肾移植受者外周血白细胞CMV抗原阳性细胞数及意义

【目的】探讨肾移植受者外周血白细胞巨细胞病毒(CMV)PP-65抗原阳性细胞数的变化及意义。【方法】用免疫细胞化学法检测外周血白细胞CMV-PP65抗原，术后头3个月每周1次。【结果】273例肾移植受者中124例术后检出CMV-PP65抗原阳性，初次检出CMV-PP65抗原的平均时间为(24.1±11.3)d，每5万白细胞中CMV抗原阳性细胞数均值为7.1±5.8，其中5例CMV抗原阳性细胞数超过10/5万白细胞。无症状性和症状性CMV感染受者初次检出CMV抗原阳性细胞数分别为(6.7±5.6)/5万白细胞、(10.1±9.3)/5万白细胞(P>0.05)；峰值水平为(8.1±4.2)/5万白细胞、(26.3±5.7)/5万白细胞(P<0.05)；分别有17例(15%)、12例(100%)患者其峰值超过10/5万白细胞(P<0.05)。抗病毒治疗中90例(72.6%)患者CMV抗原阳性细胞数进一步升高。【结论】肾移植受者在CMV感染早期病毒复制能力强，CMV抗原阳性细胞数峰值有助于预测症状性CMV感染。

Clinical Significance ofthe Changes of the Numbers of Positive Cytomegalovirus Antigen Leukocytes in RenalTransplant Recipients

【Objective】 To investigate the clinical significance of thechanges of the numbers of peripheral blood leukocyte with cytomegalovirus (CMV) PP65 antigen in renal transplant recipients. 【Methods】 Detecting CMV-PP65 antigen by immunocytochemical methods at weekly intervals during the first 3 months after transplantation. 【Results】 Among 273 recipients, CMV-65 antigen was detected, 112 of them were asymptomatic and 12 were symptomatic. The average of the first positive CMV-PP65 antigen leukocytes were 6.7±5.6、10.1±9.3 per 50,000 leukocytes respectively in asymptomatic and symptomatic CMV infection recipients. There was no significant difference between them (P>0.05). The average of the peak positive CMV-PP65 antigen leukocytes were 8.1±4.2、26.3±5.7 respectively. There was significant difference between them (P<0.05). The peak positive CMV-PP65 antigen leukocytes in 17 cases (15%) with asymptomatic CMV infection and 12 cases (100%) with symptomatic CMV infection were more than 10 per 50,000 leukocytes (P<0.05). The numbers of the positive CMV-PP65 antigen leukocytes were increased in 90 cases (72.6%) after treatment with antiviral drugs. 【Conclusion】 We suggest that CMV may reproduce rapidly in the early stage of infection. The peak numbers of the positive CMV-PP65 antigen leukocytes help to predict the symptomatic CMV infectionin renal transplant recipients.