早期监测人巨细胞病毒激活感染的两种检测方法的比较

Monitor human cytomegalovirus active infection by two quantitativly detect methods

目的 探讨人巨细胞病毒 (HCMV)的低基质磷酸化蛋白 (pp6 5 )抗原血症检测与荧光定量聚合酶链反应 (FQ PCR)方法 ,对不同人群中HCMV活动性感染的检测价值。方法 用 2种方法对从不同人群 (共 10 6例 )中收集的 2 0 4份血标本进行平行检测比较。结果 HCMVpp6 5抗原血症与血浆中HCMVDNA检测结果的一致性为 84 .8% ,相关性很高 (r=0 .86 1) ;与外周血多形核细胞 (PMNLs)中HCMVDNA检测结果的一致性为 79.8%。6例骨髓移植患者有 5例均在术后 30～ 5 0d间出现HCMVDNA拷贝数增加 ,同一时间PMNLs中HCMVDNA的拷贝数高于血浆 (81 7% )。免疫状况不同群体间HCMV激活程度不同 ,但无论有无免疫能力 ,有症状HCMV感染者HCMVDNA拷贝数平均值(7.71× 10 3 /ml)与HCMVpp6 5抗原阳染细胞数平均值 (10 4个 / 2× 10 5)均大于无症状HCMV感染者(1 5 3× 10 2 /ml;2 7个 / 2× 10 5)。结论 FQ PCR方法对监测低水平HCMV复制更为敏感 ,但HCMVpp6 5抗原血症检测对HCMV病的预测以及对抗HCMV药 (更昔洛韦 )的敏感性均高于DNA检测。两种方法的联合应用对监测HCMV活动性感染、临床疗效及预后更加客观。

Objective Detect and compare human cytomegalovirus active infection in different people by two quantitative methods. Methods 204 blood speciments from different groups (106 cases)were tested with two methods. Results The concordance of HCMV pp65 antigenemia and quantitative PCR assay in plasma is 84.8%, correlation coefficien t =0.861; the concordance of HCMV pp65 antigenemia and quantitative PCR assay in PNMLs is 79.8%. In 6 bone marrow transplant recipients, 5 patients′ HCMV DNA copy number, both in the PMNLs and plasma (81.7%), were in increased 30～50 days after transplantation. HCMV DNAcopies in PMNLs was higher than that in plasma. Either immunocompromised or immunocompetent group, the mean of HCMV DNA copy number (7.71×10 3/ml) and HCMV pp65 positive cells(104/2×10 5) in asymptomatic patients are higher than in asymptomatic patients(1.53×10 2/ml, 27/2×10 5). Conclusion The sensitivity of quantitative PCR is higher when HCMV viral load is low, but HCMV pp65 antigenemia assay has higher predictive value of HCMV disease and more sensitive to antiviral treatment than HCMV DNA detection. Detecting HCMV active infection by the two methods at the same time is effecitively.