肾移植受者巨细胞病毒即刻早期信使核糖核酸检测及其临床意义

Clinical significance of cytomegalovirus IE-mRNA detection in renal transplant recipients

目的:探讨肾移植术后巨细胞病毒(cytomegalovirus,CMV)感染的早期、快速、准确的诊断方法。方法:应用核酸基础序列扩增法(nucleic acid sequence-based amplification,NASBA)检测55例肾移植术后受者外周血CMV的即刻早期信使核糖核酸(immediate early messenger ribonucleic acid,IEmRNA),同时检测CMV的PP65抗原,并比较其结果。结果:55例中29例抗原指数阳性,发生CMV病10例,未发生CMV病19例,发生CMV病组与未发生CMV病组比较,其抗原指数值差异有统计学意义(P<0.01)。IEmRNA阳性20例,IEmRNA阳性者的CMV抗原指数值显著高于IEmRNA阴性者,两者比较差异有统计学意义(P<0.05)。术后首次检测到IEmRNA的时间显著早于首次检出PP65抗原的时间(P<0.05),经抗病毒治疗后两者转阴时间无差异。结论:应用NASBA检测IEmRNA能早期诊断CMV活动性感染,对肾移植术后抗CMV治疗具有指导意义。

Objective： To study a new method for diagnosis of active cytomegalovirus （CMV） infection in transplant recipients. Methods： The expression of immediate early messenger ribose nucleic acid （IE-mRNA） was detected by the nucleic acid sequence-based amplification （NASBA） for 55 patients after renal transplantation. In the meantime, PP65 antigenemia assay was done for all cases. Results： In 55 patients, 29 were positive for antigenemia, in which, 10 cases suffered from CMV disease. Index of antgenemia in CMV disease group was higher than that in non-CMV disease group, the differences were distinct（ P 〈 0. 01 ）. 20 cases were positive for IE-mRNA, whose index of antgenemia was higher than that in other cases（ P 〈 0. 05 ）. The first time of IE-mRNA positive detection after transplantation was earlier than that of antigenemia. The differences were distinct（ P 〈 0. 05 ）. The time of turning negative for both had no differences. Conclusion： Detection of IE-mRNA by NASBA is exactly reflect the active infection of CMV in the renal transplant recipients and is more effective in the direction for antiviral therapy.