Niubò J, Pérez J L, Manito N, García A, Roca J, Martín R
Servicio de Microbiología, Ciutat Sanitària i Universitària de Bellvitge, L'Hospitalet de Llobregat, Barcelona.
Med Clin (Barc). 1999 Feb 6;112(4):121-4.
To evaluate the usefulness of PCR in peripheral blood leukocytes for the diagnosis of CMV infection and for prognosis of CMV disease in patients with heart transplantation.
A total of 54 heart transplant recipients included in a protocolized virological follow-up with blood samples (total samples: 594). Mean time of follow-up: 14.8 months (range 1-34 months). We compared a qualitative nested PCR with tube culture (CC), shell vial culture (SV) and pp65 quantitative antigenemia test (AGC).
PCR was the most sensitive test (89.9%) followed by AGC (68.1%), SV (42.6%) and CC (33.4%). Specificity: 80 samples were positive only by PCR, 77 of which form patients with virologically documented CMV active infection, so they were considered as true positives. Three samples were from 2 patients in which the unique positive marker was PCR. If we considered these results as false positive, the calculated specificity was 99.0%. PCR was the first positive marker in 44 out of 45 patients with active CMV infection. In 9 of these patients no other viral marker was positive in the first positive sample, except for PCR. A total of 16 episodes of CMV disease were observed along the study, and a positive PCR result was detected in 15 of them. The remaining patient did not show amplification with the set of primers used in this study, but it gave a positive PCR by amplifying with a different primer pair. Positive predictive value of PCR for CMV disease was low (33.3%). Thus, a positive PCR result did not allow to distinguish between asymptomatic infection and CMV disease.
In heart transplantation recipients CMV-PCR is a highly sensitive, specific and early marker of CMV infection but its positive predictive value for CMV disease seems unsatisfactory.
评估外周血白细胞中PCR技术对心脏移植患者巨细胞病毒（CMV）感染诊断及CMV疾病预后判断的实用性。
共有54例心脏移植受者纳入病毒学随访方案，采集血样（样本总数：594份）。平均随访时间：14.8个月（范围1 - 34个月）。我们将定性巢式PCR与试管培养（CC）、空斑试验培养（SV）及pp65定量抗原血症检测（AGC）进行了比较。
PCR是最敏感的检测方法（89.9%），其次是AGC（68.1%）、SV（42.6%）和CC（33.4%）。特异性：仅PCR检测呈阳性的样本有80份，其中77份来自病毒学证实有CMV活动性感染的患者，故被视为真阳性。3份样本来自2例患者，其唯一的阳性标志物是PCR。若将这些结果视为假阳性，则计算出的特异性为99.0%。在45例活动性CMV感染患者中，有44例PCR是首个呈阳性的标志物。其中9例患者的首个阳性样本中，除PCR外无其他病毒标志物呈阳性。在本研究过程中共观察到16例CMV疾病发作，其中15例检测到PCR结果呈阳性。其余1例患者使用本研究中所用引物组未显示扩增，但使用不同引物对扩增时PCR呈阳性。PCR对CMV疾病的阳性预测值较低（33.3%）。因此，PCR阳性结果无法区分无症状感染和CMV疾病。
在心脏移植受者中，CMV - PCR是CMV感染高度敏感、特异且早期的标志物，但其对CMV疾病的阳性预测值似乎并不理想。
