巨细胞病毒pp65抗原血症检测

Detection of CMV pp65 antigenemia

目的 评估巨细胞病毒 (CMV) pp6 5白细胞抗原血症在骨髓移植或外周血干细胞移植后活动性CMV感染早期诊断和CMV病的预测、指导CMV亚临床期感染的抗病毒治疗及抗病毒疗效判断中的价值。方法 1999年 9月～ 2 0 0 0年 4月共收集 2 10份乙二胺四乙酸 (EDTA)抗凝血 ,骨髓移植或外周血干细胞移植患者 36例。移植前用ELISA法检测患者CMV特异性抗体IgG和IgM ,移植后 3周起采用CMVBrite试验盒每周检测 1次CMV pp6 5抗原血症 ,并计数抗原阳性细胞 ,直到移植后 10 0d或治疗后抗原阴转、死亡或出院。移植后患者第 1次检测到 pp6 5抗原阳性细胞即开始更昔洛韦抗病毒治疗。结果 36例骨髓移植或干细胞移植患者于移植前CMV特异性抗体IgG均阳性 ,IgM均阴性 ;移植后 16例出现CMVpp6 5抗原血症 ,其中 15例出现有症状的CMV感染或CMV病 ,14例接受更昔洛韦抗病毒治疗 ,12例治疗后抗原血症阴转、症状消失 ,死亡 2例 (病死率 14.2 % ) ,未经抗病毒治疗者 2例均死亡 (P <0 .0 1)。 16例 pp6 5抗原阳性患者中 ,仅 2例CMV特异性抗体IgM阳性。 10名健康对照组的CMV特异性抗体IgG均阳性 ,IgM均阴性 ,pp6 5抗原血症检测均阴性。结论 本研究结果提示 ,人CMV pp6 5白细胞抗原血症检测可作为骨髓移植后CMV病的预测指标 。

Objective To evaluate the clinical utility of CMV pp65 antigenemia by CMV brite Kit for predicting active/reactive CMV infection S as well as of CMV diseases in bone marrow or peripheral stem cell transplant patients. We also investigated the efficacy of preemptive therapy guided by detection of CMV antigenemia. Methods A total of 210 EDTA anticoagulant plasma samples from 36 bone marrow or Peripheral Stem Cell Transplant Patients were prospectively collected from September 1999 to April 2000. The specific CMV antibody IgG/IgM of all patients were detected by ELISA. We detected CMV pp65 antigenemia by indirect immunofluorescence assay using CMV Brite Kit. All blood samples were detected weekly from week 3 after bone marrow transplantation until 100 days or antigenemia turning negative/dischage or death. Ganciclovir preemptive therapy was initiated at first positive pp65 antigenemia. Results Of 36 bone marrow or Peripheral Stem Cell Transplant Patients, 16 patients occurred positive pp65 antigenemia, 15 patients suffered from symptomatic CMV infections or CMV diseases. In 14 patients of positive pp65 antigenemia receiving gaciclovir therapy at first antigenemia, 2 patients died (mortality rate 14.2%), 12 patients of pp65 antigenemia became negative. Otherwise, 2 untreated cases died. The study showed a significant difference in mortality rate between treated and untreated patients (P<0.01).Conclusions CMV pp65 antigenemia assay can predict active/reactive CMV infections or CMV diseases in bone marrow or peripheral stem cell transplant patients. pp65 antigenemia can guide preemptive therapy and evaluate efficacy of antiviral drug treatment and decrease mortality significantly at first positive pp65 antigenemia.