即刻早期抗原-mRNA测定对肾移植后巨细胞病毒感染的诊断价值  

Diagnostic value of immediate early antigen-mRNA in the diagnosis of cytomegalovirus infection after kidney transplantation

作　　者：张川[1] 邵勇[1] 高治忠[1] 张明刚[1] 王文涛[1] 刘云力[1] 

机构地区：[1]哈尔滨医科大学附属第二医院泌尿外利,150086

出　　处：《中国综合临床》2013年第7期714-717,共4页Clinical Medicine of China

基　　金：黑龙江省科技计划项目（GC07C35304）

摘　　要：目的探讨器官移植术后应用核酸基础序列扩增法（NASBA）检测即刻早期抗原（IE）-mRNA对人外周血中巨细胞病毒（HCMV）感染的诊断价值，以评价和推广CMV活动性感染的诊断方法。方法肾移植术后患者32例，分别于术后3、7周采血5～7ml，每次同时进行针对CMV感染的NASBA、实时荧光定量PCR（Realtime—PCR）、ELISA法检测。比较三者的敏感度和特异度。结果32例肾移植术后受体CMV检测结果显示，采用NASBA法外周血IE-mRNA阳性率为45．8％（15／32）；Realtime．PCR法检测HCMV—DNA阳性率45．8％（15／32）；ELISA法检测HCMV-（IgG＋IgM）阳性率37．5％（14／32）。IE-mRNA、HCMV—DNA灵敏度和特异度明显优于HCMV-（IgG＋IgM），且可以降低后者存在的假阳性率。有CMV症状者共14例，其中NASBA法IE—mRNA检测阳性患者占92．8％（13／14）；RealtimePCR、ELISA法阳性率分别为71．5％（10／14）和42．8％（6／14）。结论NASBA和Realtime—PCR是一种敏感、快速诊断HCMV感染的方法，灵敏度及特异性均高于传统ELISA法，并能弥补ELISA的假阴性。NASBA检测IE—mRNA对于辅助临床诊断具有很好的价值。Objective To investigate the diagnostic value of the immediate early antigen （IE） mRNA by nucleic acid sequence-based amplification（NASBA） in peripheral blood cytomegalovirus （CMV） infection, and to establish and promote the diagnosis method for CMV. Methods Five to seven ml blood was taken from 32 patients at 3 week and 7 week after renal transplantation to detect serum cytomegalovirus antigen and antibody expression by NASBA, Real time-PCR and enzyme-linked immunosorbent assay （ELISA） sensitivity and specificity were compared. Results The results of CMV detection in 32 renal transplanted patients respectively showed that the positive rate of peripheral blood IE-mRNA by NASBA was 45.8% （15/32） ;The positive rate of HCMV-DNA in blood by Real time-PCR was 45. 8% （15/32）. Using ELISA,the positive rate of HCMV-（ IgG ＋ IgM） was 37. 5% （14/32）. IE-mRNA and HCMV-DNA had higher sensitivity and specificity and lower false positive rate than HCMV-（ IgG ＋ IgM）. The positive rates of IE-mRNA by NASBA, Real time-PCR and ELISA were 92. 8% ,71.5% and 42. 8% respectively in the 14 cases. Conclusion The nucleic acid amplification method （NASBA based sequence ） and Real time-PCR are sensitive, rapid diagnosis methods of HCMV infection, with higher sensitivity and specificity and lower false positive rate than traditional ELISA. And NASBA detection of IE-mRNA has good value for auxiliary clinical diagnosis.

关 键 词：肾移植 巨细胞病毒 核酸基础序列扩增法 实时荧光定量PCR 酶联免疫吸附试验 

分 类 号：R699[医药卫生—泌尿科学]