检测巨细胞病毒(CMV)DNA及其即刻早期抗原、pp65和pp67在肾移植受者术后巨细胞病毒感染早期诊断中的价值

目的探讨检测巨细胞病毒(CMV)DNA及其即刻早期抗原(IE)、巨细胞病毒pp65和pp67抗体对肾移植受者术后巨细胞病毒感染早期诊断的临床应用价值。方法按肾移植术受者术后3个月外周血是否出现CMV抗原,将71例患者分为CMV感染组(56例)和CMV未感染组(15例),肾移植术受者手术前和术后第1个月每周检查1次,第2、3个月每2周检查1次外周血巨细胞病毒pp65和巨细胞病毒pp67、即刻早期抗原(immediate early antigen,IE),巨细胞病毒DNA和IgM、IgG,共8次;以监测与分析评价肾移植术受者手术前后各项指标变化。结果肾移植术前71例肾移植受者PP65、PP67、IE、CMV DNA均为阴性;肾移植术后CMV感染组的pp65、pp67、IE、CMV DNA阳性率分别为67.8%(38/56)、66.1%(37/56)、64.2%(36/56)和48.2%(27/56),CMV未感染组4项指标值分别为0%、0%、13.3%(2/15)、和0%,两组差异均有统计学意义(P均0.01)。肾移植术后CMV感染组(56例)和CMV未感染组(15例)CMV IgG均为阳性,而IgM阳性率在CMV感染组仅为3.5%(2/56),在CMV未感染组为0%,IgM表达率在CMV感染组和未感染组无统计学差异(P0.05)。观察期内感染组与未感染组相比,术后CMV pp65,pp67,CMV DNA和IE指标出现阳性的例数及阳性出现的具体时间均有显著性差别(P均0.01),而IgM和IgG则均无显著性差别(P均0.05)。结论肾移植术后患者外周血CMV DNA,IE,pp65和pp67抗原检测阳性与其术后巨细胞病毒感染相关。检测CMV DNA、IE、pp65和pp67抗原可能更早更准确反映器官移植术后CMV活动性感染。而CMV IgG和IgM不能作为肾移植后患者CMV感染的诊断指标。     

肾移植术后巨细胞病毒pp65检测的临床意义

目的探讨肾移植受者术后,巨细胞病毒被膜磷蛋白pp65的检测在活动性巨细胞病毒感染中的意义。方法用间接免疫荧光法检测肾移植受者术后HCMV-pp65,同时用酶联免疫捕获法检测HCMV-IgM抗体,共采集91份血标本。结果 91份血标本中,HCMV-pp65阳性24份（26.4%）,HCMV-IgM抗体阳性4份（4.4%）,在24例HC-MV-pp65抗原血症阳性的患者中,有20例出现HCMV感染症状及HCMV病。结论 HCMV-pp65在活动性巨细胞病毒感染的检测中具有早期、准确的优点,可辅助临床对HCMV感染进行早期诊断与治疗。     

