尿巨细胞病毒定量检测在巨细胞病毒感染诊断中的意义

目的探讨尿巨细胞病毒(CMV)定量检测在儿科CMV感染诊断中的意义。方法应用荧光定量聚合酶链反应 (FQ-PCR)方法检测110例确诊或疑诊CMV感染和81例对照患儿尿CMV-DNA,并与血清抗体检测、pp65抗原检测比较,对更昔洛韦治疗的17例病人进行治疗后尿CMV-DNA;拷贝监测。结果 1．确诊或疑诊为CMV活动性感染患儿110例,其中82例尿中检测到CMV-DNA;对照11例检测到尿CMV-DNA,其中10例为正常健康儿童;且不同年龄组CMV-DNA的阳性率不同。17 例更昔洛韦治疗后,尿CMV-DNA的平均拷贝数明显下降(P<0．001)。2．FQ-PCR、pp65、IgM检测方法敏感性分别为87％、 74％、59％,特异性分别为97％、86％、69％;与其他两种方法比较,FQ-PCR方法敏感性和特异性均明显高(P均<0.001)。结论 FQ-PCR检测尿CMV-DNA对诊断活动性CMV感染有一定意义,量化结果便于治疗过程中进行连续的监测。

Diagnosis of Cytomegalovirus Infection in Children by Quantitative Detection of Cytomegalovirus in Urine

Objective To explore the significance of fluorescent quantitative polymerase chain reaction(FQ- PCR) assay detecting urine cytomegalovirus(CMV) - DNA to diagnose the cytomegalovirus infection in children. Methods CMV - DNA from urine was detected by FQ-PCR. Indirect immunofluorescence assay was used to detect pp65 antigen in peripheral blood leukocytes, and ELISA to detect anti - CMV IgM in serum. Seventeen patients were treated with ganciclovir and CMV - DNA copies were detected from urine after treatment. Results 1.Among 110 patients or highly suspected to be active CMV infection, 82 were positive by quantitative PCR. A-mong 81 controls, 11 were positive for FQ- PCR with 10 healthy children. In 17 patiens with CMV infection, after ganciclovir treatment, CMV-DNA copies significantly decreased (P<0.001). 2.The sensitivity reached 87% for FQ-PCR, 74% for PP65 and 59% for anti-CMV IgM assay, respectively. The specificity of FQ- PCR was 97% , pp65 86% and anti - CMV IgM 69% , respectively. The sensitivity and specificity of FQ - PCR assay were significantly higher than those of the other two assays (all P<0.001). Conclusions Quantitative detection of CMV -DNA from urines is helpful for diagnosis of active CMV infection in pediatric patients. With the advantage of quantification this assay can be used to monitor effectiveness of therapy.