摘要
目的探讨肾移植受者巨细胞病毒(CMV)肺炎与病毒载量的关系,寻找预测CMV肺炎的病毒载量阈值.方法应用RT-PCR方法定期随访检测56例肾移植受者血浆中CMV DNA载量.比较CMV肺炎组和非肺炎组术后各时点的载量平均值,筛选预测CMV肺炎的最合适阈值.结果56例患者发生CMV肺炎8例(14.3%).移植后4周2组CMV DNA载量均在0值附近,第5周肺炎组载量开始上升,第8周达到峰值,然后迅速下降;而非肺炎组观察期间载量均在低水平波动.5～11周期间肺炎组载量平均值高于非肺炎组,其中5、7、9周载量值差异有统计学意义(P＜0.05).以术后5～15周内连续3次CMV DNA载量＞1×104拷贝/ml作为预测CMV肺炎指标,灵敏度、特异度、阳性预测值、阴性预测值分别为62.5%、93.8%、62.5%、93.8%,Kappa值0.5625(95%CI=0.2503～0.8747),预警时间2～10周. 结论肾移植后CMV肺炎发病前血浆CMV DNA载量值呈持续高水平状态,5～15周内连续3次CMV DNA载量＞1×104拷贝/ml是预测CMV肺炎的良好指标.
Objective To explore the correlation between cytomegalovirus pneumonia （CMV-IP） and viral load in renal transplant recipients and to find out the threshold value of viral load for predicting CMV-IP. Methods The blood samples of 56 renal transplant recipients were taken weekly for the first 2 months and every 2 weeks for 2-6 months after transplantation. Real-time PCR were used to quantify the plasma CMV DNA, The mean viral loads of CMV-IP group and non-CMV-IP group in each time were compared using Wilcoxon test. Different cut-off values were tested to find the suitable values to predict the CMV-IP. Results Of the 56 recipients,8 （ 14.3%） developed CMV-IP. The viral loads were near zero in the first 4 weeks in both groups;from week 5 the viral load of CMV-IP group increased gradually and reached the climax at week 8 and then declined ,but the load of non-CMV-IP group fluctuated at a low level. During weeks 5-11 ,the viral loads of CMV-IP group were higher than those of non-VMV-IP group. At 5,7 and 9 weeks,the differences of the viral loads between the 2 groups were significant （ P 〈 0.05 ）. The best index to predict CMV-IP was viral load above 1×10^4 copies/ml in 3 consecutive tests during a period of 5 - 15 weeks after operation. The sensitivity, specificity, positive predictive value and negative predictive value were 62.5%, 93.8% ,62.5% and 93.8% ,respectively. Conclusions After renal transplantation the recipient keeps a high level of viral load until the development of CMV-IP. Dynamic detection of plasma CMV DNA can predict the CMV-IP,and viral load above 1×10^4 copies/ml in 3 consecutive tests during a period of 5 - 15 weeks after renal transplantation can be used as a threshold value.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2005年第8期525-528,共4页
Chinese Journal of Urology
