聚合酶链反应方法检测造血干细胞移植患者巨细胞病毒感染状况

Detection of cytomegalovirus infection by polymerase chain reaction in hematopoi etic stem cell transplantation recipients

目的 评价PCR检测血浆和尿巨细胞病毒 (CMV)对CMV病发生的预告意义。方法 对1 999年 8月～ 2 0 0 1年 7月进行异基因造血干细胞移植的 1 31例患者 ,自预处理开始 ,每周留取血及尿标本 ,经PCR法检测血浆和尿沉渣中的CMV DNA。结果 血浆病毒血症阳性 89例 ,尿CMV DNA阳性99例 ;发生CMV病 37例 ,累计发生率为 2 8.2 %。CMV病的发生率在血CMV DNA阴性组为 1 5 .7% ,在1次血CMV DNA阳性组为 31 .3 % ,2次以上血CMV DNA阳性的患者组为 47.3 % ,三组间CMV病发生率差异有显著性 (P =0 .0 1 2 6) ,2次以上血CMV DNA阳性组比阴性组患者CMV DNA病发生率明显增高。CMV病的发生率在尿CMV DNA阴性组为 2 4 .8% ,尿CMV DNA 1次阳性组为 43 .5 % ,尿CMV DNA2次以上阳性组为 33 .0 % ,三组间CMV病发生率无统计学差异 (P =0 .845)。血浆CMV DNA对预测CMV病的阳性预告值为 40 5 % ,阴性预告值为 84.4 % ,灵敏度 75 .0 % ,特异度 69.2 %。结论 血浆CMVPCR检测结果对CMV病的发生有一定预测意义 。

Objective To evaluate the detection of cytomegalovirus( CM V) by polymerase chain reaction(PCR) for predicting the development of CMV disea se.Methods One hundred and thirty one allo-HSCT patients perfo rmed in the past 2 years were analyzed retrospectively.PCR-CMV was used to mon itor CMV viremia and vireuria once a week after transplantation.Results In the dynamic detection, CMV viremia was positive for at least one c hance in 89 patients, vireuria did in 99 patients. Thirty-seven patients devel oped CMV disease with an accumulative incidence of 32.5%. The incidence of CMV d isease was 15.6% in plasma CMV-PCR negative group, 31 3% in positive once grou p,and 47.3% in positive over twice group. There was significant difference amon g the three groups(P=0.0126). The incidence of CMV disease was 2 4.8% in urine CMV-PCR negative group, 43.5% in positive once group, and 33.0% in positive over twice group, being no significant difference among them( P=0 845).On analysis, viremia could predict the development of CMV di sease: the PPV(positive predictive value) is 40.5%, NPV (negative predictive v alue) is 84.4%,sensitivity is 75.0%, and specificity is 69.2%.Conclusi ons Detected by CMV-PCR, MCV viremia may predict the development of CM V disease, but MCV vireuria cannot.