pp67-mRNA在肾移植术后人巨细胞病毒感染中的诊断价值

目的探讨pp67对。肾移植术后人巨细胞病毒（HCMV）活动性感染及指导抗病毒治疗上的作用。方法采用NASBA测定32例肾移植术后患者外周血中的pp67，同时通过免疫荧光技术（IFA）对早期抗原pp65（CMV-Agpp6S）的检测来判断HCMV活动性，术后第3周，第7周分别用ED-TA管采血5-7rnl，每人每次两管做实验样本，立即送检并将二者结果相比较。其中检测结果有一项阳性的患者，选择更昔洛韦进行对症抗病毒治疗，对pp67-mRNA和pp65抗原检测双阳性患者，在选择更昔洛韦对症治疗时，并随访观察每周采血行pp67检测CMV活动情况，同时CMV抗原血症法检测，将二者结果比较，了解pp67与HCMV活动性感染及CMV病的关系。结果共采集样本128份，其中44份样本CMV-Agpp65阳性，19份样本pp67-mRNA阳性，8例CMV-Agpp65和pp67-mRNA均为阳性。临床诊断为HCMV病患者12例。CMV-Agpp65抗原检测灵敏度（91．7％）高于pp67-mRNA（66．7％），pp67-mRNA特异性（95．O％）高于CMV．Agpp65（50．0％）抗原检测。而在HCM~临床症状出现感染并治疗后期，随访发现选择以pp67作为抗病毒治疗指标较CMV-Ag更早转阴，可以明显缩短用药时间（P〈0．05）。结论CMV-Agpp65、pp67-mRNA对器官移植术后HCMV感染均具有诊断意义，应用NASBA法能更加快捷准确检测巨细胞病毒，pp67较准确地反映了肾移植术后HCMV的活动性，能更好的指导临床抗病毒治疗并提供了较客观的依据。

Clinical significance of human cytomegalovirus pp67-mRNA in renal transplant recipients

Objective To investigate the relation of the human cytomegalovirus pp67-mRNA with the active infection in renal transplant recipients and the role in the direction for antiviral therapy. Methods Total 128 samples were collected from peripheral blood treated with EDTA of 32 recipients at the 3rd week or the 7th week after transplantation. IFA was used to detect CMV pp65 antigen, and NASBA was used todetect pp67 mRNA assay. Compared with CMV-Ag, the recipients were followed up to observe the change of pp67 in the cases of the active infection and the CMV disease. Results Compared with the proportion be- tween two groups, 4d samples out of 128 samples showed CMV-Ag pp65 positive, while pp67-mRNA were positive in 21 samples. 8 patients had been found positive CMV-Ag pp65 and pp67-mRNA; 12 recipients were clinically diagnosed with I-ICMV disease. In the early stage of the HCMV infection, the sensitivity andspecificity of the CMV-Ag pp65 （91.7%, 50. 0%） was higher than that of pp67-mRNA （66. 7%, 95.0% ）. During the periods of symptoms appeared and the late stage of clinical treatment, the specificity of pp67-mRNA was higher than that of CMV-Ag pp65, while the sensitivity sit on the contrary. And in the antiviral therapy course, the indicator of antiviral therapy pp67 turned negative more quickly than the CMV-Ag, the therapy course could be reduced. Conclusions Both of CMV-Ag pp65 and of pp67-mRNA have clinical significance. Testing for CMV-Ag pp65 is suitable for detecting HCMV active infection at the early stage, which was important for in time anti-virus treatment in the clinical settings. The test for pp67-mRNA is a quick method to accquire the accurate results; therefore, it can be used as the reference criteria for the clinical anti-virus treatment.