多种指标检测造血干细胞移植术后人巨细胞病毒活动性感染的研究

Monitoring of active human cytomegalovirus infection in haematopoietic stem cell transplant patients by multiple indexes

目的评价免疫组化法、酶联免疫法及巢式聚合酶链法检测造血干细胞移植术后人巨细胞病毒(HCMV)活动性感染指标的诊断价值。方法选择35例造血干细胞移植受体系列血标本,免疫组化测HCMV抗原血症、ELISA测抗HCMV IgG/M 抗体,其中9例nest-PCR检测HCMV DNA。结果pp65和IE/E两种抗原血症检测方法具有很好的相关性(r=0.624,P【 0.01);外周血白细胞HCMV DNA阳性率明显高于血浆HCMV DNA阳性率(P【0.05);pp65抗原血症和特异性IgM抗体检测结果符合率49.9%,IgM抗体检测敏感性仅19.6%;IE/E抗原和pp65抗原阳性较临床症状早7.3±2.5和10.3±3.7天出现,白细胞中HCMV DNA在出现抗原血症前平均11.4天即可检出。结论检测HCMV抗原血症和DNA对移植术后早期诊断 HCMV活动性感染均非常敏感;在移植早期,结合免疫组化法、巢式PCR法检测病毒抗原和DNA可更合理的指导预防和治疗。

Objective To evaluate the diagnostic efficacy of the immunochemical assay,combining ELISA assay and nest-PCR assay in monitoring active HCMV infection of stem cell transplant patients.Methods 35 blood samples of transplant patients were detected HCMV antigenemia by immunochemical assay, the anti-HCMV specific IgG/M by ELISA, and select the blood samples from 9 patients among these patients to detect the HCMV DNA by nest-PCR assay. Results There was a good correlation between pp65 antigenemia and IE/E antigenemia(r =0. 624 ,P <0. 001) ; The positive rate of HCMV DNA of peripheral blood white cell was higher than that of plasma (P<0.05);The coincidence of IgM assay in plasma and CM V pp65 antigenemia assay was 49.9% , however, the sensitivity of IgM assay was only 19.6% ; The occur of IE/E antigenemia or pp65 antigenemia was earlier than that of clinical symptoms of recipients, there was earlier7.3±2.5 days or 10.3±3.7 days, respectively, but the positive detection of HCMV DNA in leukocytes by PCR test was earlier than that of the antigenemia(the earlier day was about 11.4 days). Conclusion There were high sensitive in early diagnose of active HCMV infection in stem cell transplant patients by the antigenemia and DNA assay. In early transplantation, detection of antigen and DNA of HCMV by combination immunochemical assay and nest-PCR could direct the prophylaxis and treatment reasonably.