人巨细胞病毒pp65特异性抗体测定在原发感染诊断中的应用

目的 通过测定患者单份血清人巨细胞病毒(HCMV)pp65特异性IgM抗体和IgG亲和指数(AI),建立HCMV原发感染的临床判断标准.方法 从临床收集40份患儿血清和尿标本,以本室自制的pp65为抗原,运用间接酶联免疫吸附试验(ELISA)检测血清标本中HCMV pp65特异性IgM抗体;同时通过尿素变性实验,以6M尿素作为温和蛋白变性剂,测定HCMVpp65 IgG AI.尿标本常规处理后接种人胚成纤维(HF)细胞进行病毒分离,观察HCMV特异性细胞病变效应(CPE),聚合酶链反应(PCR)试验检测细胞培养物UL83基因,间接免疫荧光试验检测细胞玻片HCMV抗原.并将病毒分离结果 同血清学方法 进行比较.结果 40例标本中,IgM阳性13例,IgG阳性30例,其中,仅IgM阳性4例,病毒分离结果 亦为阳性,可诊断为原发感染;30例IgG阳性标本中,2种抗体均为阳性9例(A组),其中,5例AI＜50﹪,病毒分离结果 均为阳性,判断为原发感染;1例AI在50﹪与60﹪之间,为可疑原发感染,需要进一步鉴定;3例AI＞60﹪,判断为继发感染.IgG阳性21例(B组),其中仅3例(14.29﹪)AI＜50﹪,但病毒分离结果 为阴性,提示患者不久前曾发生HCMV原发感染,特异性IgM抗体已经转阴,病毒进入潜伏状态;余18例患者AI均＞60﹪,判断为继发感染;2种抗体均为阴性的标本有6例,病毒分离结果 亦为阴性,说明患者未被感染.统计学分析,A组与B组之间差异有统计学意义(P＜0.05).血清学方法 与病毒分离比较,一致率为75.49﹪,该方法 灵敏度为100﹪,特异度为87.10﹪,准确度为90.00﹪.结论 以HCMV pp65重组蛋白为抗原检测特异性抗体以及相应IgG AI的ELISA,可快速诊断HCMV原发感染和继发感染;该方法 具有高度特异性与敏感性,操作简便,重复性好,具有良好的临床应用前景.     

流式细胞术检测人巨细胞病毒活动性感染检测方法的建立及检测效果评价

探讨流式细胞术检测人巨细胞病毒活动性感染检测方法的可行性及效果评价。分离人外周血白细胞,以商品化的小鼠抗人巨细胞病毒pp65抗原单克隆抗体为一抗,FITC标记的羊抗小鼠IgG抗体为二抗,采用流式细胞术对外周血人巨细胞病毒pp65抗原进行检测。同时采用间接免疫荧光法对外周血人巨细胞病毒pp65抗原进行检测。采用配对χ2检验对两种方法的检测效果进行评价。临床送检的65份疑似为人巨细胞病毒感染病人外周血标本中,间接免疫荧光法检出阳性9份,流式细胞术检出阳性11份,两种方法阳性检出率差异无统计学意义(P0.05)。采用流式细胞术可定量检测外周血人巨细胞病毒pp65抗原,与间接免疫荧光法检测结果无统计学差异,可在临床推广使用。     

念珠菌血症时甘露聚糖抗原及其IgG抗体检测诊断价值的临床研究

目的评价念珠菌甘露聚糖抗原（M抗原）及甘露聚糖IgG抗体（M-IgG抗体）检测诊断念珠菌血症的价值。方法收集2013年5月～2014年1月我院住院患者及健康体检人群共107例,包括念珠菌血症组（念珠菌血培养阳性患者）13例、危险因素组（临床诊断侵袭性念珠菌病或接受化疗恶性疾病、留置深静脉置管等侵袭性念珠菌病感染高危患者）63例和对照组（健康体检人群）31例。通过ELISA方法检测甘露聚糖抗原及甘露聚糖IgG抗体,比较3组人群检测阳性情况及持续时间,计算两种方法的灵敏度、特异度、阴性预测值、阳性预测值、ROC曲线下面积及Kappa值。结果白念珠菌和光滑念珠菌为念珠菌血症的主要念珠菌病原,均为5例。念珠菌血症的7／14菌株（1例患者合并2种念珠菌感染）来自重症医学科,其次为感染内科（2／14株）。除1例死亡病例外,余12例患者进行了M抗原和M—IgG抗体监测。首次M抗原检测中,4例阳性,1例可疑阳性;首次M-IgG抗体检测中,11例阳性,1例可疑阳性。经抗真菌治疗,监测14d,M-IgG抗体持续阳性时间长于M抗原。甘露聚糖抗原在诊断念珠菌血症的敏感度41．7％,特异度98．8％,阴性预测值92．4％,阳性预测值100％。甘露聚糖IgG抗体在诊断念珠菌血症的敏感度91．7％,特异度52．8％,阴性预测值100％,阳性预测值27．5％。M抗原、M抗原并M—IgG抗体作为念珠菌血症时诊断实验的ROC曲线下面积均为0．708（95％CI：0．517—0．900）,两者的Kappa值分别为0．520和0．559。结论甘露聚糖抗原在诊断念珠菌血症时的特异度较高,甘露聚糖IgG抗体在诊断念珠菌血症的敏感性较高,两者的联合检测可以适当提高检测的敏感度及特异度,有助于念珠菌血症的诊断。     

