Detection of cytomegalovirus infection by polymerase chain reaction in hematopoietic stem cell transplantation recipients

目的评价PCR检测血浆和尿巨细胞病毒(CMV)对CMV病发生的预告意义.方法对1999年8月～2001年7月进行异基因造血干细胞移植的131例患者,自预处理开始,每周留取血及尿标本,经PCR法检测血浆和尿沉渣中的CMV-DNA.结果血浆病毒血症阳性89例,尿CMV-DNA阳性99例;发生CMV病37例,累计发生率为28.2%.CMV病的发生率在血CMV-DNA阴性组为15.7%,在1次血CMV-DNA阳性组为31.3%,2次以上血CMV-DNA阳性的患者组为47.3%,三组间CMV病发生率差异有显著性(P=0.012 6),2次以上血CMV-DNA阳性组比阴性组患者CMV-DNA病发生率明显增高.CMV病的发生率在尿CMV-DNA阴性组为24.8%,尿CMV-DNA 1次阳性组为43.5%,尿CMV-DNA 2次以上阳性组为33.0%,三组间CMV病发生率无统计学差异(P=0.845).血浆CMV-DNA对预测CMV病的阳性预告值为40.5%,阴性预告值为84.4%,灵敏度75.0%,特异度69.2%.结论血浆CMV PCR检测结果对CMV病的发生有一定预测意义,单独尿CMV PCR检测结果不能预测CMV病的发生.To evaluate the detection of cytomegalovirus (CMV) by polymerase chain reaction (PCR) for predicting the development of CMV disease.One hundred and thirty one allo-HSCT patients performed in the past 2 years were analyzed retrospectively. PCR-CMV was used to monitor CMV viremia and vireuria once a week after transplantation.In the dynamic detection, CMV viremia was positive for at least one chance in 89 patients, vireuria did in 99 patients. Thirty-seven patients developed CMV disease with an accumulative incidence of 32.5%. The incidence of CMV disease was 15.6% in plasma CMV-PCR negative group, 31.3% in positive once group, and 47.3% in positive over twice group. There was significant difference among the three groups (P = 0.0126). The incidence of CMV disease was 24.8% in urine CMV-PCR negative group, 43.5% in positive once group, and 33.0% in positive over twice group, being no significant difference among them (P = 0.845). On analysis, viremia could predict the development of CMV disease: the PPV (positive predictive value) is 40.5%, NPV (negative predictive value) is 84.4%, sensitivity is 75.0%, and specificity is 69.2%.Detected by CMV-PCR, MCV viremia may predict the development of CMV disease, but MCV vireuria cannot.PubMed中文核心期刊要目总览(PKU)中国科学引文数据库(CSCD)08407-4092