患病人群巨细胞病毒感染的血清学研究
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摘要
目的探讨巨细胞病毒(cytomegalovirus,CMV)在患者中的感染情况及与共患疾病的关系。方法分析广州市某三甲医院门诊和住院患者的CMV血清学资料。化学发光法检测CMV的IgM和IgG抗体。χ~2检验比较不同性别、不同年龄和不同科室患者之间IgM和IgG检出率的统计学差异。结果在这些患病人群中,IgM总的检出率是2.01%。其中,出生后15 d～6岁者检出率最高,为8.59%,其他年龄组的IgM检出率波动在0.37%～1.00%之间。不同科室中,儿科和呼吸科患者的IgM检出率最高,分别为3.31%和2.67%。IgG在患病人群中总的检出率是87.11%,且随着年龄的增长而增长。出生后15 d～6岁患儿的IgG检出率最低,为69.23%。50岁以后患者的检出率最高,为93.91%。器官移植科患者具有最高的IgG检出率,为96.75%,重症监护病房和呼吸科次之,均为91.91%。IgM和IgG的检出率在男女之间差异无统计学意义(P>0.05)。结论患病人群高CMV的感染率提示,在临床上需着重密切关注儿科、呼吸科、器官移植和重症监护室患者的CMV感染情况,以及时采取相应的治疗措施,改善患者的预后。
Objective To investigate the infection of cytomegalovirus(CMV) in patient population.Methods The serological data of CMV infection among out-patients and in-patients in a university teaching hospital in Guangzhou were investigate. Chemiluminescence was applied in testing CMV specific IgM and IgG. Statistical significance of positive detection of IgM and IgG among genders, ages and clinical departments were compared using chis-square test. Results Among patient population, the total detection rate of IgM was 2.01%, which was the highest in patients of the age between 15 days and 6 years(8.59%). The IgM detection rate in the other age groups ranged from 0.37% to 1.00%. Patients from Department of Pediatrics and Pneumology demonstrated the highest positive rates(3.31% and 2.67%, respectively). The total detection rate of IgG among patient population was 87.11%, and increased with age. Child patients of 15 days to 6 years showed the lowest IgG detection rate of 69.23%, and patients beyond 50 years showed the highest rate of 93.91%. Patients from the Department of Organ Transplantation presented the highest IgG detection rate of 96.75%. Intensive Care Unit and Pneumology department presented the second highest IgG detection rate, and both were 91.91%. No significant difference in IgM or IgG detection rate was shown between males and females. Conclusion High prevalence of CMV infection among patient population indicates that clinicians should pay more attention on CMV infection in patients from Department of Pediatric, Pneumology, Organ Transplantation and Intensive Care Unit.
Objective To investigate the infection of cytomegalovirus(CMV) in patient population.Methods The serological data of CMV infection among out-patients and in-patients in a university teaching hospital in Guangzhou were investigate. Chemiluminescence was applied in testing CMV specific IgM and IgG. Statistical significance of positive detection of IgM and IgG among genders, ages and clinical departments were compared using chis-square test. Results Among patient population, the total detection rate of IgM was 2.01%, which was the highest in patients of the age between 15 days and 6 years(8.59%). The IgM detection rate in the other age groups ranged from 0.37% to 1.00%. Patients from Department of Pediatrics and Pneumology demonstrated the highest positive rates(3.31% and 2.67%, respectively). The total detection rate of IgG among patient population was 87.11%, and increased with age. Child patients of 15 days to 6 years showed the lowest IgG detection rate of 69.23%, and patients beyond 50 years showed the highest rate of 93.91%. Patients from the Department of Organ Transplantation presented the highest IgG detection rate of 96.75%. Intensive Care Unit and Pneumology department presented the second highest IgG detection rate, and both were 91.91%. No significant difference in IgM or IgG detection rate was shown between males and females. Conclusion High prevalence of CMV infection among patient population indicates that clinicians should pay more attention on CMV infection in patients from Department of Pediatric, Pneumology, Organ Transplantation and Intensive Care Unit.
引文
[1] Chiche L, Forel JM, Roch A, et al. Active cytomegalovirus infection is common in mechanically ventilated medical intensive care unit patients[J]. Crit Care Med, 2009,37(6):1850-1857.
[2] Grahame-Clarke C, Chan NN, Andrew D, et al. Human cytomegalovirus seropositivity is associated with impaired vascular function[J]. Circulation, 2003,108(6):678-683.
[3] Limaye AP, Boeckh M. CMV in critically ill patients: pathogen or bystander?[J]. Rev Med Virol, 2010,20(6):372-379.
[4] Gaytant MA, Steegers EA, Semmekrot BA, et al. Congenital cytomegalovirus infection: review of the epidemiology and outcome[J]. Obstet Gynecol Surv, 2002,57(4):245-256.
