巨细胞病毒即刻早期mRNA测定在肾移植后巨细胞病毒感染中的诊断价值

Diagnostic implication of human cytomegalovirus immediate early 1 mRNA detection by nucleic acid sequence-based amplification in renal transplant recipients

目的评价应用核酸基础序列扩增法(NASBA)检测巨细胞病毒(CMV)即刻早期(IE)mRNA对肾移植术后CMV活动性感染的诊断价值。方法采用NASBA法测定55例肾移植患者的外周血标本中CMVIE mRNA及pp67mRNA,免疫组化法检测CMV pp65抗原。结果55例患者中,发生有症状的CMV活动性感染者13例;IE mRNA阳性者20例,12例有CMV活动性感染,IE mRNA的敏感度、特异度、阳性预测值及阴性预测值分别为92.3%、80.9%、60.0%及97.1%。IE mRNA阳性结果出现最早,为术后(31.0±15.4)d,与pp67mRNA的(43.7±16.3)d和pp65抗原的(39.6±15.6)d相比,差异有统计学意义(P<0.05)。结论应用NASBA法检测CMV IEmRNA,能够早期、快速、准确的诊断CMV活动性感染,为临床抗病毒的治疗提供依据。

Objective To evaluate the significance of immediate early 1 （IE） mRNA detection by nucleic acid sequence-based amplification （NASBA） in the diagnosis of human cytomegalovirus （HCMV） infection after renal transplantation. Methods The expression of IE-mRNA and pp67-mRNA was detected by NASBA in 55 patients after renal transplantation, and pp65 antigenemia assays were done for all cases. Results Twenty cases were positive for IE-mRNA. Thirteen cases were suffered from CMV disease with symptoms. The sensitivity, specificity, positive predictive value （PPV） and negative predictive value （NPV） of IE-mRNA by NASBA were 92. 3%, 80. 9%, 60. 0% and 97. 1%, respectively. Time to first IE-mRNA positive detection after transplantation was shortest, compared with pp67 and antigenemia （P〈0. 05）. Conclusion Detection of IE-mRNA using NASBA presents an early, convenient and credible approach for the diagnosis of CMV infection after renal transplantation.