Early Detection Of Cytomegalovirus Infection After Allogeneic Peripheral Blood Stem Cell Transplantation And Clinical Significance

Objective.To establish a convenient and effective way for the early diagnosis of CMV infection in recipients of allogeneie peripheral blood stem cell transplantation(allo-PBSCT),and instruct the early clinical diagnosis and treatment.Methods:Forty-two patients after allo-PBSCT were dynamicly tested for CMV IgM antibody,CMV pp65 antigen and CMV DNA in blood at different time using MEIA,IFA and real time FQ-PCR methods.There were twenty donors of PBSCT as normal control.T lympholeukocyte subgroup was synchronism detected by flow cytometry(FCM)in the patients of allo-PBSCT. And we collected clinical dataes to analyze the relationship between the CMV infection and clinical prognosis.Result:(1)In transplantation group,the positive rates of CMV pp65 antigen(38.24%)and CMV DNA quantity(33.82%)were obviously higher than those of CMV IgM antibody(21.50%)(χ~2=7.099 P=0.008,χ~2=3.891 P= 0.049)There were no differences between the positive rates of CMV pp65 antigen and CMV DNA quantity(χ~2=0.399,P=0.528),but there were obvious positive correlation between them(r=0.653,P=0.000).There were no positive results in the normal group by all of the three methods.(2)The rate of CMV reactive infection was 61.90%(26/42)in patients of PBSCT.Among of them,15 patients were symptomless infection,9 patients symptom infection,2 patients CMV disease.The positive detection time of CMV pp65 antigen and CMV DNA quantity(75±64d,60±50d)were obviously earlier than that of CMV IgM antibody(127±73d)(P＜0.05).All of the 26 patients of CMV reactive infection were treated by ganciclovir and received remmison.The CMV DNA copy numbers after two weeks for treatment (8.69×10~2)was obviously lower than those before treatment(4.75×10~4)(P= 0.005).CMV pp65 became negative after five weeks for treatment.CMV IgM became negative after nine weeks.(3)There were obvious correlatations between the occurrence of CMV reactive infection and the descent of cellular immune function,the occurrence of acute graft-verse-host disease and other transplantation correlated complication (P＜0.05).Conclusion:(1)In transplantation group,the positive rates of CMV pp65 antigen and CMV DNA quantity were obviously higher than those of CMV IgM antibody.And the detection time of CMV pp65 antigen and CMV DNA quantity was obviously earlier than CMV IgM antibody.The two methods of IFA and real time FQ-PCR can diagnose early CMV infection more accurately.The detections of CMV pp65 antigen and CMV DNA quantity suit to use for early detection of allo-PBSCT patients.After allo-PBSCT,the dynamic examination of CMV pp65 antigen,CMV DNA,CMV IgM antibody and adopting early cure,could obviously cut down the incidence rate of CMV IP.(2)The descent of cellular immune function,the occurrence of aGVHD and other transplantation correlated complication are risk factors to CMV infection of allo-PB SCT patients.