Sanchez J L, Kruger R M, Paranjothi S, Trulock E P, Lynch J P, Hicks C, Shannon W D, Storch G A
Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA.
Transplantation. 2001 Aug 27;72(4):733-5. doi: 10.1097/00007890-200108270-00030.
We developed a multiplex, quantitative, real-time, polymerase chain reaction assay for cytomegalovirus (CMV) and used it to measure the CMV viral load in weekly blood specimens from 43 lung transplant recipients. The median viral load in blood samples immediately preceding bronchoscopy was 1150 copies/microg human DNA for 12 subjects with pneumonitis compared to 91 copies for 31 subjects without (P=0.02, Mann-Whitney U test). Each log10 increase in CMV viral load resulted in an increase of 1.92 in the odds ratio for CMV pneumonitis (95% confidence interval 1.03-3.56). CMV viral load was elevated (>100 copies/microg human DNA) for a median of 21 days before bronchoscopy in those subjects with pneumonitis versus 0 days in those without (P=0.004). We conclude that the risk of CMV pneumonitis after lung transplantation is related to the level of CMV DNA in blood. Quantitative PCR should be evaluated prospectively for the preemptive management of CMV in lung transplant recipients.
我们开发了一种用于巨细胞病毒（CMV）的多重、定量、实时聚合酶链反应检测方法，并使用该方法测量了43名肺移植受者每周血液样本中的CMV病毒载量。在接受支气管镜检查前，12名患有肺炎的受试者血液样本中的病毒载量中位数为每微克人类DNA 1150拷贝，而31名未患肺炎的受试者为91拷贝（P=0.02，曼-惠特尼U检验）。CMV病毒载量每增加1个对数10，CMV肺炎的优势比就增加1.92（95%置信区间1.03 - 3.56）。患有肺炎的受试者在支气管镜检查前，CMV病毒载量升高（>100拷贝/微克人类DNA）的中位数为21天，而未患肺炎的受试者为0天（P=0.004）。我们得出结论，肺移植后CMV肺炎的风险与血液中CMV DNA的水平有关。对于肺移植受者CMV的抢先管理，应前瞻性地评估定量PCR。
