方法检测CMVDNA的敏感性较高,但要注意区分活动性感染和潜伏性感染。

Objective To evaluate the incidence and clinical course of CMV infection in leukemia children, and to compare PCR assay for detecting CMV DNA and antigenemia assay for detecting CMV antigen in peripheral blood leukocytes. Methods Totally 31 leukemia children and 31 immunocompetent children as a control group were involved in the study. PCR assay was used for detecting CMV DNA in serum, urine and cerebrospinal fluid, indirect immunofluorescence assay for detecting CMV antigen in peripheral blood leukocytes, and ELISA for detecting anti CMV IgG. Results Twenty seven out of thirty one leukemia children had anti CMV IgG before chemotherapy. The rest 4 patients were found seroconverted after chemotherapy. CMV infection rate was 100% in leukemia children compared with 83 9%(26/31) in control group. There was no difference in CMV infection rate between two groups ( P =1). Active CMV infection was diagnosed in 29 1%(9/31) leukemia children while none in control group. Active CMV infection rate showed significant difference between two groups ( P =0 002). The sensitivity and specificity of PCR for detecting CMV DNA in urine, serum and cerebrospinal fluid versus the antigenemia assay were 88 9% 100% and 68 2% 81 8%, respectively. Conclusions Activation of CMV infection in leukemia children are rather common. PCR assay on urine, serum and cerebrospinal fluid can be useful for diagnosing CMV infection for its high sensitivity, but it should be noticed that the active CMV infection and the latent CMV infection cannot be easily differentiated.