人巨细胞病毒gp52蛋白与pp65蛋白融合表达及初步应用

建立以重组表达HCMV蛋白为抗原的检测试剂盒,提高试剂盒的敏感性及特异性。从病毒及质粒中分别扩增gp52（281～433aa,f1）及pp65（361～473aa,f2）2个片段,以不同酶切位点同时插入到pTrcHisB载体上,筛选正确的重组质粒并在大肠杆菌中诱导表达。表达蛋白rp52～65占菌体总蛋白的30％,以包涵体的形式存在,分子量为35000.以金属螯合亲和层析（IMAC）及分子筛方法纯化表达蛋白,纯度达到96％,得率为22．9％。以间接法检测HCMVIgM阳性血清,敏感性达到90．4％（19／21）。融合蛋白具有良好的抗原性,可代替gp52及pp65作为HCMVIgM抗体检测试剂盒的包被抗原。     

单克隆抗体间接免疫荧光法检测巨细胞病毒分离培养中的抗原

应用抗巨细胞病毒(HCMV)蛋白抗原(分子量为20千道尔顿)的单克隆抗体(McAb-20k)和HCMV IgG特异性阳性血清以间接免疫荧光试验检测28例器官移植病人尿标本接种人胚肺细胞后的HCMV感染情况,结果前法于接种后48小时检测到HCMV阳性病人9例,后者于接种6天检测到阳性病人11例。与病毒分离结果相比较,两法的敏感性分别为81.8％和90.9％,特异性相应为100％和94.12％,符合率均为92.9％,比病毒分离提前数天至数周作出诊断,重复性良好。因此,抗HCMV蛋白抗原的单克隆抗体间接免疫荧光法是一种有效的、早期快速而又敏感特异的诊断方法,操作简便,既使没有单抗,可用HCMV IgG阳性血清代替,也可取得较好效果,值得在一般实验室推广应用。     

巨细胞病毒抗原片的制备及其在快速诊断中初步应用

本文报道了用巨细胞病毒(CMV,AD_(169)株)感染的人胚肺细胞(HL)制备CMV抗原片。在这种抗原片上进行的间接免疫酶组化法(IPA)初步应用于CMV的快速诊断,并与补体结合试验(CFT)和免疫荧光技术(IFA)进行了比较。检测103份血清中抗CMV IgG抗体和18例双份血清中抗CMV IgG和IgM抗体的结果表明,本方法是特异的,其结果与CFT和IFA的结果一致。这种方法简便、快速、灵敏,不需要特殊的设备,可广泛用于临床诊断和流行病学调查。     

人巨细胞病毒cDNA文库的构建、鉴定及pp65阳性克隆筛选

为进一步进行人巨细胞病毒 (HCMV)后基因组功能的研究 ,以及为疫苗分子和早期诊断试剂的研制提供有效工具 ,从HCMVAD1 69株感染 96h的HF细胞中提取HCMV的mRNA ,逆转录合成cDNA片段 ,重组入λgt1 1EcoRI酶切位点之间 ,包装蛋白包装 ,构建HCMVAD1 69株基因组cDNA表达文库。结果表明 ,初始HCMVcDNA文库容量为 3 6× 1 0 6,重组率为 96% ;HCMV鼠多克隆抗血清筛选出 1 68个HCMV阳性克隆 ;地高辛标记pp65特异性寡核苷酸探针原位噬斑杂交筛选出 3 4个pp65阳性克隆 ,再经PCR扩增 ,筛选出 2个pp65阳性克隆 ;pp65PCR扩增产物进一步被Southernblotting证实 ;3 端测序比较 ,同源性为 98%。为进一步克隆、表达该基因及其产物功能研究奠定基础     

