获得性免疫缺陷综合征患者前房水巨细胞病毒聚合酶链反应检测  

Detection of cytomegalovirus by polymerase chain reaction in aqueous samples from patients with acquired immune deficiency syndrome

作　　者：毛菲菲[1] 孙挥宇[1] 李丹[1] 王胜男[1] 柳月红[1] 许雪静[1] 刘彬彬[1] 董瑜[1] 

机构地区：[1]首都医科大学附属北京地坛医院眼科,100015

出　　处：《中华眼底病杂志》2015年第6期564-566,共3页Chinese Journal of Ocular Fundus Diseases

基　　金：首都医科大学基础-临床科研合作基金（14JL91）;首都医科大学附属北京地坛医院院内科研基金“启航计划”项目（DTQH201406）

摘　　要：目的评价前房水巨细胞病毒（CMV）聚合酶链反应（PCR）检测在获得性免疫缺陷综合征（AIDS）诊断中的敏感性及特异性。方法临床确诊为AIDS的25例患者纳入研究。其中，男性21例，女性4例。年龄24～59岁，平均年龄（39．2±9．3）岁。CD4＋T淋巴细胞1～523个／μl，中位数40个／μl。发现人类免疫缺陷病毒（HIV）时间15d～9年，中位数10个月。根据眼底病变及治疗情况，将患者分为CMV性视网膜炎（CMVR）未治疗组、CMVR治疗组及对照组，分别为10、7、8例。其中，CMVR未治疗组为眼底存在CMVR病变，但尚未经任何全身抗CMV治疗；CMVR治疗组为眼底存在CMVR病变，已行膦甲酸钠或更昔洛韦抗CMV全身治疗；对照组为眼底未见视网膜病变或仅表现为视网膜微血管病变，并由经验丰富的眼科医师排除CMVR。分别抽取受检者房水100μl，采用PCR定量检测CMVDNA含量；分析其特异性和敏感性。结果PCR检测结果显示，CMVR未治疗组10例患者中，CMVDNA阳性9例，阴性1例；敏感性为90．0％。CMVR治疗组7例患者中，CMVDNA阳性3例，阴性4例；敏感性为42．9％。对照组8例患者CMVDNA均为阴性，特异性超过99．9％。25例患者中，除1例患者结膜下出血外，其余患者均未发生与前房穿刺相关的并发症。结论前房水CMVPCR检测在未经治疗、已经治疗的AIDS患者中敏感性分别为90．0％、42．9％；特异性超过99．9％。Objective To analyze the sensitivity and specificity of polymerase chain reaction （PCR） tests in the detection of cytomegalovirus （CMV） in the diagnosis of patients with acquired immune deficiency syndrome （AIDS）, using aqueous humor samples. Methods 25 AIDS patients （including 21 men and 4 women） were studied. The age of the patients varied from 24 to 59 years, with an average of （39.2±9.3） years. The CD4＋ T cell count was from 1 to 523 cells/μl, with a medium of 40 cells/μl. They were infected with human immunodeficiency virus（HIV）for a period from 15 days to 9 years with a median of 10 months. They were divided into three groups according to the fundus and treatment, including untreated cytomegalovirus retinitis （CMVR）, treated CMVR and control group. There were 10 patients without anti CMV treatment and 7 patients treated previously with foscarnet or ganciclovir whose eyes were diagnosed CMVR. Control group has 8 patients who had normal fundus or minor retinopathy excluded from CMVR. Approximately 100 μl of aqueous humor was obtained by anterior-chamber paracentesis and PCR was performed in all cases. Results There were CMV DNA in 9 of 10 eyes with untreated CMVR （90.0% sensitivity）. Of 7 specimens from eyes with treated CMVR, 3 were CMV PCR positive （42.9% sensitivity）. All 8 samples of the control group were negative for CMV DNA, indicating the clinical specificity of our PCR was greater than 99.9 % for CMVR. The anterior chamber paracentesis did not cause any complications in our patients except for a patient with subconjunctival hemorrhage. Conclusions The assay had an estimated sensitivity of 90.0% in detecting untreated CMVR and a sensitivity of 42.9% in detecting CMVR that had been treated. The specificity of this assay was greater than 99.9%.

关 键 词：获得性免疫缺陷综合征/并发症 巨细胞病毒视网膜炎/诊断 眼房水 聚合酶链反应 

分 类 号：R512.91[医药卫生—内科学]