CMV-IgM动态检测预测造血干细胞移植术后CMV感染研究

Dynamic Detection of CMV-IgM Can Predict the Development of CMV Infection in Patients with Haemotopoietic Stem Cell Ttransplantation

目的探讨白血病患者异基因造血干细胞移植(Allo-HSCT)术后巨细胞病毒(CMV)IgM抗体滴度的动态变化与CMV感染进展的关系。方法采用单克隆抗体免疫荧光测定法和微粒子酶免分析法对86例接受Allo-HSCT的白血病患者,在术后50d内每周检测1次,50～270d每2周检测1次CMV-Ag和CMV-IgM,同时观察有无CMV病症状出现,并分析CMV-Ag阳性细胞数和CMV-IgM滴度变化与CMV感染进展的关系。结果86例患者在移植后270d内共有57例患者发生过活动性感染。这57例患者CMV-Ag首次检出阳性时,其中只有5例患者CMV-IgM出现阳性,而且CMV-IgM首次出现阳性的平均检出时间为121.6d,明显迟于CMV-Ag的平均46.7d(P<0.05);在CMV活动性感染的中后期,由于受到抗病毒治疗的干预,CMV-Ag的平均阳性细胞数并不和CMV-IgM滴度呈相同的趋势性改变,两者之间不存在相关性(γ=0.146,P>0.05);8例患者从无症状感染进展到CMV病时,CMV-IgM滴度呈进行性升高,其中4例患者感染得到控制后,滴度逐渐下降。当CMV-IgM滴度在10以下,CMV病尚能控制,若滴度均超过10以上,大部分患者会发生死亡。结论CMV-IgM动态定量检测对预测Allo-HSCT后中后期CMV活动性感染进展及其预后有一定的临床指导意义。

Objective To observe the relationship between the alteration of cytomegalovirus（CMV） -IgM titers and the development of CMV infection after allogeneic haemotopoietic stem cell transplantation （Allo-HSCT） in leukemia patients. Methods CMV-Ag positive cells and CMV-IgM titers of 86 cases with leukemia after AIIo-HSCT were detected once a week for the first 50 days and once every two weeks for the next 220 days by monoclone antibody immunofluorescence assay and microparticle enzyme immunoassay respectively. The symptoms of CMV disease were also observed and the relationship between the changes of CMV-Ag positive cells and CMV-IgM titers and the development of CMV infection was analyzed. Results 57 cases.among the 86 patients suffered from the active infection of CMV. CMV-IgM was found positive in only 5 patients when CMV-Ag was detected positive for the first time in the 57 patients. The average time of the first positive detection for CMV-IgM is 121.6 days, and was much later than that for CMV-Ag and the difference between them was significant（ P 〈 0. 05 ）. Owing to the intervention of antiviral treatment in the middle and late stage after allo-HSCT,the changes of the mean positive cells of CMV-Ag were not in consistent with CMV- IgM titers and there was no correlation between them （ γ= 0. 146, P 〉 0.05 ）. Titers of CMV-IgM increased continuously in 8 patients of CMV disease progressed from no-symptom CMV infection and decreased in four cases when the infections were mitigated. CMV infection could be controlled when titers of CMV-IgM were below 10,but above this level most patients died. Conclusion To monitor quantitatively the changes of CMV-IgM had certain clinical guiding significance for predicting the development of CMV active infection and its prognosis in the middle and late stage after allo-HSCT.