小儿巨细胞病毒活动性感染的两种诊断方法比较

Comparison of two diagnostic methods in diagnosing for active human cytomegalovirus infection in children

目的 通过血清人巨细胞病毒 (HCMV)IgM和尿快速培养HCMV检测临床标本的比较 ,进一步评价血清特异性IgM诊断活动性HCMV感染的价值。 方法 ①ELISA法检测患儿血抗HCMV IgG、IgM。②通过检测尿培养物中HCMV即刻早期抗原 (IEA)快速诊断活动性HCMV感染。结果 ① 119例尿培养阳性者 ,血抗HCMV IgG均为阳性。②与尿快速培养法相比 ,血IgM的特异性和敏感性分别达到 97 7%和 6 9 7% ;血IgM阳性数与尿快速培养阳性数比率在≤ 1个月、～ 1岁和～ 3岁组分别为 4 5 8%、75 75和 82 4 % ,表明IgM检测结果在各年龄组均有假阴性 ,其中尤以 1个月以下婴儿多见。③ 2例 3个月左右患儿血IgM阳性而尿培养阴性。 11例随访患儿中 ,9例在结束更昔洛韦治疗后 1个月复查 ,3例IgM迟于尿培养转阴 ,2例尿培养阴性而血IgM仍为阳性 ,表明IgM检测结果可有假阳性。 结论 血清特异性IgM检测可用于诊断活动性CMV感染 ,但其意义有一定局限性 。

Objective To evaluate the significance of serum anti HCMV IgM by comparing with shell viral assay in the diagnosis of active HCMV infection.Methods ①Serum anti HCVM IgG and IgM were detected by ELISA.②HCMV IEA in urine was detected by shell viral assay (SVA).Results ①All the 119 cases with SVA positive also had positive serum anti HCMV IgG.②Compared with SVA,the specificity and sensitivity of serum IgM was 97 7% and 69 7% respectively.The ratio of IgM positive to SVA positive in ≤1m,～1y and ～3y group was 45 8%,75 7% and 82 4% respectively,showing that false negative IgM detection existed in all these groups,especially in ≤1m group.③It was found that in 2 three month old children,IgM was positive but SVA negative.Among 5 cases who were followed up after GCV treatment,SVA became negative with IgM lagged convertion in 3 case,while SVA negative with IgM positive in the other 2,which demonstrated that there were false positive detections in anti HCMV IgM assay.Conclusion Detection of anti HCMV IgM could be used to diagnose active HCMV infection with limited significance,which should be combined with some other indexes.