获得性免疫缺乏综合征患者合并巨细胞病毒性肺炎情况分析

Analysis of AIDS patients complicating cytomegalovirus pneumonia

目的调查获得性免疫缺乏综合征(AIDS)患者中合并巨细胞病毒性肺炎的发生情况,比较血清标本与痰液标本的巨细胞病毒阳性检出率。方法采用酶联免疫法和实时荧光定量聚合酶链式反应(PCR)分别检测AIDS患者中高度怀疑为巨细胞病毒肺炎的血清巨细胞IgM、血清和痰液的巨细胞病毒载量水平。结果 35例AIDS合并巨细胞病毒肺炎的患者中,入院时CD4^+T细胞水平均为(74.3±58.1)个/μL。其中血清中巨细胞IgM抗体阳性检出率为2.9%;血清中病毒载量阳性检出率为8.6%;痰液中巨细胞病毒载量阳性检出率为65.7%。CD4^+T细胞计数<50个/μL患者中,巨细胞病毒检出率为70.6%;CD4^+T细胞计数在50~100个/μL患者阳性检出率为57.1%;CD4^+T细胞计数>100个/μL患者的阳性检出率为63.6%。不同水平的CD4^+T细胞间巨细胞病毒的阳性检出率差异无统计学意义(P>0.05)。结论在AIDS合并巨细胞病毒肺炎的感染初期,痰液标本的巨细胞病毒载量检测比血液的巨细胞病毒抗体及病毒载量检测阳性率更高,可作为临床早期快速的诊治病毒性肺炎的有效辅助诊断方法。

Objective To investigate the incidence situation of cytomegalovirus（CMV）pneumonia in AIDS patients and to compare the CMV positive detection rates in serum and sputum samples.Methods ELISA and real-time fluorescent quantitative PCR methods were used to detect serum CMV IgM,serum and sputum CMV loading levels in AIDS patients with highly suspected CMV pneumonia.Results Among 35 cases of AIDS complicating CMV pneumonia,the CD4~＋T cell level at admission was（74.3±58.1）cell/μL.The positive detection rate of CMV IgM antibody in serum was 2.9%.The positive detection rate of viral load in serum was 8.6%.The positive detection rate of CMV viral load in sputum was 65.7%.The detection rate of CMV was 70.6%in the patients with CD4~＋T count〈50cell/μL,the positive detection rate in the patients with CD4~＋T cell count 50-100cell/μL was57.1%.The positive detection rate in the patients with CD4~＋T cell count〉100cell/μL patients was 63.6%.There was no statistically significant difference in the positive detection rates among different levels of CD4~＋T cells（P〉0.05）.Conclusion In the infection initial stage of AIDS patients with complicating CMV pneumonia,the CMV viral load detection of sputum specimen has higher positive rate compared with blood CMV antibody and viral load detection,which can serve as the effectively assisted diagnostic method for clinical early and rapid diagnosis and treatment of viral pneumonia.