肿瘤患者化疗后人巨细胞病毒活动性感染检测

探讨肿瘤患者化疗后人巨细胞病毒感染检测方法的应用价值。使用免疫组化法、酶联免疫吸附试验检测IgG/M抗体,以及实时荧光定量(FQ-PCR)检测HCMV DNA。47份全血标本中抗原阳性率为48.9%,平均抗原阳性细胞数7.9±8.1(1-65)/5×104WBC,HCMV DNA阳性率19.1%(10/47),HCMV DNA含量均值为6.320×105copies,白细胞HCMV-DNA阳性率51%(25/47),HCMV DNA含量均值为3.830×107 copies,HCMV pp65抗原阳性率为48.9%(23/47),IgG抗体均阳性,IgM抗体阳性率为23.4%(12/47),以PP65抗原阳性为对照,IgM抗体检测的敏感率仅为49.3%。在连续动态检测HCMV多种指标时,结合DNA及抗原动态检测具有更高临床应用价值。     

Comparison of real-time PCR and pp65 antigen assays for monitoring the development of Cytomegalovirus disease in recipients of solid organ and bone marrow transplants

Cytomegalovirus (CMV) infection is a frequent complication in transplant recipients. This retrospective study compared real-time PCR (rt-PCR) and a pp65 antigen assay as tools for monitoring CMV infection in solid organ (SOT) and bone marrow (SCT) transplant patients. The study tested 2662 samples by rt-PCR, and 1284 specimens with a pp65 antigen assay. 24.3% of the rt-PCR samples and 4.1% of the pp65 antigen samples were positive. 793 specimens, from 230 patients, were tested with both assays. In 6.7% of samples, both tests were positive; in 72.7% both were negative; in the remaining 20.6% of cases, the results were discordant. CMV disease was diagnosed in 50 patients. Results from the two methods were poorly correlated (r=0.460). The sensitivity of rt-PCR (94%) was higher than that of the pp65 antigen assay (27%). Both assays showed high specificity (92% and 99%, respectively). ROC curve analysis, performed separately for SOT and SCT patients, confirmed that rt-PCR outperformed the pp65 assay in the detection of CMV. These findings provide evidence that rt-PCR is a reliable diagnostic tool, and that it can be more effective than pp65 based assays in monitoring CMV infection progression and in guiding therapy in immunocompromised patients.     

血浆(1,3)-β-D葡聚糖检测对器官移植患者侵袭性真菌感染诊断价值

目的 探讨血浆(1,3)-β-D葡聚糖(BG)检测(G试验)在诊断器官移植术后合并侵袭性真菌感染(IFI)的诊断价值.方法 回顾性分析2011年1月～2012年12月130例在本院肝、肾移植中心住院疑似IFI的患者的血浆标本,进行G实验检测.其中64例最终确诊或临床诊断为IFI患者,设为IFI组,余66例为非IFI组.应用MB-80微生物动态快速检测系统和GKT-5M Set动态真菌检测试剂盒,血浆BG浓度≥10 pg/mL判定G试验阳性.采用四格表计算G试验诊断IFI的敏感度、特异度、阳性预测值和阴性预测值.对G试验结果进行受试者特征工作曲线(ROC曲线)分析,并计算曲线下面积.结果 130例患者中,IFI组中G试验阳性57/64,阳性率89.1％;阴性7例,假阴性率10.9％.非IFI组G试验阳性15/66,假阳性率22.7％.G试验阳性诊断IFI的敏感度、特异度、阳性预值和阴性预测值分别为89.1％,77.3％,79.2％和87.9％.根据G试验结果绘制ROC曲线,曲线下面积为0.875(95％ CI:0.813～0.937).结论 G试验对器官移植患者IFI具有中等诊断价值.适当提高诊断界值及重复检测可较大程度地消除假阳性.     

