不同标本巨细胞病毒检测在诊断小儿人巨细胞病毒感染中的应用

摘要

Objective To study the diagnostic significance of detection of human cytomegalovirus (HCMV) IgM in sera, and HCMV DNA in urine, blood lymphocytes and mother's breast milk for baby infection. Methods Chemiluminescence technology was used to detect the specific HCMV IgM antibody in sera and fluorescent quantitative PCR was used to detect HCMV DNA simultaneously in urine, blood lymphocytes and the mother's breast milk of 189 infants with suspected HCMV infection. The positive rates in these specimens were analyzed in either newborn group (less than 28 days old) or infant group (from 29 days to 12 months old), as well as boy group and girl group. Results In newborn group, the positive rate of HCMV DNA in mother's breast milk (60.3%) was higher than those both in urine (5.2%,P < 0.001) and in blood lymphocytes (12.1%, P < 0.001). In infant group, no statistical difference was detected between the positive rates of HCMV DNA in mother's breast milk (48.1%) and that in urine (55.0%), which were higher than that in blood lymphocytes (22.1%) and the positive rate of HCMV IgM in sera (24.4%). In infant group, the positive rate of HCMV DNA in urines and that of HCMV IgM in sera were higher than those in newborn group (P < 0.01). No statistical difference between boy group and girl group was detected in all specimens. The positive rate of HCMV DNA in mother's breast milk showed significant positive correlations with those of all other specimens (P < 0.001). Conclusions Combined detection of HCMV IgM in sera and HCMV DNA in urine, blood lymphocytes and mother's breast milk would contribute to auxiliary diagnosis of baby with HCMV infection. If it is not available to detect all these samples, detection of HCMV DNA in urine of infant may be the first choice. Detection of HCMV DNA in mother's breast milk and breastfeeding in a correct way would contribute to the prevention of HCMV infection.%目的：探讨尿液、淋巴细胞和母乳的 HCMV-DNA 检测以及血清 HCMV-IgM 检测在小儿人巨细胞病毒（HCMV）感染诊断中的意义。方法用实时荧光定量 PCR检测189例疑似HCMV感染患儿尿液、淋巴细胞和母乳的HCMV-DNA ，用化学发光法检测其血清HCMV-IgM ，并分年龄分性别对其阳性率进行分析比较。结果新生儿组母乳HCMV-DNA阳性检出率（60.3％）显著高于尿液（5.2％， P<0.001）和淋巴细胞（12.1％，P<0.001），也显著高于血清 HCMV-IgM 阳性率（3.4％，P<0.001）；婴儿组母乳（48.1％）与尿液（55.0％）HCMV-DNA 阳性率差异无统计学意义（P>0.05），但两者均显著高于淋巴细胞 HCMV-DNA 阳性率（22.1％， P<0.001）和血清 HCMV-IgM 阳性率（24.4％， P<0.001）；婴儿组的尿液 HCMV-DNA、血清 HCMV-IgM 阳性率均显著高于新生儿组（ P<0.01）；两组各指标男女阳性率差异均无统计学意义（ P>0.05）；母乳 HCMV-DNA 阳性率与尿液、淋巴细胞 HCMV-DNA 阳性率及血清 HCMV-IgM 阳性率均呈显著正相关（r ＝0.630，P ＝0.000；r ＝0.413，P ＝0.000；r ＝0.341，P ＝0.000）。结论联合尿液、淋巴细胞HCMV-DNA 和血清HCMV-IgM 检测有助于患儿HCMV 感染的辅助诊断；在无法联合检测的条件下，婴儿首选尿液 HCMV-DNA 检测可获得较高检出率；母乳 HCMV-DNA检测并正确喂养有助于预防HCMV感染。