巨细胞病毒-PP65抗原监测在预防肾移植术后巨细胞病毒病中的应用
作者：许元文 朱兰英 吴培根 毛海萍 梁艳冰 纪玉莲
单位：510080广州，中山医科大学附属第一医院肾内科
关键词：肾移植；巨细胞病毒感染；抗原；预防
中华肾病杂志000411摘 要：目的 探讨巨细胞病毒(CMV)-PP65抗原检测在肾移植术后CMV病预防中的应用。方法 采用免疫过氧化物酶法检测肾移植受者外周血白细胞CMV-PP65抗原，术后3个月内每周1次。结果 100例肾移植受者中42例检出CMV-PP65抗原阳性，初次检出CMV-PP65抗原的平均时间为(23.6±16.7)d，平均抗原阳性细胞数为(7.8±5.3)个/5×104白细胞。抗病毒治疗中18例抗原阳性细胞数进一步升高，平均峰值为(16.4±3.1)个。58例抗原血症阴性的受者仅1例发生CMV病。42例CMV-PP65抗原血症阳性受者抗病毒治疗后抗原血症均阴转，1例发展为CMV病，平均阴转时间为(24.6±11.3)d，平均疗程为(34.2±7.1)d。结论 CMV-PP65抗原监测可指导肾移植术后CMV病的预防性治疗。
, http://www.100md.com
The significance of CMV-PP65 antigen detection in antiviral therapy for cytomegalovirus disease in recipients of cadaveric renal allografts
XU Yuanwen ,ZHU Lanying ,WU Peigen
(Department of Nephrology, First Affiliated Hospital,Sun Yat-sen University of Medical Sciences, Guangzhou 510080, China)
Abstract：Objective To investigate the significance of cytomegalovirus (CMV) PP65 antigen detection in antiviral treatment to prevent CMV disease after renal allografts.Methods CMV-PP65 antigen was checked by immunohistochemical methods at weekly intervals during the first 3 months after transplantation.Within 24 hours after the CMV-PP65 antigenemia test became positive, ganciclovir was administered at a dose of 1.25～5 mg·kg·d-1 intravenous drip. Results 42 of 100 recipients (42%)developed CMV antigenemia, and 1 of the other 58 cases(1.7%) with negative CMV antigenemia developed CMV disease.CMV antigen in all 42 cases(100%) disappeared after antiviral treatment,and 1 of them developed CMV disease.CMV antigenemia became negative on average day 24. 6±11.3, and the average duration of antiviral therapy was(34. 2±7. 1) days. Conclusion Monitoring of CMV-PP65 antigenemia may be effective to guide the prophylactic antiviral therapy of CMV disease in renal allograft recipients,and CMV-PP65 antigen should be detected weekly within the first 3 months after renal transplantation.
, 百拇医药
Keywords：Kidney transplantation;Cytomegalovirus infection;Antigen;Prophylaxis
参考文献：
[1]Prosch S, Kimel V. Dawydowa I,et al.Monitoring of patients for cytomegalovirus after organ transplantation by centrifugation culture and PCR.J Med Virol,1992,38:246-251.
[2]洪良庆,郑克立.CMV-PP65抗原检测(LSAB法)方法.中华医学检验杂志,1998,21:33-35.
[3]van den Berg AP,van der Bij W,van Son W J,et al.Cytomegalovirus antlgenemia as useful marker of symptomatic cytomegalovirus infection after renal transplantation-a report of 130 consecutive patients.Transplantation,1989,48:991-995.
, 百拇医药
[4]Goodrich JM,Mori M,Gleaves CA,et al.Early treatment with ganciclovir to prevent cytomegalovirus disease after allogeneic bone marrow transplantation. N Engl J Med,1991,325:1601-1607.
[5]Goodrich JM,Bowden RA,Fisher L,et al.Ganciclovir prophylaxis to prevent cytomegalovirus disease after allogeneic marrow transplant.Ann Intern Med,1993,118:173-178.
[6]Barber L,Egan J J,Lomax J,et al.Comparative study of three PCR assays with antigenaemia and serology for the diagnosis of HCMV infection in thoracic transplant recipients.J Med Virol,1996,49:137-144.
, 百拇医药
[7]Birkeland S,Gahrm-Hansen B,Andersen H,et al.Cytomegalovirus prophylaxis in antibody-treated renal transplantation patients.Transplant Pro,1995,27:3473-3476.
[8]Boeckh M,Cooley TA,Myerson D,et al.Cytomegalovirus pp65 antigenemia-guided early treatment with ganciclovir versus ganciclovir at engraftment after allogeneic marrow transplantation: a randomirized double-blind study.Blood,1996,88:4063-4071.
[9]Hibberd PL,Tolkoff-Rubin NE,Conti D,et al.Preemptive ganciclovir therapy to prevent cytomegalovirus antibody- positive renal transplant recipients.Ann Intern Med,1995,123:18-26.
[10]Winston DJ,Wirin D,Shaked A,et al.Randomized comparison of ganciclovir and high-dose acyclovir for long-term cytomegalovirus prophylaxis in liver-transplant recipients. Lancet,1995,346:69-74.
