肾移植受者巨细胞病毒隐性感染的筛查方法及应用

Method of Screening Cytomegalovirus Recessive Infection in Renal Transplant Recipients and Its Application

目的探讨肾移植受者巨细胞病毒(cytomegalovirus,CMV)隐性感染的筛查方法,为临床早期发现CMV活动性感染提供诊断依据。方法收集笔者医院2009年10～12月期间门诊随访233例肾移植受者外周静脉血标本450份,分别采用实时荧光定量PCR(Real-time PCR)、巢式PCR(nPCR)以及酶联免疫吸附(ELISA)法对标本进行检测,同时采用ELISA法检测他克莫司(Tac)浓度。结果 233例肾移植受者CMV-IgG均为阳性,CMV-IgM则均为阴性;Real-time PCR技术检测CMV-DNA阳性85例(36.48%),以低拷贝数为主。nPCR技术检测CMV-DNA阳性10例(4.29%),两种技术检测总阳性率存在显著性差异(P<0.05);随着Tac药物浓度升高,CMV-DNA阳性率呈增高趋势,药物高浓度组CMV-DNA阳性率高于低浓度组(P<0.05)。结论 Real-time PCR是筛查肾移植受者CMV隐性感染较为理想的方法,尤其在受者药物浓度偏高时更具有临床应用价值。

Objective To discuss the method of screening cytomegalovirus recessive infection in renal transplant recipients,provi- ding a reference basis for early detection of cytomegalovirus active infection. Methods Totally 450 samples from 233 patients from 2009 October to December in our transplant center were detected for cytomegalovirus by real - time PCR, nPCR and ELISA,detected for tacroli- mus concentration by ELISA at the same time. Results Among the 233 cases of renal transplant recipients,all of CMV - IgG were detec- ted positive,and CMV -IgM negative,in which 36.45% of the recipients were positive to real -time PCR and 4.29% were positive to nPCR. The former had a higher sensitivity than the latter（ P 〈 0. 05 ）. The contents of positive CMV - DNA were mainly low. CMV - DNA was positive trends to be higher. With the Tac drug concentration increasing, the posiative rate of CMV - DNA in drug high concentrations group were higher than low concentration group. Conclusion Real - time PCR is a more ideal method for screening CMV recessive infec- tion in renal transplant recipients, especially it has more clinical application value in the recipients when they have more high drug concen- tration.