检测pp65抗原和IgM抗体对移植患者CMV活动性感染监测价值比较

Monitoring of active cytomegalovirus infection in transplant patients:comparison of pp65 antigenemia test and CMV-specific IgM assay

目的 比较血pp6 5抗原和IgM抗体检测对移植患者巨细胞病毒 (CMV)活动性感染的诊断价值。方法 收集 5 8位移植患者的血标本 (共 2 0 8份 ) ,分离血浆和多形核白细胞 ,血浆用于CMVIgM抗体检测 (ELISA) ,白细胞用于pp6 5抗原血症检测(荧光免疫组化 )。同时随机取部分血浆标本进行荧光定量PCR分析 ,检测CMVDNA。结果 pp6 5抗原阳性细胞数与CMVDNA拷贝数呈正相关 (r=0 .87) ,也与病人的临床症状密切相关 ,可用于监测移植患者CMV的活动性感染。IgM抗体与pp6 5抗原阳性的一致率为 2 1.2 % ,对CMV感染的敏感性为 2 2 .3% ,特异性为 95 .6 %。结论 pp6 5抗原阳性细胞数能反映CMV的数量 ,可监测CMV活动性感染 ,检测方法特异、灵敏、操作简单 ,适宜临床实验室应用。血清IgM抗体检测因为敏感性较低 ,不适用于移植患者CMV活动性感染的监测。

Objective To compare the diagnostic efficacy of the pp65 antigenemia test and the CMV-specific IgM assay in monitoring active CMV infection of transplant patients.Methods In this study 208 blood semples from 58 transplant patients were collected and detected by these two methods.And then we carried a prospective,parallel and blind study on part of these samples in order to compare the pp65 antigenemia test with a fluorescent quantitative PCR assay.Results 1.The number of CMV antigen-positive cells by the pp65 antigenemia test and the level of CMV DNA by the quantitative PCR have good correlation (r=0.87).2.The positive agreement rate of IgM assay in plasma and CMV pp65 antigenemia assay was 21.2%.For prediction of active CMV infection,the sensitivity and specificity of IgM assay in comparison with pp65 antigernemia test,were 22.3% and 95.6% respectively.Conclusion The pp65 antigenemia assay could reflect the level of CMV and predict active CMV infection in transplant patients.The CMV-specific IgM assay had moderate specificity but often gave late positive results and was not sensitive enough for use as prediction tools for transplant patients.