Cinque P, Vago L, Terreni M R, Brytting M, Marenzi R, Castagna A, Lazzarin A, Linde A
Department of Infectious Disease, San Raffaele Scientific Institute, Milan, Italy.
Scand J Infect Dis Suppl. 1995;99:92-4.
To evaluate the diagnostic relevance and the clinical impact of the cerebrospinal fluid (CSF) polymerase chain reaction (PCR) for cytomegalovirus (CMV) DNA in the diagnosis of CMV infection of the central nervous system (CNS), 220 acquired immune deficiency syndrome (AIDS) patients with neurological disease were examined. CSF was drawn 1-180 days before death, concomitantly with clinical neurological disease, and autopsy was performed in all the cases. CMV DNA was detected in the CSF from 36 of 45 patients (82%) with CMV infection of the CNS, and in 2 of 175 without CMV infection of the CNS at autopsy. The sensitivity of the method was 82%, the specificity 99%, the positive predictive value 95%, and the negative predictive value 96%. An extensive CMV ventriculitis or encephalitis was shown by histopathology in the majority of the CSF PCR-positive patients with overt clinical encephalitis. Minor CMV lesions only, not likely to cause relevant clinical symptoms, were observed in some CSF PCR-positive patients, concomitant with other opportunistic CNS diseases. CSF PCR is a reliable means for diagnosis of CMV infection of the CNS in patients with AIDS. A positive PCR result, however, requires careful interpretation in the individual clinical context.
为评估脑脊液（CSF）聚合酶链反应（PCR）检测巨细胞病毒（CMV）DNA在诊断中枢神经系统（CNS）CMV感染中的诊断相关性及临床影响，对220例患有神经系统疾病的获得性免疫缺陷综合征（AIDS）患者进行了检查。在死亡前1 - 180天，伴随临床神经系统疾病抽取脑脊液，所有病例均进行了尸检。在45例尸检确诊为CNS CMV感染的患者中，有36例（82%）脑脊液中检测到CMV DNA；而在175例尸检未发现CNS CMV感染的患者中，有2例脑脊液中检测到CMV DNA。该方法的敏感性为82%，特异性为99%，阳性预测值为95%，阴性预测值为96%。组织病理学显示，大多数脑脊液PCR检测呈阳性且有明显临床脑炎症状的患者存在广泛的CMV脑室炎或脑炎。在一些脑脊液PCR检测呈阳性的患者中，仅观察到轻微的CMV病变，不太可能引起相关临床症状，这些患者同时伴有其他机会性CNS疾病。脑脊液PCR是诊断AIDS患者CNS CMV感染的可靠方法。然而，对于PCR阳性结果，需要结合个体临床情况进行仔细解读。
