Lee Hwa Young, Rhee Chin Kook, Choi Joon Young, Lee Hea Yon, Lee Jong Wook, Lee Dong Gun
Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Internal Medicine, Division of Hematology, The Catholic University of Korea, Seoul, Korea.
Oncotarget. 2017 Jun 13;8(24):39736-39745. doi: 10.18632/oncotarget.14504.
The incidence of cytomegalovirus (CMV) pneumonia is increasing in patients diagnosed with hematologic malignancies. The utility of CMV-DNA viral load measurement has not been standardized, and viral cut-off values have not been established. This study was designed to investigate the utility of CMV quantitative real-time PCR (qRT-PCR) using bronchial washing fluid.
We retrospectively reviewed the microbiologic and pathologic results of bronchial washing fluid and biopsy specimens in addition to the patients' clinical characteristics.
A total of 565 CMV qRT-PCR assays were performed using bronchial washing fluid from patients with hematologic malignancies. Among them, 101 were positive for CMV by qRT-PCR; of these, 24 were diagnosed with CMV pneumonia and 70 with CMV infection, and 7 were excluded due to a diagnosis of invasive pulmonary aspergillosis rather than viral pneumonia. The median CMV load determined by qPCR was 1.8 × 105 copies/mL (3.6 103-1.5 × 108) in CMV pneumonia patients and 3.0 × 103 copies/mL (5.0 × 102-1.1 × 105) in those diagnosed with CMV infection (P < 0.01). Using the ROC curve, the optimal inflection points were 18,900 copies/mL (137,970 IU/mL) in post-bone marrow transplantation (BMT) patients, 316,415 copies/mL (2,309,825 IU/mL) in no-BMT patients and 28,774 copies/mL (210,054 IU/mL) in all patients.
The CMV titers in bronchial washing fluid determined by qRT-PCR differed significantly between patients diagnosed with CMV pneumonia and those with CMV infection. The viral cut-off values in bronchial washing fluid were suggested for the diagnosis of CMV pneumonia, which were different depending on the BMT status.
在被诊断为血液系统恶性肿瘤的患者中，巨细胞病毒（CMV）肺炎的发病率正在上升。CMV-DNA病毒载量检测的效用尚未标准化，且病毒临界值尚未确定。本研究旨在探讨使用支气管灌洗液进行CMV定量实时聚合酶链反应（qRT-PCR）的效用。
我们回顾性分析了支气管灌洗液和活检标本的微生物学和病理学结果，以及患者的临床特征。
共对565例血液系统恶性肿瘤患者的支气管灌洗液进行了CMV qRT-PCR检测。其中，101例qRT-PCR检测CMV呈阳性；其中，24例被诊断为CMV肺炎，70例为CMV感染，7例因诊断为侵袭性肺曲霉病而非病毒性肺炎而被排除。qPCR测定的CMV肺炎患者的CMV载量中位数为1.8×105拷贝/mL（3.6×103 - 1.5×108），诊断为CMV感染的患者为3.0×103拷贝/mL（5.0×102 - 1.1×105）（P < 0.01）。使用ROC曲线，骨髓移植（BMT）后患者的最佳拐点为18,900拷贝/mL（137,970 IU/mL），非BMT患者为316,415拷贝/mL（2,309,825 IU/mL），所有患者为28,774拷贝/mL（210,054 IU/mL）。
通过qRT-PCR测定的支气管灌洗液中的CMV滴度在诊断为CMV肺炎的患者和CMV感染的患者之间存在显著差异。建议了支气管灌洗液中用于诊断CMV肺炎的病毒临界值，其因BMT状态而异。
