肾移植受者外周血白细胞CMV抗原阳性细胞数及意义

Clinical Significance of the Changes of the Numbers of Positive Cytomegalovirus Antigen Leukocytes in Renal Transplant Recipients

【目的】探讨肾移植受者外周血白细胞巨细胞病毒 (CMV)PP 6 5抗原阳性细胞数的变化及意义。【方法】用免疫细胞化学法检测外周血白细胞CMV PP6 5抗原 ,术后头 3个月每周 1次。【结果】 2 73例肾移植受者中 12 4例术后检出CMV PP6 5抗原阳性 ,初次检出CMV PP6 5抗原的平均时间为 ( 2 4 1± 11 3)d ,每 5万白细胞中CMV抗原阳性细胞数均值为 7 1± 5 8,其中 5例CMV抗原阳性细胞数超过 10 /5万白细胞。无症状性和症状性CMV感染受者初次检出CMV抗原阳性细胞数分别为 ( 6 7± 5 6 ) /5万白细胞、( 10 1± 9 3) /5万白细胞 (P >0 0 5 ) ;峰值水平为 ( 8 1± 4 2 ) /5万白细胞、( 2 6 3± 5 7) /5万白细胞 (P <0 0 5 ) ;分别有 17例 ( 15 % )、12例 ( 10 0 % )患者其峰值超过 10 /5万白细胞 (P <0 0 5 )。抗病毒治疗中 90例( 72 6 % )患者CMV抗原阳性细胞数进一步升高。【结论】肾移植受者在CMV感染早期病毒复制能力强 。

Objective To investigate the clinical significance of the changes of the numbers of peripheral blood leukocyte with cytomegalovirus (CMV) PP65 antigen in renal transplant recipients. Methods Detecting CMV PP65 antigen by immunocytochemical methods at weekly intervals during the first 3 months after transplantation. Results Among 273 recipients, CMV 65 antigen was detected, 112 of them were asymptomatic and 12 were symptomatic. The average of the first positive CMV PP65 antigen leukocytes were 6 7±5 6、10 1±9 3 per 50,000 leukocytes respectively in asymptomatic and symptomatic CMV infection recipients. There was no significant difference between them (P>0 05). The average of the peak positive CMV PP65 antigen leukocytes were 8 1±4 2、26 3±5 7 respectively. There was significant difference between them (P<0 05). The peak positive CMV PP65 antigen leukocytes in 17 cases (15%) with asymptomatic CMV infection and 12 cases (100%) with symptomatic CMV infection were more than 10 per 50,000 leukocytes (P<0 05). The numbers of the positive CMV PP65 antigen leukocytes were increased in 90 cases (72 6%) after treatment with antiviral drugs. Conclusion We suggest that CMV may reproduce rapidly in the early stage of infection. The peak numbers of the positive CMV PP65 antigen leukocytes help to predict the symptomatic CMV infection in renal transplant recipients.