[5] Carlson JW, Radestad AF, Soderberg-Naucler C, et al. Human cytomegalovirus in high grade serous ovarian cancer possible implications for patients survival[J]. Medicine (Baltimore), 2018,97(4):e9685.
[6] Yoneda S, Imagawa A, Fukui K, et al. A Histological Study of Fulminant Type 1 Diabetes Mellitus Related to Human Cytomegalovirus Reactivation[J]. J Clin Endocrinol Metab, 2017,102(7):2394-2400.
[7] Smieja M, Gnarpe J, Lonn E, et al. Multiple infections and subsequent cardiovascular events in the Heart Outcomes Prevention Evaluation (HOPE) Study[J]. Circulation, 2003,107(2):251-257.
[8] Muhlestein JB, Horne BD, Carlquist JF, et al. Cytomegalovirus seropositivity and C-reactive protein have independent and combined predictive value for mortality in patients with angiographically demonstrated coronary artery disease[J]. Circulation, 2000,102(16):1917-1923.
[9] Tarter KD, Simanek AM, Dowd JB, et al. Persistent viral pathogens and cognitive impairment across the life course in the third national health and nutrition examination survey[J]. J Infect Dis, 2014,209(6):837-844.
[10] Gkrania-Klotsas E, Langenberg C, Sharp SJ, et al. Higher immunoglobulin G antibody levels against cytomegalovirus are associated with incident ischemic heart disease in the population-based EPIC-Norfolk cohort[J]. J Infect Dis, 2012,206(12):1897-1903.
[11] Griffiths P, Baraniak I, Reeves M. The pathogenesis of human cytomegalovirus[J]. J Pathol, 2015,235(2):288-297.
[12] Arvin AM, Fast P, Myers M, et al. Vaccine development to prevent cytomegalovirus disease: report from the National Vaccine Advisory Committee[J]. Clin Infect Dis, 2004,39(2):233-239.
[13] Lanzieri TM, Dollard SC, Bialek SR, et al. Systematic review of the birth prevalence of congenital cytomegalovirus infection in developing countries[J]. Int J Infect Dis, 2014,22:44-48.
[14] Chen J, Hu L, Wu M, et al. Kinetics of IgG antibody to cytomegalovirus (CMV) after birth and seroprevalence of anti-CMV IgG in Chinese children[J]. Virol J, 2012,9:304.
[15] Lanzieri TM, Kruszon-Moran D, Amin MM, et al. Seroprevalence of cytomegalovirus among children 1 to 5 years of age in the United States from the National Health and Nutrition Examination Survey of 2011 to 2012[J]. Clin Vaccine Immunol, 2015,22(2):245-247.
[16] Cannon MJ, Schmid DS, Hyde TB. Review of cytomegalovirus seroprevalence and demographic characteristics associated with infection[J]. Rev Med Virol, 2010,20(4):202-213.
[17] Fang FQ, Fan QS, Yang ZJ, et al. Incidence of cytomegalovirus infection in Shanghai, China[J]. Clin Vaccine Immunol, 2009,16(11):1700-1703.
[18] Wang S, Wang T, Zhang W, et al. Cohort study on maternal cytomegalovirus seroprevalence and prevalence and clinical manifestations of congenital infection in China[J]. Medicine (Baltimore), 2017,96(5):e6007.
[19] Savva GM, Pachnio A, Kaul B, et al. Cytomegalovirus infection is associated with increased mortality in the older population[J]. Aging Cell, 2013,12(3):381-387.
[20] Spyridopoulos I, Martin-Ruiz C, Hilkens C, et al. CMV seropositivity and T-cell senescence predict increased cardiovascular mortality in octogenarians: results from the Newcastle 85+ study[J]. Aging Cell, 2016,15(2):389-392.
[21] Kalil AC, Florescu DF. Prevalence and mortality associated with cytomegalovirus infection in nonimmunosuppressed patients in the intensive care unit[J]. Crit Care Med, 2009,37(8):2350-2358.
[22] 润袁敏, 管建, 徐春芬. 武汉地区儿童感染巨细胞病毒状况[J]. 广东医学, 2013,34(18):2849-2851.
[23] Kenneson A, Cannon MJ. Review and meta-analysis of the epidemiology of congenital cytomegalovirus (CMV) infection[J]. Rev Med Virol, 2007,17(4):253-276.
[24] Ross SA, Ahmed A, Palmer AL, et al. Detection of congenital cytomegalovirus infection by real-time polymerase chain reaction analysis of saliva or urine specimens[J]. J Infect Dis, 2014,210(9):1415-1418.
[2] Grahame-Clarke C, Chan NN, Andrew D, et al. Human cytomegalovirus seropositivity is associated with impaired vascular function[J]. Circulation, 2003,108(6):678-683.
[3] Limaye AP, Boeckh M. CMV in critically ill patients: pathogen or bystander?[J]. Rev Med Virol, 2010,20(6):372-379.
