巨细胞病毒定量PCR与pp65抗原测定监测异基因造血干细胞移植巨细胞病毒感染的比较

本研究比较巨细胞病毒（CMV）定量PCR检测和CMV—pp65抗原检测在异基因造血干细胞移植CMV感染中的诊断价值。以84例异基因造血干细胞移植患者为研究对象，自预处理开始每周对患者EDTA抗凝外周血血标本进行CMV—pp65抗原及cMV定量PCR动态检测，直至出院，比较观察两者在诊断CMV感染中的作用。结果表明：84例移植患者的732份系列血标本中，26例移植后检出CMV定量PCR阳性，检出率30．95％，其中9例为cMV血症，13例为cMV病，检出中位时间为37．1（7—105）天；22例CMVpp65抗原检测阳性，检出率26．19％，检出中位时间为46．6（10—128）天；所有CMV—pp65抗原检测阳性患者CMV定量PCR均为阳性，4例CMV定量PCR阳性但CMV—pp65抗原检测阴性患者均未发展为CMV病。CMV病多出现于CMV定量PCR中等至高拷贝数或中等至高水平病毒血症（CMV—pp65抗原）病例中。治疗后CMV定量PCR转阴中位时间为17．5（11—28）天。CMV—pp65抗原转阴中位时间为10．0（7—21）天。结论：CMV定量PCR和CMV—pv65抗原检测均能作为异基因造血干细胞移植CMV感染早期诊断的有效手段，CMV定量PCR更敏感，CMV—pp65抗原检测更特异，两者同时使用能更有效地提高CMV感染诊断水平，监控其发生发展。

Comparison between CMV Quantitative PCR and CMV-pp65 Antigen Test for Detection of CMV Infection in Allogeneic Hematopoietic Stem Cell Transplantation

The study was aimed to compare the effeciency of cytomegalovirus （CMV） quantitative PCR and CMV- pp65 antigen test for detection of CMV infection and their clinical significance in patients received allogeneic hematopoietic stem cell transplantation （HSCT）. 84 patients received allogeneic HSCT were enrolled in study. Anticoagulant blood samples were obtained from the recipients before and after transplantation and in the convalescence. CMV quantitative PCR and CMV-pp65 antigen test were performed weekly. The results showed that out of 84 patients, 26 cases were positive （30.95%） by CMV quantitative PCR method. Of the 26 cases, 9 cases were CMV antigenemia and 13 cases were CMV disease, the median positive time was 37.1 （7 -105 ）days after HSCT. 22 cases were positive （26.19%） by CMV -pp65 antigen test method, the median positive time was 46.6 （ 10 - 128 ） days after HSCT. All the 22 positive cases detected by CMV-pp65 antigen test were also positive by CMV quantitative PCR method. Nevertheless, 4 positive cases detected by CMV quantitative PCR but negative detected by CMV-pp65 antigen test method did not develop CMV disease. The CMV disease was found in the cases either with moderate to high copies of CMV quantitative PCR or moderate to high level CMV antigenemia by CMV-pp65 antigen test method. The clearance median time was 17. 5 （11 -28 ）days by CMV quantitative PCR method after receiving antiviral therapy and was 10.0 （7 -21 ） days by CMV-pp65 antigen detection method. It is concluded that both CMV quantitative PCR and CMV-pp65 antigen test can detect the infection of CMV early and effectively in patients received HSCT. CMV quantitative PCR is more sensitive, and CMV-pp65 is more specific. It can be more effective to guide the antiviral treatment and evaluate its efficacy when combining the two methods.