高危新生儿先天性巨细胞病毒感染的诊断。

Diagnosis of congenital cytomegalovirus infection in high risk neonates.

机构信息

Pediatric, Faculty of Medicine, Zagazig University.

出版信息

Mediterr J Hematol Infect Dis. 2013 Jul 10;5(1):e2013049. doi: 10.4084/MJHID.2013.049. Print 2013.

DOI:10.4084/MJHID.2013.049

PMID:23936620

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3736879/

Abstract

OBJECTIVES

This study aimed to compare polymerase chain reaction (PCR) and IgM detection using enzyme linked immune-sorbent assay (ELISA) in diagnosis of congenital cytomegalovirus (CMV) infection.

METHODS

This study was conducted from May 2009 to December 2010. Urine and blood samples were collected from 94 neonates with suspected congenital CMV infection. Serum and part of urine samples were stored at -20°C freezer, until the serologic and PCR tests were achieved. A 94 fresh urine samples were processed for cell culture. Nineteen (20.2%) out of 94 urine samples were proven positive for CMV infection by viral culture. For comparing PCR and IgM ELISA we used tissue culture technique as a reference, the 19 positive samples on culture (CMV group) and 20 negative samples (control group) were included in the comparison. Some characteristics of CMV and control groups were compared including sex, age, birth weight, gestational age < 37 and small for gestational age. Clinical and laboratory abnormalities were also compared in both groups.

RESULTS

This study showed that the sensitivity and specificity of PCR in relation to viral culture were 100% and 100% respectively, there was excellent agreement between both tests (Kappa coefficient was 1 and P=0.000). On the other hand, the sensitivity of IgM CMV ELISA in relation to viral culture was 63.2% and the specificity was 85%. There was good agreement between both tests (Kappa coefficient was 0.48 and P=0.002). By comparing CMV and control groups, there were high statistically significant differences between both groups as regard the birth weight, gestational age < 37 and small for gestational age items (P= 0.00, 0.03 and 0.01 respectively). There were statistically insignificant differences as regarding the clinical and laboratory abnormalities detected for neonates of both groups. In this study jaundice (63%) and hepato-splenomegaly (42%) were the most common clinical signs in both groups.

CONCLUSIONS

PCR is more sensitive and specific technique for detection of congenital CMV infection than CMV IgM ELISA. Being more cost effective, less cumbersome and less time consuming in relation to viral culture, PCR may be used in detection of congenital CMV infection.

摘要

目的

本研究旨在比较聚合酶链反应（PCR）和酶联免疫吸附试验（ELISA）检测 IgM 在先天性巨细胞病毒（CMV）感染诊断中的应用。

方法

本研究于 2009 年 5 月至 2010 年 12 月进行。采集 94 例疑似先天性 CMV 感染新生儿的尿液和血液样本。血清和部分尿液样本储存在-20°C 冰箱中，直至进行血清学和 PCR 检测。对 94 例新鲜尿液样本进行细胞培养。19 例尿液样本（19/94，20.2%）经病毒培养证实为 CMV 感染阳性。为了比较 PCR 和 IgM ELISA，我们使用组织培养技术作为参考，将培养阳性的 19 例样本（CMV 组）和 20 例阴性样本（对照组）纳入比较。比较 CMV 组和对照组的一些特征，包括性别、年龄、出生体重、<37 周和小于胎龄。比较两组的临床和实验室异常。

结果

本研究显示，PCR 与病毒培养的敏感性和特异性分别为 100%和 100%，两种检测方法之间具有极好的一致性（Kappa 系数为 1，P=0.000）。另一方面，IgM CMV ELISA 与病毒培养的敏感性为 63.2%，特异性为 85%。两种检测方法之间具有良好的一致性（Kappa 系数为 0.48，P=0.002）。比较 CMV 组和对照组，两组在出生体重、<37 周和小于胎龄方面有统计学意义上的显著差异（P=0.00、0.03 和 0.01）。两组新生儿的临床和实验室异常无统计学差异。在本研究中，黄疸（63%）和肝脾肿大（42%）是两组中最常见的临床体征。