巨细胞病毒核酸和抗体检测在不同特征患者中的一致性分析及临床指导意义

doi:10.19723/j.issn.1671-167X.2022.02.011

摘要/Abstract

摘要：

目的: 探讨巨细胞病毒(cytomegalovirus,CMV)脱氧核糖核酸(deoxyribo nucleic acid,DNA)检测和免疫球蛋白M(immunoglobulin M,IgM)抗体检测在不同特征患者中的一致性及对临床工作的指导价值。方法: 2014年12月至2019年11月期间,北京大学国际医院检验科同时进行CMV-IgM抗体和CMV-DNA检测的患者共计507例,收集患者性别、年龄一般资料,同时收集患者的诊断、用药及转归等临床资料。根据患者CMV-DNA阴性或阳性、CMV-IgM抗体阴性或阳性,以及年龄、性别和是否接受免疫抑制治疗进行分组和分层,组别之间率的比较采用Pearson卡方检验或Fisher精确经验,P<0.05为差异有统计学意义。结果: 507例送检患者中,CMV-DNA阳性患者55例(10.85%),CMV-IgM抗体阳性患者74例(14.60%),CMV-DNA和CMV-IgM抗体同时阳性患者20例(3.94%)。55例CMV-DNA阳性患者中,男性37例(67.27%),60岁以上者25例(45.45%),接受免疫抑制治疗者33例(60%),均高于CMV-DNA阴性组的47.35%(P=0.005)、31.86%(P=0.043)和46.02%(P=0.050)。CMV-DNA和IgM抗体双阳性患者中45%接受免疫抑制治疗,低于CMV-DNA阳性但IgM抗体阴性患者(68.57%,P=0.086),也低于CMV-DNA阴性但IgM抗体阳性患者(68.52%,P=0.064)。CMV-DNA和IgM抗体双阳性患者接受更昔洛韦治疗后91.67%出现好转,而CMV-DNA阳性但IgM抗体阴性患者的好转率仅为60%(P=0.067)。结论: CMV-IgM抗体检测受到年龄、性别、免疫状态等影响,不推荐对存在免疫抑制状态和年龄大于60岁的患者单独采用CMV-IgM抗体检测判断CMV感染;CMV-DNA和CMV-IgM抗体联合检测可能有助于预判患者的免疫状态和抗病毒治疗的结局转归。

关键词: 巨细胞病毒, DNA, 免疫球蛋白M, 免疫抑制

Abstract:

Objective: To investigate the consistency of cytomegalovirus deoxyribo nucleic acid (CMV-DNA) and immunoglobulin M (IgM) antibody detections in patients with different clinical characteristics and their guiding value for clinical practice. Methods: From December 2014 to November 2019, a total of 507 patients who were detected with both CMV-IgM and CMV-DNA were collected in Peking University International Hospital. Their general information, such as gender, age and clinical data, including the patient’s diagnosis, medication, and outcome were also collected. The groups were stratified according to whether CMV-DNA was negative or positive, CMV-IgM was negative or positive, age, gender, and whether they received immunosuppressive therapy or not. The Pearson Chi-square test or Fisher’s exact test was used for comparison of the rates between the groups. P<0.05 means the difference is statisti-cally significant. Results: Of the 507 patients submitted for examination, 55 (10.85%) were positive for CMV-DNA, 74 (14.60%) were positive for CMV-IgM, and 20 (3.94%) were positive for both CMV-DNA and CMV-IgM. Of the 55 patients with CMV-DNA positive, 37 were male, accounting for 67.27%. In addition, 25 patients were older than 60 years, accounting for 45.45% and 33 patients received immunosuppressive therapy, accounting for 60%. The rates were higher than that of CMV-DNA negative group, 47.35% (P=0.005), 68.14% (P=0.043), 46.02% (P=0.050), respectively. Of the patients with both CMV-DNA and IgM positive, 45% received immunosuppressive threapy, which was lower than that of CMV-DNA positive but IgM negative patients (68.57%, P=0.086), and also lower than CMV-DNA negative but IgM positive patients (68.52%, P=0.064). In the patients with both CMV-DNA and IgM positive, 91.67% showed remission after receiving ganciclovir, whereas in the patients with CMV-DNA positive but IgM negative, the rate was only 60% (P=0.067). Conclusion: CMV-IgM antibody detection is affected by age, gender, and immune status. It is not recommended to use CMV-IgM alone to determine CMV infection in patients with immunosuppressive status and those older than 60 years. CMV-DNA and CMV-IgM combined detection may help to predict patients’ immune status and outcomes of antiviral therapy.

Key words: Cytomegalovirus, DNA, Immunoglobulin M, Immunosuppression

中图分类号:

R446

戴菊华,孙新平,张捷,石连杰. 巨细胞病毒核酸和抗体检测在不同特征患者中的一致性分析及临床指导意义[J]. 北京大学学报（医学版）, 2022, 54(2): 267-271.

DAI Ju-hua,SUN Xin-ping,ZHANG Jie,SHI Lian-jie. Consistency analysis and clinical guiding significance of cytomegalovirus nucleic acid and antibody detections in patients with different clinical characteristics[J]. Journal of Peking University (Health Sciences), 2022, 54(2): 267-271.

