A prospective study comparing quantitative Cytomegalovirus (CMV) polymerase chain reaction in plasma and pp65 antigenemia assay in monitoring patients after allogeneic stem cell transplantation
A prospective study comparing quantitative Cytomegalovirus (CMV) polymerase chain reaction in plasma and pp65 antigenemia assay in monitoring patients after allogeneic stem cell transplantation
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DOI：
10.1186/1471-2334-6-167
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发表时间：
2006-11-21
影响因子：
3.7
通讯作者：
de Fabritiis, Paolo
中科院分区：
文献类型：
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作者：
Gentile, Giuseppe;Picardi, Alessandra;de Fabritiis, Paolo
背景：异基因干细胞移植(SCT)后经常检测到低水平的巨细胞病毒(CMV)病毒载量，一些pp65抗原阴性或DNA检测不到的异基因SCT患者仍可能发生CMV病。Pp65Ag是诊断CMV感染的敏感方法。血浆中CMV-DNA定量聚合酶链式反应已被提出用于监测SCT患者的CMV感染。方法：在一项前瞻性的纵向研究中，对38例有CMV感染风险的患者(供者和/或受者CMV血清阳性)在SCT后的前100天每周用血浆中CMV定量聚合酶链式反应(COBAS Amplicor CMV监测仪)和pp65抗原检测CMV感染。总体而言，28/38名患者(74%)在SCT后100天内有CMV活动性感染。16例患者首次用pp65抗原检测CMV，5例同时用两种方法检测，6例仅用聚合酶链式反应(PCR)检测，1例CMV活检证实为肠道疾病，未检出pp65抗原，且在发病前用聚合酶链式反应检测呈阳性。3例患者发生肠道CMV病(7.9%)：1例CMV病前pp65Ag和PCR检测均为阴性，1例CMV病前两种方法同时阳性，另1例CMV病前仅pp65Ag阳性。结论：血浆聚合酶链式反应(COBAS Amplicor CMV监护仪)和pp65Ag检测CMV感染是有效的，但两种方法常有不一致之处。血浆聚合酶链式反应和pp65Ag检测可作为巨细胞病毒感染诊断和治疗的补充。
Background: Low levels of Cytomegalovirus (CMV) viral load are frequently detected following allogeneic stem cell transplantation (SCT) and CMV disease may still develop in some allogeneic SCT patients who have negative pp65-antigenemia (pp65-Ag) or undetectable DNA. Pp65Ag is a sensitive method to diagnose CMV infection. Quantitative CMV-DNA PCR assay in plasma has been proposed to monitor CMV infection in SCT patients. We evaluated the clinical utility of pp65Ag and PCR assay in plasma of SCT recipients.Methods: In a prospective longitudinal study, 38 consecutive patients at risk of CMV infection ( donor and/or recipient CMV seropositive) were weekly monitored for CMV infection by both quantitative CMV-PCR in plasma (COBAS AMPLICOR CMV MONITOR) and pp65 Ag, during the first 100 days after SCT.Results: A total of 534 blood samples were simultaneously analysed for pp65Ag and PCR. Overall, 28/38 patients (74%) had active CMV infection within 100 days from SCT. In 16 patients, CMV was first detected by pp65 Ag alone; in 5 patients by both methods and in 6 by PCR assay alone; one patient had CMV biopsy-proven intestinal disease without pp65Ag and PCR assays positivity before CMV disease. Overall, three patients developed intestinal CMV disease (7.9%): one had negative both pp65Ag and PCR assays before CMV disease, one had disease and concomitant positivity of both methods, while in the remaining patient, only pp65Ag was positive before CMV disease.Conclusion: Plasma PCR( COBAS AMPLICOR CMV MONITOR) and pp65Ag assays were effective in detecting CMV infection, however, discordance between both methods were frequently observed. Plasma PCR and pp65Ag assays may be complementary for diagnosis and management of CMV infection.