pp65抗原血症检测法诊断婴儿巨细胞病毒感染的研究

Diagnosis of Cytomegalovirus infection in infant with pp65 antigenemia assay

目的 探讨pp6 5抗原血症检测方法 (AA)对新生儿和小婴儿巨细胞病毒 (CMV)感染的诊断价值。方法 对 2 1例有典型CMV感染症状患儿及 42例无典型症状的患儿 ,进行外周血AA、尿PCR及血清ELISA法IgM检测 ,比较 3种方法的检测结果 ,结合抗原血症的量化结果及对部分患儿的短期随访 ,分析AA的临床应用价值。结果 (1) 6 3例中CMV症状性感染 15例 ,亚临床型感染 8例。症状性感染组AA、PCR、ELISA阳性检出率分别为 93% (14/ 15 )、10 0 % (15 / 15 )和 80 % (12 / 15 ) ;亚临床型感染组阳性检出率分别为 5 0 % (4/ 8) ,75 % (6 / 8)和 38% (3/ 8)。AA相对于PCR的敏感性为 86 %(18/ 2 1) ,特异性为 10 0 %。 (2 )症状性感染通常伴高水平抗原血症 [(4～ 2 0 6 )个 / 1 5× 10 5多形核白细胞 (PMNL) ],亚临床型感染通常抗原血症水平较低 [(0～ 3)个 / (1 5× 10 5)PMNL],症状性感染组抗原血症水平明显高于亚临床型感染组 (P <0 0 1)。 (3)症状性感染组中 4例婴儿肝炎患儿恢复期AA转为阴性或低水平。结论 pp6 5抗原血症检测方法是一种敏感、特异的检测方法 ,量化结果有助于诊断活动感染及监测病情。

Objective To evaluate the feasibility and utility of pp65 antigenemia assay (AA) in diagnosis of CMV infection in infants and neonates. Methods (1) Sixty three patients, including 21 patients with typical symptoms of CMV infection with multiple system involvements and 42 cases with non hemolytic hyperbilirubinemia without abnormal liver function test results and CMV related symptoms, were enrolled in this study. (2) All the cases were examined with AA, PCR for CMV DNA and ELISA for serum IgM antibody to CMV. The authors compared the results of these 3 assays in 2 groups and calculated the sensitivity and specificity of AA. (3) Some of the cases were followed up for a short period of time. Results (1) Twenty three of the 63 patients were diagnosed as CMV infection, 15 had symptomatic infection, the other 8 cases had subclinical infection The percentage of positive pp65 antigenemia, positive CMV DNA and positive IgM in the symptomatic infection group were 93% (14/15), 100%(15/15)and 80%(12/15), and 50%(4/8),75%(6/8), 38%(3/8) in the subclinical infection group, respectively No positive AA was found in patients without CMV infection was found Compared with PCR, the sensitivity of AA was 86%, the specificity 100%. (2) Antigenemia level of the symptomatic cases was significantly higher than that of subclinical one( P <0 01). Higher AA level [(4-206)/(1 5×10 5) polymorphonuclear leukocyte (PMNL)] was correlated with apparent clinical manifestations of CMV infection, while lower level of AA [(0 3)/(1 5×10 5) PMNL] was either in the patients at recovering stage or in patients without symptoms (3) Higher AA level of 4 CMV hepatitis patients returned to lower level or became negative in recovery stage Conclusions CMV pp65 antigenemia assay was sensitive, and specific in diagnosis of CMV infection Quantitative monitoring of CMV AA level was useful in diagnosis and evaluation in CMV infection of pediatric patients.