Cariani Elisabetta, Pollara Caterina P, Valloncini Barbara, Perandin Francesca, Bonfanti Carlo, Manca Nino
Department of Experimental and Applied Medicine, Section of Microbiology, University of Brescia, and A.O. Spedali Civili, Brescia, Italy.
BMC Infect Dis. 2007 Nov 23;7:138. doi: 10.1186/1471-2334-7-138.
Quantitative real-time PCR assays, which are more rapid and practical than pp65 antigenemia determination, are progressively becoming the preferred method for monitoring Human Cytomegalovirus (HCMV) reactivation. However, the relationship between HCMV DNA and antigenemia levels is still under investigation. The aim of this study was to analyse the relationship between HCMV DNA and pp65 antigenemia levels in order to identify clinically useful threshold values for the management of patients.
475 consecutive samples from 156 immunosuppressed patients were tested for HCMV by pp65 antigenemia and Real-time PCR assay.
136 out of 475 consecutive samples derived from 48 patients showed evidence of HCMV infection. HCMV DNA was detected in 106 samples, pp65 antigen in 3, and both markers in 27. pp65 antigen detection was associated with higher HCMV DNA levels. The cut-off HCMV DNA level that best predicted pp65 antigenemia in this series of samples was 11,500 copies/ml, but different threshold levels could be observed for specific groups of patients. HCMV disease was observed in 5 out of 48 patients with active HCMV infection. The presence of clinical symptoms was associated with positive pp65 and with higher antigenemia levels. Higher HCMV DNA load at the onset of viral replication was correlated to the development of clinical symptoms.
Both pp65 antigenemia and HCMV DNA load can be useful for the prospective monitoring of immunocompromised subjects. Specific cut-off levels capable of triggering preemptive antiviral treatment should be determined in accordance to the type of test used and the characteristics of patients and prospectively validated.
定量实时聚合酶链反应检测比 pp65 抗原血症检测更快速、实用，正逐渐成为监测人巨细胞病毒（HCMV）再激活的首选方法。然而，HCMV DNA 与抗原血症水平之间的关系仍在研究中。本研究旨在分析 HCMV DNA 与 pp65 抗原血症水平之间的关系，以确定对患者管理具有临床实用价值的阈值。
对 156 例免疫抑制患者的 475 份连续样本进行 pp65 抗原血症和实时聚合酶链反应检测，以检测 HCMV。
475 份连续样本中的 136 份来自 48 例患者，显示有 HCMV 感染证据。106 份样本检测到 HCMV DNA，3 份检测到 pp65 抗原，27 份同时检测到这两种标志物。pp65 抗原检测与较高的 HCMV DNA 水平相关。在这一系列样本中，最能预测 pp65 抗原血症的 HCMV DNA 截断水平为 11,500 拷贝/毫升，但特定患者组可观察到不同的阈值水平。48 例活动性 HCMV 感染患者中有 5 例出现 HCMV 疾病。临床症状的出现与 pp65 阳性及较高的抗原血症水平相关。病毒复制开始时较高的 HCMV DNA 载量与临床症状的发展相关。
pp65 抗原血症和 HCMV DNA 载量均可用于免疫受损受试者的前瞻性监测。应根据所用检测方法的类型、患者的特征确定能够触发抢先抗病毒治疗的特定截断水平，并进行前瞻性验证。