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参考文献 14

[1]	阮强. 人巨细胞病毒感染的实验室检测与诊断[J]. 实用儿科临床杂志, 2012, 27(10):729-731.
[2]	陈兰兰, 倪安平. 免疫抑制患者巨细胞病毒感染的实验室检测及临床意义[J]. 中华检验医学杂志, 2014, 37(2):155-158.
[3]	王晗, 李廷栋, 郭小怡. 巨细胞病毒实验室检测方法研究进展及其用于新生儿筛查的可行性[J]. 临床儿科杂志, 2018, 36(3):221-226.
[4]	李玲霞, 高申, 张特, 等. 人巨细胞病毒感染DNA检测和IgM检测的比较及其联合应用价值的探讨[J]. 中国实验诊断学, 2015(1):78-80.
[5]	陈雁汶. 血清学检测和聚合酶链反应在急性和慢性巨细胞病毒感染监测中的比较[J]. 检验医学, 2016, 31(6):458-461.
[6]	Furui Y, Satake M, Hoshi Y, et al. Cytomegalovirus (CMV) seroprevalence in Japanese blood donors and high detection frequency of CMV DNA in elderly donors[J]. Transfusion, 2013, 53(10):2190-2197.
[7]	Yoshida M, Matsuda H, Yoshinaga Y, et al. Can measurement of maternal anti-cytomegalovirus immunoglobulin-M antibody levels be used to screen for cytomegalovirus infection in embryos and fetuses?[J]. J Obstet Gynaecol Res, 2013, 39(1):166-169. doi: 10.1111/j.1447-0756.2012.01900.x
[8]	李婧辰, 张梅, 李镒冲, 等. 我国40岁及以上人群慢性呼吸系统疾病症状流行现况及影响因素研究[J]. 中华流行病学杂志, 2018, 39(6):786-791.
[9]	Mirza S, Clay RD, Koslow MA, et al. Copd guidelines: A review of the 2018 gold report[J]. Mayo Clin Proc, 2018, 93(10):1488-1502. doi: 10.1016/j.mayocp.2018.05.026
[10]	Fava A, Petri M. Systemic lupus erythematosus: Diagnosis and clinical management[J]. J Autoimmun, 2019, 96:1-13. doi: 10.1016/j.jaut.2018.11.001
[11]	Lisnevskaia L, Murphy G, Isenberg D. Systemic lupus erythematosus[J]. Lancet, 2014, 384(9957):1878-1888. doi: S0140-6736(14)60128-8 pmid: 24881804
[12]	邓晓莉, 迟妮妮, 李欣艺, 等. 系统性红斑狼疮患者巨细胞病毒感染的临床特点分析[J]. 中华风湿病学杂志, 2016, 20(6):378-381.
[13]	Rasmussen NS, Draborg AH, Nielsen CT, et al. Antibodies to early EBV, CMV, and HHV6 antigens in systemic lupus erythematosus patients[J]. Scand J Rheumatol, 2015, 44(2):143-149. doi: 10.3109/03009742.2014.973061 pmid: 25562120
[14]	Perez-Mercado AE, Vila-Perez S. Cytomegalovirus as a trigger for systemic lupus erythematosus[J]. J Clin Rheumatol, 2010, 16(7):335-337. doi: 10.1097/RHU.0b013e3181f4cf52

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Items	CMV-DNA (+)	CMV-DNA (-)	Total
CMV-IgM (+)	20	54	74
CMV-IgM (-)	35	398	433
Total	55	452	507

Items	CMV-DNA (+), n (%)	CMV-DNA (-), n (%)	P
Gender			0.005
Male	37 (67.27)	214 (47.35)
Female	18 (32.73)	238 (52.65)
Age			0.043
<60 years	30 (54.55)	308 (68.14)
≥60 years	25 (45.45)	144 (31.86)
Immunosuppressant			0.050
Yes	33 (60.00)	208 (46.02)
No	22 (40.00)	244 (53.98)

Items	CMV-DNA (+), n (%)			CMV-IgM (+), n (%)
Items	CMV-IgM (+)	CMV-IgM (-)	P	CMV-DNA (+)	CMV-DNA (-)	P
Gender			0.356			0.054
Male	15 (75.00)	22 (62.86)		15 (75.00)	27 (50.00)
Female	5 (25.00)	13 (37.14)		5 (25.00)	27 (50.00)
Age			0.799			0.153
<60 years	11 (55.00)	18 (51.43)		11 (55.00)	40 (74.07)
≥60 years	9 (45.00)	17 (48.57)		9 (45.00)	14 (25.93)
Immunosuppressant			0.086			0.064
Yes	9 (45.00)	24 (68.57)		9 (45.00)	37 (68.52)
No	11 (55.00)	11 (31.43)		11 (55.00)	17 (31.48)

Response	CMV-DNA (+), n (%)			CMV-DNA (+), n (%)
Response	With immunosuppressant	Without immunosuppressant	P	CMV-IgM (+)	CMV-IgM (-)	P
Remission	19 (65.52)	10 (76.92)	0.719	11 (91.67)	18 (60.00)	0.067
Poor	10 (34.48)	3 (23.08)		1 (8.33)	12 (40.00)