血浆巨细胞病毒多聚酶链反应检测用于指导干预性治疗

目的：分析用血浆巨细胞病毒（cytomegalovirus,CMV)多聚酶链反应（plymerase chain reaction,PCR)检测结果指导抗CMV干预性治疗的临床意义。方法：1999年8月至2001年7月行异基因造血干细胞移植（hematopoietic stem cell transplantation,HSCT)的所有患者自预处理开始，常规用PCR法检测血浆的CMV－DNA（采用华美公司生产的巨细胞病毒4℃ PCR检测试剂盒），每周1次。其中尚无CMV病的临床表现而检测到血浆CMV阳性的患者89例。随机选取52例阳性患者给予干预性治疗。将上述89例患者分为3组（分别为停止治疗时血浆CMV－PCR转阴组、停止治疗时未转阴组、血浆CMV阳性未治疗组）比较各组CMV病的发生率。CMV病的发生率采用Kaplan-Meier曲线表示，曲线间的比较用Log-Rank（曲线无交叉）或Breslow（曲线交叉）检验，某时点率的比较采用RXC列联表或χ^2检验。结果：100d内CMV病的发生率，在治疗后血浆CMV－PCR由阳性转为阴性组为10．26％，治疗结束时血浆CMV－PCR仍为阳性组为66.67%，血浆CMV－PCR阳性未治疗组为36．24％（P＝0.0000)。上述3组中任两组移植后100d CMV病的发生率差异均有显著性。移植后1年时上述3例CMV病累积发生率分别为30.65%、75.00%、42.95%(P=0.0009)，治疗未转阴组与治疗转阴组和阳性未治疗组相比，CMV病的发生率明显升高。结论：血浆CMV－PCR检测结果用来指导干预性治疗有一定临床意义。干预性治疗后血浆CMV－DNA仍未转阴者，应考虑换药或联合用药治疗。

Pre-emptive antiviral therapy guided by extended routine plasma polymerase chain reaction surveillance

OBJECTIVE: To evaluate the utility of plasma CMV-PCR to guide anti-CMV pre-emptive therapy. METHODS: We analyzed 89 Allogeneic hematologic stem cell transplantation (allo-HSCT) patients with plasma CMV-DNA positive after HSCT. From the day of HSCT, plasma CMV-DNA were monitored weekly(CMV 4 degrees C PCR kits), and 52 cases were chosen randomisely to receive pre-emptive therapy. The 89 patients were divided into three groups: patients without pre-emptive therapy, patients with plasma CMV-DNA remaining positive after pre-emptive therapy, and patients with plasma CMV-DNA turning to negative after pre-emptive therapy. Kaplan-Meier curve differences were compared by Log-Rank or Breslow test, RXC tables or chi 2 tests were used to compare the incidence of CMV disease. RESULTS: The accumulative incidence of CMV disease within the first 100 days after HSCT was 36.24% among the PV-PCR (CMV-PCR) positive patients without pre-emptive therapy, 66.67% among the patients with PV-PCR remaining positive after pre-emptive therapy, and 10.26% among the patients with PV-PCR turning to be negative after pre-emptive therapy respectively (P = 0.0000). The incidence of CMV disease 100 days post HSCT between any two groups was different. The accumulative incidence of CMV disease 1 year after HSCT was 42.95%, 75.00% and 30.65%, respectively among the above three groups (P = 0.0009). The incidence of CMV disease in 1 year among patients with PV-PCR remaining positive after pre-emptive treatment was higher than the others. CONCLUSION: PV-PCR guided pre-emptive therapy may decrease the incidence of CMV disease within 100 days after HSCT, and patients with PV-PCR remaining positive after pre-emptive therapy may need a combined treatment.