巨细胞病毒检测及在异基因造血干细胞移植中应用研究

目的:探讨检测巨细胞病毒(CMV)的方法学及在异基因造血干细胞移植(Allo-HSCT)中临床应用的价值.方法:以45例Allo-HSCT为研究对象,采集移植前供者、移植前后及恢复期受者的抗凝血标本,分别采用CMV-pp65单克隆抗体免疫组化法和ELISA法,检测CMV早期抗原和IgG、IgM抗体,并进行多点动态观察.结果:45例患者163份系列标本,CMV早期抗原阳性75份,是在移植后6～242天首次检出,平均70天;其中≤45天出现阳性者26例,占58%.术前供、受者CMV-IgG抗体均阳性,CMV-IgM抗体供、受者各1例阳性,其中受者持续阳性.术后45例中21例出现CMV-IgM抗体阳性,首次检出时间在14～234天,平均127天,比早期抗原检出时间推迟近2个月.45例中因CMV感染而致间质性肺炎25例,占55%.结论:异基因造血干细胞移植采用CMVpp55单克隆抗体免疫组化法检测巨细胞病毒感染,快捷、准确、灵敏,对患者的诊断、治疗和预后判断有重要意义,值得推广.

Detection of cytomegalovirus and its clinical value in allogeneic hematopoietic stem cell transplantation

Objectives:To investigate the method of detecting the antigen(Ag) and antibody(Ab) of human cytomegalovirus(CMV) and its clinical value in allogeneic hematopoietic stem cell transplantation(HSCT). Methods: Forty five patients with undergoing allogeneic HSCT were studied. Anticoagulant blood samples were obtained from the donors before transplantation and from the recipients before and after transplantation and in the convalescence. The methods of monoclonal Ab immunohistochemistry and ELISA were used to examine the early stage Ag and IgG, IgM Ab of CMV, and the dynamic changes were determined. Results: Among the 163 samples of the 45 patients, 75 samples were CMV Ag positive at day 6 to day 242 after transplantation (mean time 70 days). Twenty six(58%) patients were positive in no more than 45 days. Before operation both the 45 donors and the 45 recipients were CMV IgG Ab positive. One donor was IgM Ab positive, and one recipient was IgM Ab positive in whole process. Twenty one(47%) patients became IgM Ab positive 14 to 234 days after operation (mean time 127 days which was about two months after the CMV Ag was positive). There were 25(55%) cases suffered from interstitial pneumonia(IP) caused by CMV. Conclusions: In allogeneic HSCT, the method of CMV pp65 monoclonal Ab immunhistochemistry can detect the infection of CMV earlier and faster, which is important for the clinical diagnosis, therapy, and prognosis. The technique of CMV pp65 monoclonal Ab immunohistochemistry is convenient, accurate, and sensitive. It is worthy to be popularized.