收稿日期：1999-08-15, 百拇医药
单位：510080广州，中山医科大学附属第一医院肾内科
关键词：肾移植；巨细胞病毒感染；抗原；预防
中华肾病杂志000411摘 要：目的 探讨巨细胞病毒(CMV)-PP65抗原检测在肾移植术后CMV病预防中的应用。方法 采用免疫过氧化物酶法检测肾移植受者外周血白细胞CMV-PP65抗原，术后3个月内每周1次。结果 100例肾移植受者中42例检出CMV-PP65抗原阳性，初次检出CMV-PP65抗原的平均时间为(23.6±16.7)d，平均抗原阳性细胞数为(7.8±5.3)个/5×104白细胞。抗病毒治疗中18例抗原阳性细胞数进一步升高，平均峰值为(16.4±3.1)个。58例抗原血症阴性的受者仅1例发生CMV病。42例CMV-PP65抗原血症阳性受者抗病毒治疗后抗原血症均阴转，1例发展为CMV病，平均阴转时间为(24.6±11.3)d，平均疗程为(34.2±7.1)d。结论 CMV-PP65抗原监测可指导肾移植术后CMV病的预防性治疗。
, http://www.100md.com
The significance of CMV-PP65 antigen detection in antiviral therapy for cytomegalovirus disease in recipients of cadaveric renal allografts
XU Yuanwen ,ZHU Lanying ,WU Peigen
(Department of Nephrology, First Affiliated Hospital,Sun Yat-sen University of Medical Sciences, Guangzhou 510080, China)
Abstract：Objective To investigate the significance of cytomegalovirus (CMV) PP65 antigen detection in antiviral treatment to prevent CMV disease after renal allografts.Methods CMV-PP65 antigen was checked by immunohistochemical methods at weekly intervals during the first 3 months after transplantation.Within 24 hours after the CMV-PP65 antigenemia test became positive, ganciclovir was administered at a dose of 1.25～5 mg·kg·d-1 intravenous drip. Results 42 of 100 recipients (42%)developed CMV antigenemia, and 1 of the other 58 cases(1.7%) with negative CMV antigenemia developed CMV disease.CMV antigen in all 42 cases(100%) disappeared after antiviral treatment,and 1 of them developed CMV disease.CMV antigenemia became negative on average day 24. 6±11.3, and the average duration of antiviral therapy was(34. 2±7. 1) days. Conclusion Monitoring of CMV-PP65 antigenemia may be effective to guide the prophylactic antiviral therapy of CMV disease in renal allograft recipients,and CMV-PP65 antigen should be detected weekly within the first 3 months after renal transplantation.
, 百拇医药
Keywords：Kidney transplantation;Cytomegalovirus infection;Antigen;Prophylaxis
参考文献：
[1]Prosch S, Kimel V. Dawydowa I,et al.Monitoring of patients for cytomegalovirus after organ transplantation by centrifugation culture and PCR.J Med Virol,1992,38:246-251.
[2]洪良庆,郑克立.CMV-PP65抗原检测(LSAB法)方法.中华医学检验杂志,1998,21:33-35.
[3]van den Berg AP,van der Bij W,van Son W J,et al.Cytomegalovirus antlgenemia as useful marker of symptomatic cytomegalovirus infection after renal transplantation-a report of 130 consecutive patients.Transplantation,1989,48:991-995.
, 百拇医药
[4]Goodrich JM,Mori M,Gleaves CA,et al.Early treatment with ganciclovir to prevent cytomegalovirus disease after allogeneic bone marrow transplantation. N Engl J Med,1991,325:1601-1607.
[5]Goodrich JM,Bowden RA,Fisher L,et al.Ganciclovir prophylaxis to prevent cytomegalovirus disease after allogeneic marrow transplant.Ann Intern Med,1993,118:173-178.
[6]Barber L,Egan J J,Lomax J,et al.Comparative study of three PCR assays with antigenaemia and serology for the diagnosis of HCMV infection in thoracic transplant recipients.J Med Virol,1996,49:137-144.
, 百拇医药
[7]Birkeland S,Gahrm-Hansen B,Andersen H,et al.Cytomegalovirus prophylaxis in antibody-treated renal transplantation patients.Transplant Pro,1995,27:3473-3476.
[8]Boeckh M,Cooley TA,Myerson D,et al.Cytomegalovirus pp65 antigenemia-guided early treatment with ganciclovir versus ganciclovir at engraftment after allogeneic marrow transplantation: a randomirized double-blind study.Blood,1996,88:4063-4071.
[9]Hibberd PL,Tolkoff-Rubin NE,Conti D,et al.Preemptive ganciclovir therapy to prevent cytomegalovirus antibody- positive renal transplant recipients.Ann Intern Med,1995,123:18-26.
[10]Winston DJ,Wirin D,Shaked A,et al.Randomized comparison of ganciclovir and high-dose acyclovir for long-term cytomegalovirus prophylaxis in liver-transplant recipients. Lancet,1995,346:69-74.
收稿日期：1999-08-15, 百拇医药