人巨细胞病毒DNA检测在小儿人巨细胞病毒感染诊断中的应用

目的 探讨小儿血液、尿液及其母亲母乳的人巨细胞病毒DNA检测结果在人巨细胞病毒感染的诊断价值。 方法 选取2017年—2018年期间在浙江大学丽水医院就诊的疑似人巨细胞病毒感染的患儿328例为研究对象。收集患儿血液、尿液和对应母乳标本,进行实时荧光定量PCR,检测人巨细胞病毒DNA载量;再将患儿血清用化学发光法检测HCMV-IgM,比较不同标本不同检测方法的阳性率。针对阳性患儿,对不同临床症状分布构成进行分析。 结果 328例患儿检测总阳性率为71.04%,男性患儿和女性患儿阳性率分别为71.02%和69.74%,差异无统计学意义(χ2=0.065,P=0.799)。血液、尿液和乳汁的人巨细胞病毒阳性率分别为49.09%、70.43%和58.23%,尿液阳性率最高,差异有统计学意义(χ2=31.147,P<0.001)。新生儿组的乳汁阳性率最高,为72.41%,28 d到1岁之间和1岁以上患儿尿液阳性率最高,各年龄组之间阳性率差异有统计学意义(P<0.05);血人巨细胞病毒DNA和血清HCMV-IgM阳性率检出率分别为49.09%(161/328)和16.16%(53/328),2种方法联合检测的阳性检出率为49.69%,对比单一血DNA检测方法,两者差异无统计学意义(P>0.05)。临床症状小于1岁患儿主要以黄疸,腹泻为主,大于1岁的患儿主要以肝损害和肺炎为主。 结论 在小儿血液、尿液及其母亲母乳HCMV-DNA的检测中,尿液HCMV-DNA对诊断患儿人巨细胞病毒有更好的临床应用价值。且尿标本留取方便、无创,易为家长和小儿接受,所以采用FQ-PCR方法对小儿尿标本进行检测能起到快速、简洁、灵敏的作用,对提高HCMV感染的诊断率有实际的临床意义,对于小月龄患儿临床应推广尿液HCMV-DNA检测。 

Application of human cytomegalovirus DNA detection in diagnosis of human cytomegalovirus infection in children

Objective To investigate the diagnostic value of human cytomegalovirus(HCMV) DNA detection results in children's blood, urine and mother's breast milk in HCMV infection. Methods A total of 328 children with suspected HCMV infection who were admitted to the hospital from 2017 to 2018 were enrolled. Blood, urine and corresponding breast milk samples were collected for real-time fluorescent quantitative PCR to detect the HCMV-DNA load. Serum HCMV-IgM was detected by chemiluminescence method. The positive rates of different methods in different samples were compared. For positive children, the distribution of different clinical symptoms was analyzed. Results The total positive rate of 328 children was 71.04%, and the positive rates of male and female children were 71.02% and 69.74%, respectively, with no statistically significant(χ2=0.065, P=0.799). The positive rates in blood, urine and milk were 49.09%, 70.43% and 58.23%, respectively, and the positive rate of urine was the highest, with statistically significant(χ2=31.147, P<0.001). The positive rate of milk(72.41%) in the neonatal group was the highest. The positive rate of urine was highest in children between 28 days and 1 year old and 1 year old. The positive rate was statistically different among all age groups(all P<0.05). The positive rates of blood HCMV-DNA and serum HCMV-IgM were 49.09%(161/328) and 16.16%(53/328), respectively. The positive detection rate of the combined detection of the two methods was 49.69%. There was no statistically difference significant between combined detection and single blood DNA detection method(P>0.05). The main clinical symptoms were jaundice and diarrhea in children under one year old, and liver damage and pneumonia in children over one year old. Conclusion The detection of urine HCMV-DNA has a better clinical value in the diagnosis of HCMV. At the same time, urine is convenient to take, and urine HCMV-DNA detection should be promoted in children with small age.