特发性血小板减少性紫癜与巨细胞病毒、EB病毒感染相关性

目的：探讨小儿特发性血小板减少性紫癜（ITP）与巨细胞病毒、EB病毒感染的关系。方法：实验组：48例确诊断为ITP患儿,对照组：44例同期呼吸道感染患儿,应用酶联免疫吸附法（ELISA）对两组小儿外周血进行巨细胞病毒IgM抗体（HCMV-IgM）、EB病毒感染IgM抗体（EB-IgM）检测。结果：48例ITP患儿中HCMV-IgM抗体阳性者20例,阳性率为41.67%,明显高于对照组,两组之间差异有显著性（P〈0.01）;EBV-IgM抗体阳性者14例,阳性率为29.17%,明显高于正常对照组,两组之间差异有显著性（P〈0.05）。结论：1、巨细胞病毒感染是引起特发性血小板减少性紫癜的重要原因之一,且通过临床观察巨细胞病毒感染引起的ITP患儿病情重,病程长,治疗时间长,转为慢性ITP的可能性大;2、EB病毒感染可能是引起特发性血小板减少性紫癜的原因之一,并且EB病毒感染引起的特发性血小板减少性紫癜病情也偏重。     

Experimental Preemptive Immunotherapy of Murine Cytomegalovirus Disease with CD8 T-Cell Lines Specific for ppM83 and pM84, the Two Homologs of Human Cytomegalovirus Tegument Protein ppUL83 (pp65)

CD8 T cells are the principal antiviral effectors controlling cytomegalovirus (CMV) infection. For human CMV, the virion tegument protein ppUL83 (pp65) has been identified as a source of immunodominant peptides and is regarded as a candidate for cytoimmunotherapy and vaccination. Two sequence homologs of ppUL83 are known for murine CMV, namely the virion protein ppM83 (pp105) expressed late in the viral replication cycle and the nonstructural protein pM84 (p65) expressed in the early phase. Here we show that ppM83, unlike ppUL83, is not delivered into the antigen presentation pathway after virus penetration before or in absence of viral gene expression, while other virion proteins of murine CMV are processed along this route. In cytokine secretion-based assays, ppM83 and pM84 appeared to barely contribute to the acute immune response and to immunological memory. Specifically, the frequencies of M83 and M84 peptide-specific CD8 T cells were low and undetectable, respectively. Nonetheless, in a murine model of cytoimmunotherapy of lethal CMV disease, M83 and M84 peptide-specific cytolytic T-cell lines proved to be highly efficient in resolving productive infection in multiple organs of cell transfer recipients. These findings demonstrate that proteins which fail to prime a quantitatively dominant immune response can nevertheless represent relevant antigens in the effector phase. We conclude that quantitative and qualitative immunodominance are not necessarily correlated. As a consequence of these findings, there is no longer a rationale for considering T-cell abundance as the key criterion for choosing specificities to be included in immunotherapy and immunoprophylaxis of CMV disease and of viral infections in general.     

人巨细胞病毒pp150蛋白片段与MDBP蛋白片段的融合表达及初步应用

人巨细胞病毒(HCMV)感染是临床上常见的一种病毒性传播疾病,正常人群常无明显的临床症状,而对器官移植患者、免疫力低下及孕妇等人可产生严重的危害。以HCMVAD169病毒株基因为模板,经PCR扩增了编码pp150蛋白片段的UL32基因和编码MDBP蛋白片段的UL57基因,目的基因转化入pMD18-T克隆载体后再经酶切与表达载体pET-11a连接构建出融合基因表达载体,然后转入大肠杆菌BL21,重组大肠杆菌经诱导表达融合蛋白pp150/MDBP。经SDS-PAGE分析,其相对分子量约为27kD,表达量约占菌体蛋白的17.45%,Westernblot鉴定为阳性,ELISA及蛋白芯片检测表明融合蛋白具有良好的抗原性,经过初步应用表明其对血清IgG及IgM的检出率与全抗原相比一致,具有进一步开发应用的价值。     

Regulated expression of the human cytomegalovirus pp65 gene: octamer sequence in the promoter is required for activation by viral gene products.

