病毒载量检测在婴幼儿巨细胞病毒感染中的诊断价值

The value of CMV viral load test in diagnosis of cytomegalovirus infection in infants

目的评估全血及尿液巨细胞病毒（CMV）载量检测在婴幼儿巨细胞病毒感染及判断预后的价值。方法在血清学检测CMV—IgM或者CMV—IgG滴度t〉40阳性患儿中筛选PP65抗原阳性CMV活动性感染婴幼儿50例，用更昔洛韦抗病毒治疗，一个疗程前后检测全血及尿液CMV荧光定量及治疗后PP65抗原。结果治疗前全血CMV荧光定量阳性率98％，治疗后14％，PP65抗原阳性率6％，治疗前后全血荧光定量与PP65抗原检测差异无统计学意义（P〉0．05）。治疗前尿液CMV荧光定量阳性率98％，治疗后90％，治疗前后尿液荧光定量与CMV感染临床特性不一致（尸〈0．05，sp=0．11，PVP=0．55，Youden指数=0．09）。结论全血CMV荧光定量与PP65抗原有很好的相关性，可作为CMV活动性感染的指标；单独尿CMV荧光定量检测对区分CMV活动性和潜伏性感染及动态监测CMV治疗意义不大。

Objective To assess the value of CMV viral load test in the diagnosis and prognostic judgment of infantile cytomegalovirus infection with whole blood and urine specimens. Methods 50 infants with active CMV infection were selected, which pp65 antigen was positive in serological detection and either CMV-IgM positive or the titer of CMV-IgG I〉40. The viral load in whole blood and urine specimens was detected before and after a course of preemptive ganciclovir treatment and the pp65 antigen was determined after treatment. Results 98% patients were manifested as eytomegalovinis viral load quantitative measurement in whole blood positive before the treatment, while 14% after. The positive ratio of pp65 assay after therapy was 6%. And there was no significant difference between the results of the two kinds of detection methods （ P 〉 0. 05, K = 0. 86）. The positive ratio of cytomegalovirus viral load quantitative measurement in urine before and after treatment was 98% and 90%, respectively. The results of urinary viral load quantitative detection did not coincide with clinical characteristics of CMV infection （ P 〈 O. 05, Sp = O. 11, PVP = O. 55, J （Youdeng index） =0. 09）. Conclusions Good coincidence could be found betw6en CMV-DNA quantitative measurement in whole blood and pp65 antigenemia assay. And the former could be used as a diagnostic index of CMV positive infection. While single urinary viral load quantitative detection had no significance for the distinction between active and latent CMV infection and dynamic monitoring of CMV treatment.