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目的探讨白血病患者异基因造血干细胞移植(Allo-HSCT)术后巨细胞病毒(CMV)IgM抗体滴度的动态变化与CMV感染进展的关系。方法采用单克隆抗体免疫荧光测定法和微粒子酶免分析法对86例接受Allo-HSCT的白血病患者,在术后50d内每周检测1次,50～270d每2周检测1次CMV-Ag和CMV-IgM,同时观察有无CMV病症状出现,并分析CMV-Ag阳性细胞数和CMV-IgM滴度变化与CMV感染进展的关系。结果86例患者在移植后270d内共有57例患者发生过活动性感染。这57例患者CMV-Ag首次检出阳性时,其中只有5例患者CMV-IgM出现阳性,而且CMV-IgM首次出现阳性的平均检出时间为121.6d,明显迟于CMV-Ag的平均46.7d(P<0.05);在CMV活动性感染的中后期,由于受到抗病毒治疗的干预,CMV-Ag的平均阳性细胞数并不和CMV-IgM滴度呈相同的趋势性改变,两者之间不存在相关性(γ=0.146,P>0.05);8例患者从无症状感染进展到CMV病时,CMV-IgM滴度呈进行性升高,其中4例患者感染得到控制后,滴度逐渐下降。当CMV-IgM滴度在10以下,CMV病尚能控制,若滴度均超过10以上,大部分患者会发生死亡。结论CMV-IgM动态定量检测对预测Allo-HSCT后中后期CMV活动性感染进展及其预后有一定的临床指导意义。
Objective To investigate the relationship between the dynamic changes of cytomegalovirus (CMV) IgM antibody titer and the progress of CMV infection after leukemia allo-HSCT. Methods Eighty-six patients with leukemia who received Allo-HSCT were detected by monoclonal antibody immunofluorescence assay and microparticle enzyme immunoassay. The patients were tested once a week for 50 days after operation and once every two weeks for 50 ~ 270 days. CMV-IgM. At the same time, observe the presence or absence of symptoms of CMV disease, and analyze the relationship between CMV-Ag positive cells and CMV-IgM titer and the progress of CMV infection. Results A total of 57 patients had active infection in 86 patients within 270 days after transplantation. When the CMV-Ag positive was detected for the first time in only 57 patients, CMV-IgM was positive in only 5 of them and the average positive detection time of CMV-IgM was 121.6d, significantly lower than that of CMV-Ag (P <0.05). During the middle and late stages of active CMV infection, the mean number of CMV-Ag positive cells did not change in the same trend as the CMV-IgM titer due to antiviral treatment intervention. There was no correlation (γ = 0.146, P> 0.05). CMV-IgM titers increased progressively from asymptomatic infection to CMV in 8 patients. After 4 patients were infected, the titers gradually increased decline. When the CMV-IgM titer below 10, CMV disease can still control, if the titers are more than 10 or more, the majority of patients will die. Conclusion CMV-IgM dynamic quantitative detection of Allo-HSCT in the late CMV active infection progression and prognosis of a certain clinical significance.