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신장이식 환자에서 HCMV 항원혈증 검사의 임상적 유용성

Clinical Usefulness of Human Cytomegalovirus Antigenemia Assay after Kidney Transplantation

감염과화학요법 2009년 41권 2호 p.72 ~ 77
김탁, 성흥섭, 박관태, 김송철, 김성한, 최상호, 김양수, 우준희, 박수길, 한덕종, 이상오,
소속 상세정보
김탁 ( Kim Tark ) - 울산대학교 의과대학 서울아산병원 내과학교실
성흥섭 ( Sung Heung-Sup ) - 울산대학교 의과대학 서울아산병원 진단검사의학교실
박관태 ( Park Kwan-Tae ) - 울산대학교 의과대학 서울아산병원 외과학교실
김송철 ( Kim Song-Chael ) - 울산대학교 의과대학 서울아산병원 외과학교실
김성한 ( Kim Sung-Han ) - 울산대학교 의과대학 서울아산병원 내과학교실
최상호 ( Choi Sang-Ho ) - 울산대학교 의과대학 서울아산병원 내과학교실
김양수 ( Kim Yang-Soo ) - 울산대학교 의과대학 서울아산병원 내과학교실
우준희 ( Woo Jun-Hee ) - 울산대학교 의과대학 서울아산병원 내과학교실
박수길 ( Park Su-Kil ) - 울산대학교 의과대학 서울아산병원 내과학교실
한덕종 ( Han Duck-Jong ) - 울산대학교 의과대학 서울아산병원 외과학교실
이상오 ( Lee Sang-Oh ) - 울산대학교 의과대학 서울아산병원 내과학교실

Abstract


Background: This study was performed to determine the cut-off value and the predictability of symptomatic human cytomegalovirus (HCMV) infection according to the peak value of HCMV antigenemia assay in kidney transplant recipients.

Materials and Methods : We reviewed the results of HCMV antigenemia assay (Chemicon, CA, USA) in patients who received kidney transplantation at our institution from May 2003 through May 2008, and investigated the existence and the type of HCMV infection by the medical record review. Patients who underwent the test only once during the episode or those who received ganciclovir for more than 48hrs before the test were excluded. The receiver-operator characteristic curve was drawn and the point showing maximum likelihood ratio (LR) was chosen as the cut-off value of symptomatic HCMV infection.

Results: A total of 689 episodes were screened and 134 episodes were enrolled. Thirty-three (24.6 %) episodes were symptomatic HCMV infection, 23 (17.2%) episodes were associated with HCMV syndrome, and 10 (7.5%) episodes were tissue-invasive diseases. The maximum LR was 7.5 (95% confidence interval, 4.014.2) and the cut-off value was 29.5 cells/200,000 WBC. The sensitivity, specificity, positive predictive value, and negative predictive value were 66.7%, 91.1%, 71.0%, and 89.3%, respectively.

Conclusions: The cut-off value of symptomatic HCMV infection by the peak value of HCMV antigenemia assay in our study was similar with previous results, although the sensitivity was relatively low.

키워드

Human cytomegalovirus;Antigenemia;Kidney transplantation

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