血清学检测和聚合酶链反应在急性和慢性巨细胞病毒感染监测中的比较

Comparison of serological assay and polymerase chain reaction for the monitoring of acute and chronic cytomegalovirus infections

目的比较血清学(免疫化学发光法)巨细胞病毒(CMV)特异性抗体检测和实时荧光聚合酶链反应(PCR)定性CMV DNA检测对监测CMV急性和慢性感染的意义。方法回顾性分析临床疑似CMV感染的患者361例,单独或同时出现非特异性症状和体征,发热、白细胞减少症、高胆红素血症和丙氨酸氨基转移酶升高等都被视为疑似CMV感染。疑似患者同步检测CMV Ig M、Ig G抗体和CMV DNA。结果只有7例CMV Ig M抗体和CMV DNA检测结果均为阳性,13例CMV Ig M抗体阳性而CMV DNA阴性,23例CMV Ig M抗体阴性而CMV DNA阳性,2种检测方法结果缺乏一致性(Kappa=0.229,P<0.05)。将327例仅CMV Ig G抗体阳性病例按CMV DNA检测结果分为2个组,即CMV DNA阴性300例和CMV DNA阳性27例,其CMV Ig G抗体浓度在2个组间差异无统计学意义[中位数(四分位数)分别为195.24(73.80,250.00)和221.90(129.60,250.00)AU/m L,P=0.137]。结论血清学检测CMV抗体对于诊断活动性CMV感染不敏感,与CMV DNA结果的一致性较差,同时也不能用于CMV感染慢性期的监测。在判断CMV感染的临床应用中,应结合CMV DNA和CMV抗体检测(包括Ig G滴度变化)综合评价。

Objective To compare serological assay(chemiluminescence immunoassay) in cytomegalovirus(CMV) antibody determination and real-time fluorescence polymerase chain reaction(PCR) in qualitative CMV DNA determination for the monitoring of acute and chronic CMV infections. Methods A total of 361 patients suspected with CMV infections were analyzed retrospectively. Patients suspected with CMV infections were determined on the bases of nonspecific symptoms,including fever,leukopenia,hyperbilirubinemia and alanine aminotransferase elevation,alone or in combination. All patients were screened for CMV Ig M and Ig G antibodies and CMV DNA. Results CMV Ig M antibody and CMV DNA by the 2 methods were all positive in only 7 patients. A total of 13 patients were positive for CMV Ig M antibody and negative for CMV DNA,23 patients were positive for CMV DNA and negative for CMV Ig M antibody. There was no consistency between the 2 methods(Kappa=0.229,P<0.05). Furthermore,327 patients with positive CMV Ig G antibody were classified into CMV DNA negative group(300 cases) and CMV DNA positive group(27 cases) according to CMV DNA determination results,and there was no statistical significance for CMV Ig G antibody level [medians(quartiles) were 195.24(73.80,250.00) and 221.90(129.60,250.00) AU/m L,P=0.137]. Conclusions Having poor consistency with CMV DNA determination results,serological assay for CMV antibodies is not sensitive enough to diagnose acute CMV infection and cannot be used for monitoring CMV infections during the chronic period. The clinical diagnosis of CMV infections should be evaluated by the combination determination of CMV DNA and CMV antibodies,including the quantitation of CMV Ig G.