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器官移植后巨细胞病毒的院内感染:检测与监测

张丽萍,白  剑   

  1. 辽宁省中医院医院感染管理处,辽宁省沈阳市  110032
  • 出版日期:2015-05-14
  • 通讯作者: 白剑,辽宁省中医院医院感染管理处,辽宁省沈阳市 110032
  • 作者简介:张丽萍,女,1965年生,辽宁省沈阳市人,汉族,1987年辽宁中医药大学毕业,主管护师,主要从事医院感染管理工作。
  • 基金资助:

    国家自然科学基金面上项目(81170692)

Cytomegalovirus nosocomial infection following organ transplantation: detection and monitoring  

Zhang Li-ping, Bai Jian   

  1. Department of Hospital Infection Management, Liaoning Hospital of Traditional Chinese Medicine, Shenyang 110032, Liaoning Province, China
  • Online:2015-05-14
  • Contact: Bai Jian, Department of Hospital Infection Management, Liaoning Hospital of Traditional Chinese Medicine, Shenyang 110032, Liaoning Province, China
  • About author:Zhang Li-ping, Nurse in charge, Department of Hospital Infection Management, Liaoning Hospital of Traditional Chinese Medicine, Shenyang 110032, Liaoning Province, China
  • Supported by:

    the National Natural Science Foundation of China, No. 81170692

摘要:

背景:巨细胞病毒是器官移植患者最易感染的机会性病毒之一,严重者可导致移植器官失去功能甚至危及生命,因此早期准确诊断巨细胞病毒感染是临床治疗的关键。
目的:对器官移植后巨细胞病毒感染的检测方法、准确程度、检测时间和临床意义分析。
方法:通过计算机分别检索维普数据库、PubMed数据库和中国知网数据库2007年1月至2014年12月有关器官移植和巨细胞病毒感染的文献,以及通过手工查阅书籍,以“transplantation,cytomegalovirus”为英文检索词,“器官移植,巨细胞病毒”为中文检索词。共检出中文31篇,英文1 894篇,选择代表性好、相关领域权威杂志的文献共35篇做进一步分析。
结果与结论:对巨细胞病毒活动性感染的无创检测仍然是以巨细胞病毒-pp65抗原为主,该方法可以准确反映巨细胞病毒感染的状况,敏感性和特异性均较好,也是临床上最具诊断价值的方法。对巨细胞病毒的分子进行生物学检测可以从可以帮助检出潜在的感染人群,而且其检出时间比巨细胞病毒-pp65抗原早,适用于巨细胞病毒感染的早期诊断和抢先给药治疗。定量核酸检测技术可通过定量的分析巨细胞病毒-DNA的拷贝数判断患者体内的病毒含量,为判断隐性感染的患者提供了更为灵敏的监测方案。血清中巨细胞病毒-IgG和巨细胞病毒-IgM可以判断器官移植受者是否感染过巨细胞病毒以及后期的发病风险。病毒培养以及组织学的检测已经沿用数年,这两者是检测巨细胞病毒的金标准,但这些方法对于早期发现感染和诊断活动性感染意义不大。免疫学检测方法为诊断巨细胞病毒感染提供了新的思路,巨细胞病毒特异性的细胞的监测可以从早期、动态、准确的监测巨细胞病毒在体内的发展,评估巨细胞病毒发病风险,为巨细胞病毒感染的诊断发展提供新途径。

关键词: 组织构建, 组织工程, 器官移植, 巨细胞病毒, 诊断, pp65抗原, 荧光定量PCR, 催化信号扩增法, pp67抗原, 核酸基础序列扩增法, 定量核酸检测技术, HLA-G, 国家自然科学基金

Abstract:

BACKGROUND: Cytomegalovirus is one of the opportunistic infection viruses for organ transplant patients, and it can lead to functional loss of organ grafts and even endanger lives. Therefore, accurate diagnosis of cytomegalovirus infection at early phase is the key to clinical treatment.
OBJECTIVE: To analyze the detection method, accuracy, detection time and clinical significance of cytomegalovirus infection after organ transplantation.
METHODS: A computer-based search of VIP, PubMed and CNKI as well as manual search of books were performed for literatures concerning organ transplantation and cytomegalovirus infection published from January 2007 to December 2014. The keywords were “transplantation, cytomegalovirus” in English and Chinese, respectively. Total 1 894 papers in English and 31 articles in Chinese were found. Among them, only 35 papers which were highly representative and published in related authoritative journals were chosen for further analysis.
RESULTS AND CONCLUSION: The main non-invasive detection of cytomegalovirus infection is still the test of CMV-pp65 antigen with good sensitivity and specificity which can accurately reflect the status of cytomegalovirus infection. This method is also the most important clinical diagnostic method. Molecular biological detection of cytomegalovirus can detect potentially infected people, and this method can detect the infection earlier than CMV-pp65 antigen method, which is suitable for the early diagnosis of cytomegalovirus infection and early drug treatment. Quantitative nucleic acid test can be used to analyze cytomegalovirus-DNA copies so as to determine the concentrations of the virus in patients, which may provide a more sensitive monitoring way for inapparently infected patients. Cytomegalovirus-IgG and cytomegalovirus-IgM in serum can be used to determine whether organ transplant recipients have been infected by cytomegalovirus. Virus culture and histological examination have been used for several years, both of which are the gold standard for detecting cytomegalovirus. However, these methods cannot be used in early diagnosis and active infection. Immunological detection method provides a new ideal for the diagnosis of cytomegalovirus infection. This method can monitor cytomegalovirus infection from early phase accurately and assess the risk of cytomegalovirus, providing a new way for the development of the diagnosis of cytomegalovirus infection.

Key words: Tissue Engineering, Organ Transplantation, Cytomegalovirus

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