尿液巨细胞病毒DNA检测在诊断婴幼儿巨细胞病毒感染应用中的价值

目的探讨尿液中巨细胞病毒DNA在婴幼儿感染中的临床诊断价值.方法选取自2017年1月至2018年12月收治的256例巨细胞感染疑似住院患儿作为观察对象,并选取同期在医院体检的健康婴幼儿130例设为对照组,用化学发光法和实时荧光定量PCR(FQ-PCR)进行检测,比较两种检测方法对婴幼儿巨细胞病毒的诊断价值.结果尿液FQ-PCR与化学发光法两种方法在256例患儿的检出分别为69.9%和17.96%,FQ-PCR检出率明显高于化学发光法,差异有统计学意义(P=0.000),Kappa值为0.147,结果缺乏一致性;尿液FQ-PCR检测HCMV-DNA的灵敏度,准确率均高于化学发光法,血HCMV-IgM的漏诊率及误诊率高;尿液FQ-PCR和化学发光检测ROC曲线下面积分别为0.836和0.663.结论尿液HCMV-DNA对诊断患儿人巨细胞病毒有更好的临床应用价值.且尿标本留取方便、无创、易为家长和小儿接受,所以采用FQ-PCR方法对小儿尿标本进行检测能起到快速、简洁、灵敏的作用,对提高HCMV感染的诊断率有实际的临床意义,对于小月龄患儿临床应推广尿液HCMV-DNA检测.

Objective To explore the clinical diagnostic value of cytomegalovirus DNA in urine in infants and young children.Methods 256 cases of suspected hospitalized children with giant cell infection admitted to Lishui Hospital of Zhejiang University from January 2017 to December 2018 were selected as the study subjects,and 130 healthy children in the same period were selected as the control group.Luminescence and realtime quantitative PCR(FQ-PC R)were used to detect the diagnostic value of the two methods for infant cytomegalovirus.Results Urine FQ-PCR and chemiluminescence were detected in 256 children,69.9% and 17.96%,the detection rate of FQ-PCR was significantly higher than that of chemiluminescence method,the difference was statistically significant(P=0.000),Kappa value was 0.147,and the results lacked consistency.The sensitivity of urine FQ-PCR for detection of HCMV-DNA was higher than that of chemiluminescence method.The rate of missed diagnosis and misdiagnosis of blood HCMV-IgM was high.The area under the ROC curve of urine FQ-PCR and chemiluminescence detection were 0.836 and 0.663.Conclusion Urine HCMV-DNA has a better clinical value in the diagnosis of human cytomegalovirus.The urine specimens are convenient,non-invasive and easy for parents and children to accept.Therefore,the FQ-PCR method can be used to detect the urine samples of children,which can be rapid,concise and sensitive.It has practical clinical evaluation for improving the diagnosis rate of HCMV infection.Significance,urine HCMV-DNA detection should be promoted in children with small age.