二次浓缩尿动态监测肾移植术后巨细胞病毒感染的研究

目的 通过与原尿沉渣、血浆标本比较人巨细胞病毒DNA(HCMV-DNA)含量的差异,评估二次浓缩尿沉渣在监测肾移植术后HCMV感染的应用价值.方法 将165例肾移植患者血浆、原尿沉渣和二次浓缩尿沉渣标本用荧光定量PCR(FQ-PCR)方法 检测肾移植前、移植后、抗病毒治疗过程中HCMV-DNA拷贝数,二次浓缩尿标本与原尿沉渣监测HCMV-DNA均阳性组进行更昔洛韦(GCV)抗病毒干预,采用卡方检验和秩和检验方法 进行组间比较.结果 165例肾移植患者术前血浆、原尿沉渣和二次浓缩尿沉渣标本中均未检测到HCMV-DNA;术后原尿沉渣中检出率25.45%,浓缩尿沉渣中检出率38.79%,差异有统计学意义(x~2=6.727,P＜0.01),血浆检出率18.18%,与二次浓缩尿组比较,差异有统计学意义(χ~2=8.598,P＜0.01);同一时间点浓缩尿HCMV-DNA检出的病毒拷贝数均高于原尿,差异有统计学意义(U=4.772,P＜0.01);二次浓缩尿比原尿标本检出HCMV-DNA早7～14 d,HCMV.DNA检出高峰均集中于术后第6～8周.施加临床干预患者浓缩尿HCMV-DNA拷贝数显著下降、或调整干预方案后下降.结论 二次浓缩尿沉渣方法 能明显缩短HCMV-DNA检出时间,提高阳性检出率,能及时有效地为临床提供诊断和治疗依据,尤其在监测肾移植术后HCMV感染中具有临床应用价值.

Dynamic surveillance of the human cytomegalovirus in second urinary concentration of renal transplant recipients

Objective To evaluate the clinical value of dynamic surveillance of human cytomegalovirus(HCMV)-DNA in second urinary concentration for diagnosis of HCMV infection.Methods Thesamples of blood,primary urine and second urinary concentration were all seriously collected from 165 rehal transplant recipients and the viral load was detected by fluorescent quantitative polymeraee chain njaction polymerase chain reaction(FQ-PCR).The patients positive for HCMV-DNA in primary urine and urinary concentration were all treated by ganeielovir.Results All the samples pre-operation were negative.Positive rate of HCMV-DNA in blood,primary urine and urinary eoncemmtion wag 18.18%,25.45%and 38.79%,respectively(P＜0.01).The viral load and positive rate of urinary concentration were higher than primary urine(U=4.772,P＜0.01).The peak of HCMV-DNA appeared from the sixth to eighth week after operation.The viral 10ad of urinary concentration was significantly declined or descended by adjnsting the dose of ganeiclovir based on the GFR.Conclusion Second urinary concentration not only obvionsly shortens the detection time and increases the positive rate.but also provides the scientific proof for clinicM prognosis and treantmen,especially it has important clinical price for dynamic surveillance of HCMV infeetion.