Human Cytomegalovirus Pp65 Antigen And HCMV-specsfic IgM And IgG Assay For Diagnosis Of Cytomegalovirus Active Infection In The Renal Transplantation Recipients

Human cytomegalovirus (HCMV) is a beta herpes virus。It is a ubiquitous human pathogen, and a new infection or the reactivation of a latent infection in immunocompromised individuals can result in life-threatening disease.Although the use of Ganciclovir makes the healing of HCMV disease to show a large turning point, the significant work is early diagnosis and promptly treatement.So the detection of the HCMV is very important.After the infection of HCMV, the organism can produce specific antibodys. Now, the serological method we offen use is enzyme-linked immunosorbent assay(ELISA). This method can reach a level of ng.HCMV pp65 is an immediately early ptotein,which located between the capsid and the peplos.Quantitys of pp65 appeared in the polymorphocyte of peripheral blood is an conspicuous sign of HCMV actively replication. Now ,pp65 detection is an important method to diagnose HCMV antigenaemia.Objective To compare the diagnostic efficacy of the human cytomeg- alovirus (HCMV) pp65 antigenemia assay and the HCMV-specific IgM test in the diagnosis of active HCMV infection in the renal transplantation recipientsMethods Sequential blood specimens obtained from 86 renal transplantation recipients. The plasma and the ploy-morphonuclear cells were separated from the whole blood. The former was used for the IgG and IgM assay and the latter was used for the pp65 antigenemia testResults 278 blood samples were obtained, the positive rate of pp65 antigenemia , IgG and IgM were 66.19%,100% and3.23% respectively. The average number of positive leukocytes of HCMV pp65 antigen was10.87±4.32/1×105 leukocytes.The positive agreement rate of IgM assay and HCMV pp65 antigenemia assay was 37.05%.For prediction of active HCMV infection, the sensitivity of IgM assay in comparison with pp65 antigenemia test, were 4.69% respectively. The positive and negative predictive value were 100% and 15.38% respectively. In our study,25 of 86 patients(30.23%) developed HCMV disease at a median of 98.12±68.24 days after renal transplant. When HCMV disease developed, the average number of positive leukocytes of pp65 antigenemia was 17.86±3.86/1×105 leukocytes, higher than they have no signs of HCMV infection markedly (P <0.01).There have no relation of HCMV-specific IgM with symptom of HCMV infection.Conclusion The pp65 antigenemia assay could reflect the level of HCMV and predict active HCMV infection in stem cell transplantation recipients. The HCMV specific IgM assay had moderate specificity but often gave late positive results and was not sensitive enough for use as prediction tools for transplant patients. The HCMV specific IgM assay had insufficient specificity and was not fit to use as a early diagnosis tools.