Zmonarski S C, Boratynska M, Madziarska K, Klinger M, Kusztel M, Patrzalek D, Szyber P
Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
Transplant Proc. 2003 Sep;35(6):2205-6. doi: 10.1016/s0041-1345(03)00764-4.
Estimation of anti-CMV-IgG and anti-CMV-IgM is considered a relatively inexpensive screening tool of CMV status. The aim of study was to estimate how the immunosuppressive protocol influence serum anti-CMV IgG and IgM concentration in renal graft recipients and to estimate the adequacy of anti-CMV-IgG concentration and anti-CMV-IgM index as screening parameters of active CMV disease in patients receiving different immunosuppression. The study group consisted of 33 patients with clinical signs of CMV disease who received one of three types of immunosuppression: (1) azathioprine (Aza) + cyclosporine (CyA) + prednisone (Pr), 20 patients; (2) mycophenolate mofetil (MMF) + CyA + Pr, eight patients; tacrolimus (Tac) + MMF, five patients. Patients were enrolled when the pp65-antigen (pp65) of PBL was positive within 1 to 5 months after transplant (75 patients tested). The IgM-i in the Aza + CyA + Pr group was higher than in MMF + CyA + Pr group (2.73 + 1.8 vs 1.08 +/- 1.07, P =.021). The IgM-i in the Aza + CyA + Pr group was higher than in Tac + MMF (2.73 +/- 1.8 vs 0.78 +/- 0.69; P =.014). There was no difference in IgM-i between MMF + CyA + Pr and Tac + MMF. There was no difference in relative increase of IgG-c among all groups but there was a difference in relative increase of IgM-i between Aza + CyA + Pr and MMF + CyA + Pr groups (6.7 +/- 9.4 vs 2.3 +/- 5.9; P =.007) and between Aza + CyA + Pr and MMF + Tac groups (6.7 +/- 9.4 vs 0.6 +/- 0.54; P =.003). Immunosuppressive protocols including MMF exert an inhibitory influence on B-cell response and synthesis of anti-CMV-IgM. It makes the anti-CMV-IgM index an inadequate rough screening diagnostic parameter of active CMV disease.
抗巨细胞病毒IgG和抗巨细胞病毒IgM的检测被认为是一种相对廉价的巨细胞病毒感染状态筛查工具。本研究的目的是评估免疫抑制方案如何影响肾移植受者血清中抗巨细胞病毒IgG和IgM的浓度，并评估抗巨细胞病毒IgG浓度和抗巨细胞病毒IgM指数作为接受不同免疫抑制治疗患者活动性巨细胞病毒疾病筛查参数的充分性。研究组由33例有巨细胞病毒疾病临床症状的患者组成，他们接受了三种免疫抑制方案中的一种：（1）硫唑嘌呤（Aza）+环孢素（CyA）+泼尼松（Pr），20例患者；（2）霉酚酸酯（MMF）+CyA+Pr，8例患者；（3）他克莫司（Tac）+MMF，5例患者。当移植后1至5个月内外周血淋巴细胞（PBL）的pp65抗原（pp65）呈阳性时纳入患者（共检测75例患者）。Aza+CyA+Pr组的IgM-i高于MMF+CyA+Pr组（2.73±1.8 vs 1.08±1.07，P=0.021）。Aza+CyA+Pr组的IgM-i高于Tac+MMF组（2.73±1.8 vs 0.78±0.69；P=0.014）。MMF+CyA+Pr组和Tac+MMF组之间的IgM-i无差异。所有组之间IgG-c的相对增加无差异，但Aza+CyA+Pr组与MMF+CyA+Pr组之间IgM-i的相对增加有差异（6.7±9.4 vs 2.3±5.9；P=0.007），Aza+CyA+Pr组与MMF+Tac组之间也有差异（6.7±9.4 vs 0.6±0.54；P=0.003）。包括MMF的免疫抑制方案对B细胞反应和抗巨细胞病毒IgM的合成有抑制作用。这使得抗巨细胞病毒IgM指数作为活动性巨细胞病毒疾病的粗略筛查诊断参数并不充分。
