Monitoring method of human cytomegalovirus latent infection and viral reactivation

人巨细胞病毒（HCMV）是导致器官或骨髓移植（BMT）等免疫功能低下患者、艾滋病患者和发育中的新生儿发病和死亡的重要原因。一些抗病毒药物，如更昔洛韦和膦甲酸，是有用的治疗HCMV疾病，但这些药物必须谨慎使用，因为它们的副作用。因此，建立一个敏感的HCMV感染监测系统是非常重要的，在HCMV感染的诊断中，区分有症状和无症状感染是非常重要的。比较了核酸序列扩增（NASBA）技术与单一PCR和巢式PCR方法的优缺点，选择HCMV特异性表达的β 2. 7转录本作为NASBA检测的靶基因。在20例儿童骨髓移植受者中，8例出现了HCMV相关的临床症状。单PCR的敏感性和特异性分别为50%和100%，巢式PCR为100%和67%，NASBA为100%和83%。对儿童BMT受者中HCMV感染的随访表明，NASBA既可以在临床症状发作之前检测病毒转录物，又可以反映抗病毒治疗引起的临床改善。这些数据表明，NASBA应该是有用的预测HCMV疾病的发展和监测抗病毒治疗的效果。

Human cytomegalovirus (HCMV) is a significant cause of morbidity and mortality in immunocompromised patients, such as organ or bone marrow transplant (BMT), AIDS patients and developing neonates. Some antiviral drugs, such as ganciclovir and foscarnet, are useful for treating HCMV diseases, but these drugs must be used carefully because of their side effects. Therfore, it is important to establish a sensitive system by which to monitor HCMV infection.In the diagnosis of HCMV infection, it is very important to distinguish symptomatic from asymptomatic infection. The nucleic acid sequence-based amplification (NASBA) technique was compared with single and nested polymerase chain reaction (PCR) methods.For NASBA detection, the beta 2.7 transcript was chosen as a target because of its abundant active HCMV-specific expression. Of 20 pediatric BMT recipients, 8 developed HCMV-related clinical symptoms. The clinical sensitivities and specificities were 50% and 100% for single PCR, 100% and 67% for nested PCR, and 100% and 83% for NASBA, respectively. Follow-up of HCMV infections in pediatric BMT recipients showed that NASBA could both detect viral transcript prior to the onset of clinical symptoms and reflect clinical improvement due to antiviral therapy. These data suggest that NASBA should be useful for both predicting HCMV disease development and monitoring the effect of antiviral therapy.