肾移植受者巨细胞病毒感染检测的临床意义

The Clinical Significance on Determination of Cytomegalovirus Infection in Renal Transplant Recipients

目的 比较肾移植受者采用不同方法检测巨细胞病毒 (CMV)感染的意义。方法 比较肾移植受者和健康供肾者外周血中的CMV -IgM ,CMV -IgG和CMV抗原 (CMV -Ag)的阳性率及其与CMV病的关系。结果 167例肾移植受者CMV -IgM阳性率为 1 8% ,CMV -IgG阳性率为 98 8% ,CMV -Ag阳性率为47 2 % ,平均阳性抗原指数 3 2个 /5万白细胞 ;对照组 13例CMV -IgM均阴性 ,CMV -IgG均阳性。观察组3 6例CMV肺炎中CMV -IgG均阳性 ,CMV -IgM5 6%阳性 ,CMV -Ag91 7%阳性 ,平均阳性抗原指数 3 6个 /5万白细胞。结论 肾移植受者以CMV -Ag检测诊断CMV活动性感染及CMV病敏感性及特异性优于CMV -IgM及CMV -IgG。

Objective To understand the clinical significance of detecting cytomegalovirus (CMV) infection in renal transplant recipients. Methods The positive rates of CMV_IgM, CMV_IgG, and CMV_Ag were compared in peripheral blood between renal transplant recipients and health controls. And their association with CMV disease was determined. Results In 167 renal recipients, the positive rates of CMV_IgM, CMV_IgG and CMV_Ag was 1 8%(3/167), 98 8%(165/167) and 47 2%(79/167) respectively; the average positive antigen index was 3 2/fifty thousand white blood cells. In 13 control individuals, the CMV_IgM was negative, but the CMV_IgG was positive. In 36 CMV pneumonia patients, the CMV_IgG was positive, the positive rates of CMV_IgM and CMV_Ag was 5 6%(2/36) and 91 7(33/36) respectively; average positive antigen index was 3 6/fifty thousand white blood cells. Conclusions Monitoring the CMV_Ag for diagnosing active CMV infection and CMV disease in renal transplant recipients is more specific and sensitive than CMV_IgM or CMV_IgG.