Wolff M A, Rand K H, Houck H J, Brunson M E, Howard R J, Langham M R, Davis G L, Mailliard M E, Myers B M, Andres J
Department of Medicine, University of Florida, Gainesville.
Transplantation. 1993 Sep;56(3):572-6. doi: 10.1097/00007890-199309000-00015.
In a pilot study, the polymerase chain reaction was found to be more sensitive than standard viral culture methods for the detection of cytomegalovirus, particularly from blood and tissues. We therefore applied this technique to 71 serially collected liver biopsies from 16 orthotopic liver transplant patients. All patients were CMV-seropositive (n = 15) or seroconverted (n = 1). Seven patients (9 biopsies) had histologically proved CMV hepatitis, and all these biopsies were CMV PCR-positive. Six of these 7 patients had a prior liver biopsy that was CMV PCR-positive, but culture and histology-negative, an average of 13.2 +/- 6.9 days before the histologically positive biopsy. The 7th patient was not biopsied prior to the diagnostic biopsy. Three patients had 7 liver biopsies that were CMV PCR-positive, but histologically negative for CMV hepatitis. Two of these three had CMV infection confirmed by viral culture of blood or liver biopsy. The remaining 6 patients had a total of 26 liver biopsies that were negative for CMV by PCR, culture, and histology. Among liver transplant patients, CMV PCR performed on liver biopsy specimens correctly identified all histologically proven cases of CMV hepatitis. CMV PCR positivity in liver tissue did not correlate with latent infection and preceded the development of CMV hepatitis or other meaningful CMV infection in 8 of 10 patients.
在一项初步研究中，发现聚合酶链反应在检测巨细胞病毒方面比标准病毒培养方法更敏感，尤其是从血液和组织中检测时。因此，我们将这项技术应用于16例原位肝移植患者连续采集的71份肝活检标本。所有患者均为巨细胞病毒血清阳性（n = 15）或血清转化（n = 1）。7例患者（9份活检标本）经组织学证实患有巨细胞病毒性肝炎，所有这些活检标本的巨细胞病毒聚合酶链反应均为阳性。这7例患者中有6例之前的肝活检标本巨细胞病毒聚合酶链反应呈阳性，但培养和组织学检查为阴性，在组织学检查呈阳性的活检之前平均为13.2±6.9天。第7例患者在诊断性活检之前未进行过活检。3例患者有7份肝活检标本巨细胞病毒聚合酶链反应呈阳性，但组织学检查未发现巨细胞病毒性肝炎。这3例患者中有2例通过血液或肝活检的病毒培养确诊为巨细胞病毒感染。其余6例患者共有26份肝活检标本，经聚合酶链反应、培养和组织学检查均未发现巨细胞病毒。在肝移植患者中，对肝活检标本进行的巨细胞病毒聚合酶链反应正确识别了所有经组织学证实的巨细胞病毒性肝炎病例。肝组织中巨细胞病毒聚合酶链反应阳性与潜伏感染无关，并且在10例患者中有8例在巨细胞病毒性肝炎或其他有意义的巨细胞病毒感染发生之前就已出现阳性。
