pp65和gB抗原检测在造血干细胞移植后人巨细胞病毒感染中的临床价值  

Clinical value of pp65 and gB antigen detection in human cytomegalovirus infection after hematopoietic stem cell transplantation

作　　者：章惠萍 吴志华[3] 张汝楠[1] 张艳悦[1] 黄雅萍 杨鎔[1] 梁韩英[1] 龚圣楠[1] 王慧琦 桂根勇[1] 陈晓明 胡建华[1] 范骏[1] ZHANG Hui-ping;WU Zhi-hua;ZHANG Ru-nan;ZHANG Yan-yue;HUANG Ya-ping;YANG Rong;LIANG Han-ying;GONG Sheng-nan;WANG Hui-qi;GUI Gen-yong;CHEN Xiao-ming;HU Jian-hua;FAN Jun(State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,National Clinical Research Center for Infectious Diseases,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases,The First Affiliated Hospital,College of Medicine,Zhejiang University,Hangzhou,Zhejiang 310003,China;不详)

机构地区：[1]浙江大学医学院附属第一医院传染病诊治国家重点实验室、国家感染性疾病临床医学研究中心、感染性疾病诊治协同创新中心,浙江杭州310003 [2]杭州市肿瘤医院检验科,浙江杭州310002 [3]浙江省立同德医院检验科,浙江杭州310012

出　　处：《中华医院感染学杂志》2020年第4期615-620,共6页Chinese Journal of Nosocomiology

基　　金：浙江省自然科学基金资助项目(LY14H190002)。

摘　　要：目的通过对患者人巨细胞病毒(Human cytomegalovirus,HCMV)磷蛋白65(Phosphoprotein 65,pp65)和包膜糖蛋白B(Glycoprotein B,gB)的研究,评价其在造血干细胞移植(Hematopoietic stem cell transplantation,HSCT)后HCMV感染中的临床意义。方法回顾性分析2010年11月-2015年7月于浙江大学医学院附属第一医院行HSCT的17例血液病患者的临床资料,包括患者术后24个月内检测的HCMV pp65、gB抗原、免疫球蛋白M(Immunoglobulin M,IgM)和免疫球蛋白G(Immunoglobulin G,IgG)抗体。选取患者三个时间段的检测数据,采用SPSS17.0软件分析这些指标在HCMV感染中的关系。结果患者移植后24个月内HCMV pp65与gB抗原呈正相关(P=0.001),HCMV gB抗原与HCMV IgG抗体呈正相关(P=0.016)。HCMV pp65、gB抗原、HCMV IgM和IgG抗体阳性率分别为64.71%、39.22%、11.76%、100.00%,其中,pp65抗原阳性率高于gB,IgG抗体阳性率高于IgM,均有统计学意义(P<0.05)。B时间段HCMV gB抗原阳性率高于A时间段,具有统计学意义(P=0.013)。期间,16例患者先后感染HCMV,占94.12%。不同原发病类型HCMV pp65抗原阳性率差异有统计学意义(P=0.039),急性髓细胞白血病(Acute myeloid leukemia,AML)患者最高,为91.67%;骨髓增生异常综合症(Myelodysplastic syndrome,MDS)患者最低,为33.33%。HSCT后未发生急性移植物抗宿主病(acute graft-versus-host disease,aGVHD)的患者HCMV pp65抗原阳性率高于发生aGVHD的患者(P=0.042)。HCMV pp65抗原阳性率在不同性别、不同年龄、不同供者来源、预处理是否应用抗胸腺细胞球蛋白(Anti-thymocyte globulin,ATG)及有无发生慢性移植物抗宿主病(chronic graft-versus-host disease,cGVHD)之间差异均无统计学意义。HCMV gB抗原阳性率在上述临床特征之间差异均无统计学意义。结论HSCT后定期监测HCMV抗原和抗体可有效地指导临床合理地抗HCMV治疗和使用免疫抑制剂。OBJECTIVE To evaluate the clinical significance of phosphoprotein 65(pp65)and glycoprotein B(gB)in human cytomegalovirus(HCMV)infection of patients underwent hematopoietic stem cell transplantation(HSCT)based on the study of these two antigens.METHODS Clinical data of 17 patients with hematologic diseases who underwent HSCT in the First Affiliated Hospital of Zhejiang University from Nov.2010 to Jul.2015 were retrospectively analyzed,including the detection of HCMV pp65,gB,immunoglobulin M(IgM)and immunoglobulin G(IgG)within 24 months after transplantation.The patients were divided into three groups according to the detection time,and the relationship of these indicators in HCMV infection were analyzed by SPSS 17.0 software.RESULTS Within 24 months after transplantation,HCMV pp65 was positively correlated with gB antigen(P=0.001),and HCMV gB antigen was positively correlated with HCMV IgG antibody(P=0.016).The positive rates of HCMV pp65,gB antigen,HCMV IgM,and IgG antibodies were 64.71%,39.22%,11.76%,and 100.00%,respectively.Among them,The positive rate of pp65 was significantly higher than that of gB,and the positive rate of IgG was significantly higher than IgM(P<0.05,respectively).The positive rate of HCMV gB antigen in group B was significantly higher than that in group A(P=0.013).During this period,16 patients were infected with HCMV,accounting for 94.12%.The positive rate of HCMV pp65 antigen was significantly different among different primary disease types(P=0.039),the highest in acute myeloid leukemia(AML)patients was 91.67%,and the lowest in myelodysplastic syndrome(MDS)patients was 33.33%.The positive rate of HCMV pp65 antigen in patients without acute graft-versus-host disease(aGVHD)after HSCT was significantly higher than in patients with aGVHD(P=0.042).There was no significant difference of pp65 antigen positive rate of HCMV among different genders,different ages,different sources of donors,whether anti-thymocyte globulin(ATG)was used in pretreatment and whether chronic graft-versus-host disease(cGV

关 键 词：造血干细胞移植 人巨细胞病毒 感染 抗原 

分 类 号：R378[医药卫生—病原生物学]