To better understand the regulation of late gene expression in human cytomegalovirus (CMV)-infected cells, we examined expression of the gene that codes for the 65-kilodalton lower-matrix phosphoprotein (pp65). Analysis of RNA isolated at 72 h from cells infected with CMV Towne or ts66, a DNA-negative temperature-sensitive mutant, supported the fact that pp65 is expressed at low levels prior to viral DNA replication but maximally expressed after the initiation of viral DNA replication. To investigate promoter activation in a transient expression assay, the pp65 promoter was cloned into the indicator plasmid containing the gene for chloramphenicol acetyltransferase (CAT). Transfection of the promoter-CAT construct and subsequent superinfection with CMV resulted in activation of the promoter at early times after infection. Cotransfection with plasmids capable of expressing immediate-early (IE) proteins demonstrated that the promoter was activated by IE proteins and that both IE regions 1 and 2 were necessary. Analysis of promoter deletion mutants indicated that the 5' minimal sequence required for activation is -61 from the CAP site (+1) and that an 8-base-pair sequence located at -51 to -58 is necessary for activation of the pp65 promoter. This sequence is repeated once at +93 and is found as an inverted repeat at +67. These studies suggest that interactions between IE proteins and this octamer sequence may be important for the regulation and expression of this CMV gene.     

Evaluating Human T-Cell Therapy of Cytomegalovirus Organ Disease in HLA-Transgenic Mice

Reactivation of human cytomegalovirus (HCMV) can cause severe disease in recipients of hematopoietic stem cell transplantation. Although preclinical research in murine models as well as clinical trials have provided ''proof of concept'' for infection control by pre-emptive CD8 T-cell immunotherapy, there exists no predictive model to experimentally evaluate parameters that determine antiviral efficacy of human T cells in terms of virus control in functional organs, prevention of organ disease, and host survival benefit. We here introduce a novel mouse model for testing HCMV epitope-specific human T cells. The HCMV UL83/pp65-derived NLV-peptide was presented by transgenic HLA-A2.1 in the context of a lethal infection of NOD/SCID/IL-2rg^-/- mice with a chimeric murine CMV, mCMV-NLV. Scenarios of HCMV-seropositive and -seronegative human T-cell donors were modeled by testing peptide-restimulated and T-cell receptor-transduced human T cells, respectively. Upon transfer, the T cells infiltrated host tissues in an epitope-specific manner, confining the infection to nodular inflammatory foci. This resulted in a significant reduction of viral load, diminished organ pathology, and prolonged survival. The model has thus proven its potential for a preclinical testing of the protective antiviral efficacy of HCMV epitope-specific human T cells in the evaluation of new approaches to an immunotherapy of CMV disease.     

支气管哮喘急性发作期超敏C-反应蛋白、白细胞、中性粒细胞比例检测的意义及比较

探讨超敏C-反应蛋白（hs-CRP）、血白细胞总数（WBC）、中性粒细胞比例（N％）在支气管哮喘（简称哮喘）急性发作期诊治中的临床意义。方法：分析60例患者治疗前及自觉症状缓解时hs—CRP、WBC、N％动态变化情况,观察上述指标在急性发作期的阳性率以及自觉症状缓解时的阴性率。结果：①hs-CRP、N％、WBC在自觉症状缓解时均明显低于哮喘急性发作期（P〈0．05）;②哮喘患者急性发作期hs—CRP、N％阳性率均高于WBC阳性率,且与后者比较均具有统计学差异（P〈0．05）;③哮喘患者经治疗自觉症状缓解时hs-CRP、WBC阴性率均高于N％阴性率,且与后者比较均具有统计学差异（P〈0．05）。结论-血清hs-CRP既可作为哮喘患者急性发作期感染的敏感指标,又是反映急性发作期治疗效果的早期评判指标,比WBC、N％更迅速、敏感。