mRNA检测在器官移植术后人类巨细胞病毒感染的临床应用

Detection of Cytomegalovirus mRNA in Recipients after Organ Transplantation and Its Clinical Significance

目的探讨mRNA检测在器官移植术后受者人类巨细胞病毒(HCMV)感染的临床应用。方法应用核酸基础序列扩增技术检测120例移植术后患者外周血中HCMV-即刻早期信使RNA(IE mRNA),并与HCMV-Ag进行比较,同时结合临床资料进行回顾性分析。结果 HCMV IE mRNA检测诊断HCMV感染的敏感度、特异度、阳性预测值和阴性预测值分别为92.31%、89.36%、70.59%和97.67%;120例患者中有62例术后至少一项检测呈阳性,发生了HCMV感染,其中36例患者属于无症状活动性感染,另外26例患者出现明显临床症状属于HCMV感染患者;经抗病毒治疗后,36例无症状感染患者的检测结果均转阴,26例HCMV感染患者中,有24例治愈,同时临床症状消失,2例患者死于并发症。结论移植后HCMV感染与多种因素有关,积极预防、早期诊断和治疗在移植术后患者感染非常重要,mRNA检测可作为监视移植后HCMV感染和指导抗病毒治疗的依据。

OBJECTIVE To investigate the diagnosis and treatment of human cytomegalovirus（HCMV） infection in the recipients after organ transplantation by detecting HCMV mRNA.METHODS HCMV-immediae early（IE） mRNA was detected in 120 whole-blood samples from organ transplant patients by nucleic acid sequence-based amplification（NASBA）,and HCMV-Ag was detected to compare each with others.At the same time the clinical data of 132 patients after organ transplantation were analyzed.RESULTS The sensitivity,specificity,positive predictive value and negative predictive value for HCMV-IE mRNA was 92.31%,89.36%,70.59% and 97.67%,respectively.Sixty-two patients were positive of HCMV IE-mRNA or HCMV-Ag at least detected by NASBA and immunofluorescence techniques in 120 recipients after organ transplantation.HCMV active infection occurred in these patients,26 patients were infected with HCMV disease,and 36 patients had no symptoms of HCMV infection.HCMV IE-mRNA or HCMV-Ag in whole blood of 36 from 62 recipients became negative after anti-virus therapy.of the 26 patients,24 patients recovered,2 patients died from complications.CONCLUSION HCMV infection after organ transplantation is associated with many factors,The key point of HCMV infection is the active prevention,early diagnosis and treatment after transplantation.IE mRNA of HCMV by NASBA assay is suitable for early diagnosis and guiding treatment of HCMV disease.