器官移植术后HCMV感染的实验诊断及其临床意义

Diagnosis of human cytomegalovirus infection after organ transplantation and its clinical significance

目的 探讨对器官移植术后受者人类巨细胞病毒 (HCMV)感染的早期、快速诊断。方法 以 12 2例器官移植术后患者为研究对象 ,采集移植术后 2～ 12周内外周血 32 8份。利用抗HCMV单克隆抗体 ,建立了免疫组化Envision二步法。检测外周血白细胞中的HCMV抗原。并观察该法在早期诊断活动性HCMV感染中的价值。结果 32 8份外周血标本中 ,HCMV抗原阳性 135份 (4 1 2 % )。阳性细胞数为 3 0～ 6 8 0个 / 5万白细胞 ,平均 (15 3± 6 8)个 / 5万白细胞。 5 8例患者出现HCMV活动性感染 (4 7 5 % ) ,其中 35例发展为HCMV病。HCMV病患者和无症状HCMV感染者的HCMV阳性细胞数平均分别为 (2 3 0± 13 6 )个 / 5万白细胞和 (15 2± 8 5 )个 / 5万白细胞 ,两者差异具有显著性 (P <0 0 5 )。结论 Envision二步法检测HCMV抗原具有简便 ,快速等优点 ,且能区分潜伏感染和活动性感染 ,其结果与患者的临床症状相关 ,可作为临床对HCMV感染的早期快速诊断 ,为预防及指导HCMV感染的抗病毒治疗提供依据。

Objective To study method for early and rapid diagnosis of the active human cytomegalovirus(HCMV) infection after organ transplantation. Methods 328 samples were collected from 122 organ transplant patients in 2～12 weeks after transplantation. A two-step technique of immunohistochemical Envision was established to detect immediate early antigen(IEA) and early antigen(EA) in peripheral blood using HCMV monclonal antibody.Results Among 328 blood samples taken from 122 patients, 135(41.2%) were positive for HCMV and active infection of HCMV were detected in 58 patients of 122. 35 patients had HCMV disease out of 58. The average count of positive cells were (15.3±6.8)/5.0×10 4 WBC. The average count of positive cells was (23.0±13.6)/5.0×10 4 WBC in HCMV disease and (15.2±8.5)/5.0×10 4 WBC in subclinical infection patients. The results correlated with clinical symptoms. Conclusion Antigen assay by immunohistochemistry technique are effective in the early diagnosis of HCMV active infection in organ transplant recipients. It can monitor HCMV infection and provide indication for antiviral therapy.