炎性脱髓鞘型神经系统疾病人巨细胞病毒抗原血症检测的临床意义

Clinical Significance of Examination of Human Cytomegalovirus pp65 Antigenaemia in Patients of Inflammatory Demyelinating Encephalopathy

目的探讨人巨细胞病毒pp65(HCMVpp65)抗原血症与炎性脱髓鞘型神经系统疾病的关系。方法采用HCMV单克隆抗体免疫荧光法检测60例炎性脱髓鞘型神经系统疾病及30例脑梗死及脑供血不足患者外周血的HCMVpp65抗原阳性细胞水平,同时对抗病毒药物疗效进行分析。结果炎性脱髓鞘型神经系统疾病组HCMVpp65阳性18例,阳性率为30%,包括急性脱髓鞘脑病9例、吉兰-巴雷综合征5例、脑脊髓炎2例、视神经脊髓炎1例、多发性硬化1例。对照组HCMVpp65阳性3例,阳性率10%,两组比较差异有统计学意义(P<0.05)。对HCMVpp65阳性患者应用抗病毒药物(膦甲酸钠)治疗,有效率88.9%,其中1例急性脱髓鞘脑病患者及1例多发性硬化患者治疗后复查HCMVpp65转为阴性。结论HCMV与炎性脱髓鞘型神经系统疾病的发生密切相关。HCMVpp65抗原血症检测动态观察对临床治疗有指导意义。膦甲酸钠对HCMV所致炎性脱髓鞘型神经系统疾病有良好疗效。

Objective To investigate the relationship between human cytomegalovirus （HCMV） pp65 antigenaemia and inflammatory demyelinating encephalopathy （ IDE ）. Methods HCMV pp65 antigen positive cells in peripheral blood （ PB ） from 60 IDE patients and 30 patients with brain infarction （BI） and cerebral ischemia （CI） were detected by HCMV monoclonal antibody immunofluorescence. Results In IDE group, HCMV pp65 was positive in 18 patients, with a 30% positive rate, including 9 acute IDE patients, 5 Guillain - Barré syndrome, 2 encephalomyelitis, 1 neuromyelitis optica, 1 disseminated sclerosis （DS）; in control group, 3 patients were positive to HCMV pp65, with a 10% positive rate; patients with positive pp65 antigenemia were treated with phosphonoformic acid （PFA）, and therapeutic effectiveness was noted in 88 89% patients. HCMV pp65 of 1 acute IDE patient and 1 DS patient reviewed negative after treatment. Conclusion HCMV is closely correlated with IDE. Dynamic observation of HCMV pp65 antigenaemia test is of guiding significance in clinical treatment. PFA is of good effect in treatment of IDE nervous system diseases caused by HCMV.