急性脱髓鞘脑病患者人巨细胞病毒pp65抗原血症检测的临床意义

Clinical significance of examination of human cytomegalovirus pp65 antigenemia in acute demyelinating brain disease

目的探讨人巨细胞病毒(HCMV)在急性脱髓鞘脑病(ADBD)中的病原学作用,并评估HCMV-pp65抗原血症在ADBD活动性HCMV感染早期诊断、抗病毒治疗及疗效判断中的价值。方法采用HCMV单克隆抗体免疫荧光法,对64例ADBD患者的外周血进行HCMV-pp65抗原检测,同时采用金标免疫斑点法检测血清HCMV-IgM,并对检测结果以及抗病毒药物应用与疗效进行分析。结果64例ADBD中HCMV-pp65阳性17例(26.6%),HCMV-IgM阳性8例(12.5%);HCMV-pp65阳性者,应用膦甲酸钠治疗9例,痊愈6例(66.7%),好转3例(33.3%);应用无环鸟苷治疗8例,痊愈2例(25.0%),好转4例(50.0%),无效2例(25.0%)。结论HCMV与ADBD的发生密切相关,HCMV-pp65抗原检测是一种敏感性、特异性强的方法,有助于HCMV感染疾病的早期诊断,指导抗病毒治疗及疗效的评价;膦甲酸钠对HCMV感染所致ADBD效果良好。

Objective To investigate the etiological role of human cytomegalovims（HCMV）pp65 in patients with acute demyelinating brain disease （ADBD）, and to evaluate the significance of HCMV-pp65 in early diagnosis of HCMV infection, antiviral therapy and judgement of the therapeutic effect. Methods HCMV monoclonal antibody immunofluorescence method was used to detect HCMV-pp65 antigen in blood of ADBD patients. At the same time, aurimark immune blotch was used to detect blood serum HCMV-IgM. The test results and the therapeutic effect of antiviral drags were analyzed. Results Among 64 samples of ADBD, 17 cases （26.56%） were positive for HCMV-pp65,8 cases （12.5%） were positive for HCMV-IgM. For the patients with positive response to HCMV-pp65,9 cases were treated with foscamet sodium, in which 6 cases （66.7%） recovered, and 3 cases （33.3%） were improved, however, 8 cases were treated with acycloguanosine, of which 2 cases （25.0%） recovered, 4 cases （50.0%） were improved and 2 cases （25.0 % ） were not effective. Conclusion HCMV has a close relationship with the occurrence of ADBD. HCMV-pp65 antigen detection is an excellent method, with good sensibility and specifity, which is helpful to early diagnosis of ADBD, directing antiviral therapy and evaluating therapeutic effect. Foscamet sodium has good effect in treating ADBD caused by HCMV infection.