用间接免疫荧光法和PCR技术重新评价抗CMV－抗体检测的临床意义

为了正确评价临床常用的检测抗巨细胞病毒（ＣＭＶ）抗体的临床意义，用间接免疫荧光法（ＩＦＡ）和聚合酶链反应技术（ＰＣＲ）检测了５０例急性黄疸型甲型肝炎患儿血白细胞中ＣＭＶ早期抗原（ＥＡ）和晚期抗原（ＬＡ）、血白细胞及尿沉渣ＣＭＶ－ＤＮＡ，阳性率分别为５８％、２２％、６８％、６２％。同期检测抗ＣＭＶ－ＩｇＧ、抗ＣＭＶ－ＩｇＭ，并观察ＩｇＧ急性期／恢复期是否升高４倍以上（ＩｇＧ↑↑），阳性率分别为８６％、３４％及４６％。仅检测１次ＩｇＧ，１４％的患者会漏诊；动态监测ＩｇＧ，４３．９％的活动性ＣＭＶ感染者会漏判；仅检测１次ＩｇＭ，５８．５％的活动性ＣＭＶ感染者会漏判。７９％的ＩｇＧ阳性患者为活动性感染（ＥＡ、ＬＡ、ＩｇＧ↑↑或ＩｇＭ任何１项阳性）；原发性及继发性活动性ＣＭＶ感染者的ＩｇＧ↑↑、ＥＡ、ＩｇＭ阳性率分别为１００％、４２．９％、２８．６％和４７．０％、７６．５％、４４．１％，表明原发感染诊断主要依靠ＩｇＧ↑↑，而继发活动感染则需多种指标。同期检测了２２名健康ＣＭＶ感染儿童的上述指标，与之无显著差异。

Detection of Cytomegalovirus by Indirect Immunofluorescence Assay and PCR Compared with Cytomegalovirus Antibody Test

cases of acute icteric hepatitis A virus(HAV)hepatitis were investigated for 3 months for detection of cytomegalovirus(CMV)antigen in white blood cells by indirect immunofluorescence assay(IFA)and CMV DNA in urine by PCR to compare with the commonly used serological assay for CMV IgG and IgM. The results showed that 58%,22%,68%and 62%of all cases were positive for CMV early antigen(EA),late antigen(LA),WBC-CMV-DNA and urine-CMV-DNA,while86%,46%and 34% for CMV-IgG,IgG significant conversion and CMV-IgM,respectively. 14%of sufferers from CMV infection would be ignored by initial CMV IgG test,43.4%and 58.8%of active CMV infection ignored by IgG significant conversion and IgM test,respectively,100%,42.9%and 28.6% of primary infection were positive for CMV IgG significant seroconversion,EA and CMV IgM,while 47.0%,76.5%and 44.1%of secondary active infection positive,which suggested that diagnosis of primary infection relied on anti-CMV-IgG seroconversion test while diagnosis of secondary infection needed several of the above tests. No difference in the CMV infection markers described above was found between 22 healthy children with CMV infection and the cases with HAV hepatitis.