Humar A, O'Rourke K, Lipton J, Messner H, Meharchand J, Mahony J, Walker I, Wasi P, McGeer A, Moussa G, Chua R, Mazzulli T
Department of Medicine, University of Toronto, Mount Sinai Hospital, Ontario, Canada.
Bone Marrow Transplant. 1999 Jan;23(1):45-51. doi: 10.1038/sj.bmt.1701525.
At our institution, the cytomegalovirus (CMV) prophylaxis protocol for allogeneic bone marrow transplant (BMT) recipients who are CMV-seropositive or receive marrow from a CMV-seropositive donor consists of a surveillance bronchoscopy approximately 35 days posttransplant. Patients with a positive surveillance bronchoscopy for CMV receive pre-emptive ganciclovir. In order to determine the utility of other screening methods for CMV, we prospectively performed weekly CMV antigenemia, and blood, urine and throat cultures from time of engraftment to day 120 post-BMT in 126 consecutive patients. Pre-emptive ganciclovir was given to 11/81 patients (13.6%) because of a positive surveillance bronchoscopy for CMV. Results of CMV blood, urine and throat cultures and the antigenemia assay done prior to or at the time of the surveillance bronchoscopy were analyzed for their ability to predict the bronchoscopy result. The antigenemia test had the highest positive and negative predictive values (72% and 96%, respectively). The ability of these tests to predict CMV disease was evaluated in the 70 patients with a negative surveillance bronchoscopy who did not receive pre-emptive ganciclovir. Of 19 cases of active CMV disease, CMV antigenemia was positive in 15 patients (79%) a mean of 34 days preceding symptoms. Blood cultures were positive in 14/19 patients (74%) a mean of 31 days before onset of disease. CMV antigenemia is useful for predicting the surveillance bronchoscopy result, and also predicts the development of CMV disease in the majority of patients missed by the surveillance bronchoscopy.
在我们机构，对于巨细胞病毒（CMV）血清学阳性的异基因骨髓移植（BMT）受者或接受来自CMV血清学阳性供者骨髓的受者，CMV预防方案包括在移植后约35天进行一次监测性支气管镜检查。监测性支气管镜检查CMV呈阳性的患者接受抢先性更昔洛韦治疗。为了确定CMV其他筛查方法的效用，我们前瞻性地对126例连续患者从植入时到BMT后第120天每周进行CMV抗原血症检测以及血液、尿液和咽拭子培养。11/81例患者（13.6%）因监测性支气管镜检查CMV呈阳性而接受了抢先性更昔洛韦治疗。分析了监测性支气管镜检查之前或之时进行的CMV血液、尿液和咽拭子培养结果以及抗原血症检测结果预测支气管镜检查结果的能力。抗原血症检测具有最高的阳性和阴性预测值（分别为72%和96%）。在70例监测性支气管镜检查呈阴性且未接受抢先性更昔洛韦治疗的患者中评估了这些检测预测CMV疾病的能力。在19例活动性CMV疾病病例中，15例患者（79%）的CMV抗原血症呈阳性，平均在出现症状前34天。14/19例患者（74%）的血培养呈阳性，平均在疾病发作前31天。CMV抗原血症有助于预测监测性支气管镜检查结果，并且还能预测大多数监测性支气管镜检查遗漏患者中CMV疾病的发生。
