Steininger Christoph, Graninger W, Zoufaly A, Zöllner B, Feucht H-H, Kundi M, Stahmer I, Stellbrink H-J, van Lunzen J
Medical University of Vienna, Department of Medicine I, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
Eur J Med Res. 2008 Jun 24;13(6):304-8.
We evaluated assays for the measurement of acute phase protein levels in plasma for their usefulness to identify sensitively an inflammatory response to active cytomegalovirus CMV infection in HIV-infected patients.
Plasma samples were collected from 28 CMV-seropositive patients with advanced HIV-infection (CD4-cell count <200/microl) before commencement of antiretroviral therapy. Sensitivity, specificity, and area under receiver operating characteristic curve for the selected acute phase protein assays (haptoglobin, fibronectin, high-sensitivity C-reactive protein (hs-CRP), human interleukin-6, serum amyloid A (SAA), and human lipopolysacharide binding protein) were compared with results of a CMV-specific PCR assay.
CMV viremia was detectable in 8/28 patients. Levels of SAA correlated well with those of hs-CRP (r' = 0.439, P = 0.019 (Spearman rank correlation)). Levels of SAA >3 mg/L discriminated with 100% sensitivity and 40% specificity between HIV-infected patients with and without active CMV infection. Sensitivity of fibronectin was 100% and specificity 15% at a threshold-value corresponding with the lower limit of normal values as defined by the manufacturer of the assay (>29 mg/dL). Levels of the other acute phase proteins evaluated did not correlate with detection of CMV-DNA in plasma.
Increased levels of SAA indicate sensitively an inflammatory response to active CMV infection. Use of a CMV-specific virological assay is required to confirm the specificity of a high SAA-level but may be limited to samples with high SAA-levels. Hence, screening for increased levels of SAA in patients with advanced HIV-infection may allow early identification of active CMV infection.
我们评估了用于测量血浆中急性期蛋白水平的检测方法，以确定其在灵敏识别HIV感染患者对活动性巨细胞病毒（CMV）感染的炎症反应方面的实用性。
在抗逆转录病毒治疗开始前，从28例晚期HIV感染（CD4细胞计数<200/μl）且CMV血清学阳性的患者中采集血浆样本。将所选急性期蛋白检测方法（触珠蛋白、纤连蛋白、高敏C反应蛋白（hs-CRP）、人白细胞介素-6、血清淀粉样蛋白A（SAA）和人脂多糖结合蛋白）的敏感性、特异性和受试者操作特征曲线下面积与CMV特异性PCR检测结果进行比较。
28例患者中有8例可检测到CMV病毒血症。SAA水平与hs-CRP水平相关性良好（r' = 0.439，P = 0.019（Spearman等级相关性））。SAA>3 mg/L时，在有和无活动性CMV感染的HIV感染患者之间的鉴别敏感性为100%，特异性为40%。在与检测方法制造商定义的正常下限相对应的阈值（>29 mg/dL）下，纤连蛋白的敏感性为100%，特异性为15%。所评估的其他急性期蛋白水平与血浆中CMV-DNA的检测不相关。
SAA水平升高灵敏地表明对活动性CMV感染有炎症反应。需要使用CMV特异性病毒学检测来确认高SAA水平的特异性，但可能仅限于SAA水平高的样本。因此，对晚期HIV感染患者筛查SAA水平升高可能有助于早期识别活动性CMV感染。