[4] Gaytant MA, Steegers EA, Semmekrot BA, et al. Congenital cytomegalovirus infection: review of the epidemiology and outcome[J]. Obstet Gynecol Surv, 2002,57(4):245-256.
[5] Carlson JW, Radestad AF, Soderberg-Naucler C, et al. Human cytomegalovirus in high grade serous ovarian cancer possible implications for patients survival[J]. Medicine (Baltimore), 2018,97(4):e9685.
[6] Yoneda S, Imagawa A, Fukui K, et al. A Histological Study of Fulminant Type 1 Diabetes Mellitus Related to Human Cytomegalovirus Reactivation[J]. J Clin Endocrinol Metab, 2017,102(7):2394-2400.
[7] Smieja M, Gnarpe J, Lonn E, et al. Multiple infections and subsequent cardiovascular events in the Heart Outcomes Prevention Evaluation (HOPE) Study[J]. Circulation, 2003,107(2):251-257.
[8] Muhlestein JB, Horne BD, Carlquist JF, et al. Cytomegalovirus seropositivity and C-reactive protein have independent and combined predictive value for mortality in patients with angiographically demonstrated coronary artery disease[J]. Circulation, 2000,102(16):1917-1923.
[9] Tarter KD, Simanek AM, Dowd JB, et al. Persistent viral pathogens and cognitive impairment across the life course in the third national health and nutrition examination survey[J]. J Infect Dis, 2014,209(6):837-844.
[10] Gkrania-Klotsas E, Langenberg C, Sharp SJ, et al. Higher immunoglobulin G antibody levels against cytomegalovirus are associated with incident ischemic heart disease in the population-based EPIC-Norfolk cohort[J]. J Infect Dis, 2012,206(12):1897-1903.
[11] Griffiths P, Baraniak I, Reeves M. The pathogenesis of human cytomegalovirus[J]. J Pathol, 2015,235(2):288-297.
[12] Arvin AM, Fast P, Myers M, et al. Vaccine development to prevent cytomegalovirus disease: report from the National Vaccine Advisory Committee[J]. Clin Infect Dis, 2004,39(2):233-239.
[13] Lanzieri TM, Dollard SC, Bialek SR, et al. Systematic review of the birth prevalence of congenital cytomegalovirus infection in developing countries[J]. Int J Infect Dis, 2014,22:44-48.
[14] Chen J, Hu L, Wu M, et al. Kinetics of IgG antibody to cytomegalovirus (CMV) after birth and seroprevalence of anti-CMV IgG in Chinese children[J]. Virol J, 2012,9:304.
[15] Lanzieri TM, Kruszon-Moran D, Amin MM, et al. Seroprevalence of cytomegalovirus among children 1 to 5 years of age in the United States from the National Health and Nutrition Examination Survey of 2011 to 2012[J]. Clin Vaccine Immunol, 2015,22(2):245-247.
[16] Cannon MJ, Schmid DS, Hyde TB. Review of cytomegalovirus seroprevalence and demographic characteristics associated with infection[J]. Rev Med Virol, 2010,20(4):202-213.
[17] Fang FQ, Fan QS, Yang ZJ, et al. Incidence of cytomegalovirus infection in Shanghai, China[J]. Clin Vaccine Immunol, 2009,16(11):1700-1703.
[18] Wang S, Wang T, Zhang W, et al. Cohort study on maternal cytomegalovirus seroprevalence and prevalence and clinical manifestations of congenital infection in China[J]. Medicine (Baltimore), 2017,96(5):e6007.
[19] Savva GM, Pachnio A, Kaul B, et al. Cytomegalovirus infection is associated with increased mortality in the older population[J]. Aging Cell, 2013,12(3):381-387.
[20] Spyridopoulos I, Martin-Ruiz C, Hilkens C, et al. CMV seropositivity and T-cell senescence predict increased cardiovascular mortality in octogenarians: results from the Newcastle 85+ study[J]. Aging Cell, 2016,15(2):389-392.
[21] Kalil AC, Florescu DF. Prevalence and mortality associated with cytomegalovirus infection in nonimmunosuppressed patients in the intensive care unit[J]. Crit Care Med, 2009,37(8):2350-2358.
[22] 润袁敏, 管建, 徐春芬. 武汉地区儿童感染巨细胞病毒状况[J]. 广东医学, 2013,34(18):2849-2851.
[23] Kenneson A, Cannon MJ. Review and meta-analysis of the epidemiology of congenital cytomegalovirus (CMV) infection[J]. Rev Med Virol, 2007,17(4):253-276.
[24] Ross SA, Ahmed A, Palmer AL, et al. Detection of congenital cytomegalovirus infection by real-time polymerase chain reaction analysis of saliva or urine specimens[J]. J Infect Dis, 2014,210(9):1415-1418.