基于核酸序列的扩增技术在异基因外周血干细胞移植后受者HCMV感染诊断的应用_论文.docxVIP

基于核酸序列的扩增技术在异基因外周血干细胞移植后受者HCMV感染诊断的应用 作者：徐鸿绪　刘雅峰　谭恩勋　蔡建涛 【摘要】 　　本研究探讨基于核酸序列的扩增技术(nucleic acid sequence based amplification，NASBA)检测mRNA对异基因外周血干细胞移植受者术后人类巨细胞病毒(HCMV)感染的诊断价值，并评价该技术对抗病毒治疗的指导意义。以128例移植术后患者为研究对象,采集移植术后外周血352份;利用NASBA检测外周血中HCMV基质外壳蛋白PP67（UL65）mRNA,并与HCMV DNA的结果进行比较。结果表明：352份血标本中，HCMV mRNA阳性105份（%），HCMV DNA阳性183份（%）。128例患者术后有45例发展为HCMV病， HCMV DNA和HCMV mRNA检测诊断HCMV病的敏感性和特异性分别为%(43/45)、%(42/45)和%(50/83)、%(81/83)。两者特异性的比较差异具有显著性（P＜）。结论：HCMV-PP67的NASBA检测方法具有快速、敏感性高和特异性强等优点，可作为快速检测HCMV病的方法用于临床。该法检测结果与移植受者的临床症状相关，故也可用作监视异基因造血干细胞移植受者术后HCMV感染和指导抗病毒治疗的依据。 【关键词】 异基因外周血干细胞移植 人类巨细胞病毒感染 基于核酸序列的扩增技术 Application of Nucleic Acid Sequence-Based Amplification in Detection of Cytomegalovirus mRNA of Recipients after Allogeneic Peripheral Blood Stem Cell Transplantation AbstractThe study was purposed to investigate diagnostic value of late-mRNA detection by nucleic acid sequence-based amplification ( NASBA) technique for human cytomegalovirus (HCMV) infection of the recipients after allo-geneic peripheral blood stem cell transplantation (allo-PBSCT) and to evaluate the clinical significance for guiding antiviral therapy. 352 samples were collected from 128 transplant patients after allo-PBSCT. A molecular biological diagnostic technique-NASBA was used to detect human cytomegalovirus (HCMV) late mRNA encoding the viral structural protein PP67 (UL65) expression in peripheral blood of recipients after allo-PBSCT, and the detected results were compared with HCMV DNA detection by PCR. The sensitivity, specificity and early diagnostic value of HCMV mRNA detection for HCMV disease were evaluated. The results showed that out of 352 detected blood specimens from 84 patients 183 specimens （%）were positive of HCMV DNA by PCR, 105 specimens ( %) were positive of HCMV mRNA by NASBA. 45 patients were infected by HCMV. The sensitivity and specificity of HCMV DNA and HCMV mRNA for detecting HCMV disease were % (43/45),% (42/45) and % (50/83),% (81/83). The results of specificity show