간이식 환자에서 CMV 항원혈증 검사의 임상적 유용성에 대한 고찰 = Usefulness of Cytomegalovirus (CMV) Antigenemia Assay after Liver Transplantation

국문 초록 (Abstract)

목 적 : 본 연구는 간이식 후 발생한 CMV 감염증의 임상적 양상과 진단을 위한 CMV 항원혈증 검사의 진단적인 유용성에 대하여 검토하고자 진행하였다.재료 및 방법 : 후향적인 연구로서 1996년 1월부터 2003년 8월 까지 삼성서울병원 이식외과에서 간이식을 시행한 환자들을 대상으로 의무기록과 검사기록 등에 대하여 검토를 시행하였다. 결 과 : 총 284명의 환자에서 간이식을 시행하였으며 CMV 항체는 공여자는 모두 양성이었으며 수혜자는 272명이 양성이었다(95.4%). 이중 133명의 환자에서 CMV 감염증이 발생하였으며(46.8%) 40명은 증상을 동반한 감염증이 발생하였다(30.1%). 증상을 동반한 환자 중 12명은 특정 장기를 침범하는 CMV 질환이 발생하였다. 9명의 환자를 제외하고 대부분의 감염증은 이식 후 180일 이내에 발생하였다(93.3%). CMV 항원혈증 검사 결과 검사에서 양성을 보인 환자들의 경우 최고치는 평균 19.36개(19.36±37.64/200,000) 였으며 지속기간은 8.72일 이었다(8.72±9.99일). CMV 항원혈증의 최고치와 지속기간은 증상을 동반한 CMV 감염증에서 높았으며(P=0.002) 재발률도 증상을 동반한 환자에서 높았다(P=0.001). CMV 항원혈증 검사의 치료 기준치를 20만개 중 5개 이상에서 양성을 보이는 경우로 한정하였을 때 기존의 3개 이상과 비교할 때 민감도는 유사하였고 특이도는 증가하였다. 결 론:수혜자의 CMV 항체 양성율이 95.4%인 본 연구에서 CMV 감염증 및 CMV 질환의 발생빈도는 각각 46.8%, 4.2% 이었다. CMV 항원혈증 검사의 치료기준치는 20만개 중 5개 이상에서 양성을 보이는 경우로 올리는 것이 민감도와 특이도를 고려하였을 때 더 적절할 것으로 생각된다.

다국어 초록 (Multilingual Abstract)

Objective : To evaluate the clinical usefulness of cytomegalovirus (CMV) antigenemia assay among liver transplant recipients in Samsung Medical Center.
Materials and Methods : All recipients of liver transplantation during the period from Jan. 1996 to Aug. 2003 were enrolled. Medical records and microbiologic data for CMV infections were reviewed retrospectively.
Results : All 284 enrolled patients received livers from CMV seropositive donors, and 272 recipients (95.8%) were CMV seropositive before transplantation. One hundred thirty three recipients (46.8%) had evidences of CMV reactivation. Among patients with CMV reactivation, 40 recipients were symptomatic (30.1%) and 12 patients had organ-specific CMV diseases. Most of the CMV infections occurred within 180 days after transplantation except for 9 patients (6.7%). Among the antigenemia positive patients, the mean number of CMV antigen-positive WBC was 19.36 per 200,000 cells (19.36±37.64 cells). The mean duration of CMV antigenemia was 8.72 days (8.72±9.99 days). Peak value of CMV antigenemia was significantly higher in symptomatic patients compared to asymptomatic patients (P=0.002). Duration of CMV antigenemia was significantly longer (P=0.002) in symptomatic patients. If we would use ≥5 cells of CMV antigenemia as a cut-off value sensitivity and specificity for symptomatic CMV infections would be 85% and 50% respectively.
Conclusion : About half of the recipients experienced CMV reactivation, mostly within 180 days after liver transplantation. Thirty percents of reactivation were symptomatic. Five cells per 200,000 leukocytes of CMV antigenemia was the best cut-off level for preemptive treatment.

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