CMV-DNA和IgM抗体检测对慢性重型乙型肝炎患者活动性巨细胞病毒感染的诊断价值评估

Diagnostic value of CMV-DNA and IgM antibody detection in chronic severe hepatitis B patients with active cytomegalovirus infection

目的评估CMV-DNA和IgM抗体检测对慢性重型乙型肝炎患者活动性巨细胞病毒感染的诊断价值。方法 100例慢性重型乙型肝炎(CSHB)患者采用免疫组化二步法检测CMV-pp65抗原、荧光定量PCR法检测CMV-DNA及酶联免疫吸附反应法(ELISA)检测CMV-IgM抗体,以CMV-pp65抗原为对照,分析比较不同检测方法的差异性。结果 100例CSHB患者CMV-DNA阳性27例,阳性率为27%(27/100);CMVpp65抗原阳性45例,阳性率为45%(45/100);差异有统计学意义(P<0.05)。CMV-IgM抗体阳性4例,阳性率为4%(4/100),明显低于CMV-pp65抗原和CMV-DNA阳性率(均P<0.05)。CMV-pp65与CMVDNA诊断一致性分析采用Kappa检验,Kappa值为0.483,在0.4~0.7之间,表示吻合程度一般。CMVDNA诊断巨细胞病毒感染的灵敏度为0.486,特异度为0.906;CMV-IgM抗体诊断巨细胞病毒感染的灵敏度为0.064;特异度为0.981。CMV-DNA诊断巨细胞病毒感染的ROC曲线下面积(AUC)为0.687,P=0.001;IgM抗体诊断巨细胞病毒感染的AUC为0.522,P=0.699。结论 CMV-DNA诊断慢性重型乙型肝炎患者合并活动性巨细胞病毒感染的价值不如CMV-pp65抗原,但CMV-DNA可作为CMV-pp65抗原诊断的对照和补充,而CMV-IgM抗体无诊断价值。

Objective To evaluate the diagnostic value of CMV-DNA and IgM antibody detection in chronic severe hepatitis B patients with active cytomegalovirus （CMV） infection. Methods CMV- pp65 antigen of 100 chronic se-vere hepatitis B patients, as the control, detected by inmiunohistochemical method were compared to the CMV-DNA detected by quantitative PCR and CMY-IgM antibody detected by enzyme-linked immunosorbent assay （ELISA）. Results The positive CMV-DNA rate was 27%（27/100） while the positive rate of CMV- pp65 antigen was 4 5 % （45/100）, with statistically significance（P 〈 0.05）. The positive rate of CMV-IgM antibody was 4 % （4/100）, which was significantly lower than that of CMY- pp65 antigen and CMV-DNA positive rate（ allP 〈 0.05）. The consistency between CMV- pp65 and CMV-DNA was analyzed by Kappa test, and the value of Kappa was 0.4830 （0.4 - 0.7）, which indicated the anastomosis was in general. The sensitivity of cytomegalovirus infection by CMV-DNA was 0.486 and the specificity was 0.906. The sensitivity of IgM antibody for the diagnosis of CMV infection was 0.064and the specificity was 0.981. The ROC curve analysis of CMV-DNA showed that CMV-DNA had an area under the ROC curve （AUC） of 0.687 （ P=0.01）, and IgM antibody had an AUC of 0.522（P=0.699）. Conclusions The value of CMV-DNA in the diagnosis of chronic severe hepatitis B patients with active CMV infection is not as valuable as CMV- pp65 antigen, but CMV-DNA can be used as the control and supplement of CMV- pp65 antigen detection. IgM antibody has no diagnostic value.