EB病毒多抗体联合检测在儿童EB病毒感染诊断中的应用研究
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摘要
目的探索EB病毒(Epstain-Barr Virus,EBV)多抗体联合检测在儿童EBV感染诊断的应用价值。方法采用Liaison化学发光分析仪定量检测2016年8月-2017年2月疑似EBV感染的4251例患儿血清中EBV(VCA-IgM、VCA-IgG、EA-IgG和NA-IgG)抗体,结合临床症状分析患儿EBV感染阶段,用PCR荧光探针法检测EBV-DNA含量。结果患儿EBV阳性1799例,阳性检出率为42.3%,其中抗体VCA-IgG阳性1769例(41.6%)、NA-IgG阳性1719例(40.4%)、VCA-IgM阳性329例(7.7%)及EA-IgG阳性136例(3.2%);四种抗体联合检测结果显示,无感染、既往感染、复发感染和原发感染比例分别为57.6%、30.7%、9.8%和1.9%;80例原发感染患儿的主要疾病为传染性单核细胞增多症(38.8%)、支气管炎及肺炎(27.5%);VCA-IgM抗体检测与EBV-DNA检测阳性率差异无统计学意义。结论通过EA-IgG、VCA-IgG、NA-IgG和VCA-IgM四种抗体联合检测,结合患儿的临床表现,可为感染EB病毒患儿早发现、早诊断、早治疗提供依据,值得推广应用。
OBJECTIVE To explore the value of joint detection of Epstain-Barr Virus(EBV)multiple antibodies I n diagnosis of children with EBV infection.METHODS From Aug 2016 to Feb 2017,the serum EBV antibodies(VCA-IgM,VCA-IgG,EA-IgG,NA-IgG)of 4251 children with suspected EBV infection were detected by using Liaison chemiluminescence analyzer.The stages of EBV infection were analyzed according to clinical symptoms,and the EBV-DNA content was determined by means of PCR fluorescence probe.RESULTS Totally 1799 children showed positive for EBV,with the positive rate 42.3%,1769(41.6%)of whom were positive for VCA-IgG,1719(40.4%)were positive for NA-IgG,329(7.7%)were positive for VCA-IgM,and 136(3.2%)were positive for EA-IgG.The result of the joint detection of four antibodies indicated that the children without infection accounted for 57.6%,the children with previous infection 30.7%,the children with recurrent infection 9.8%,the children with primary infection 1.9%.Of the 80 children with primary infection,38.8% had infectious mononucleosis,and27.5% had bronchitis and pneumonia.There was no significant difference in the positive rate between the VCAIgM detection and the EBV-DNA detection.CONCLUSION The joint detection of the four types of antibodies,in cluding EA-IgG,VCA-IgG,NA-IgG and VCA-IgM,in combination with clinical manifestations,may provide bases for early detection,diagnosis and treatment of the children with EBV infection,and it is worthy to be promoted.
OBJECTIVE To explore the value of joint detection of Epstain-Barr Virus(EBV)multiple antibodies I n diagnosis of children with EBV infection.METHODS From Aug 2016 to Feb 2017,the serum EBV antibodies(VCA-IgM,VCA-IgG,EA-IgG,NA-IgG)of 4251 children with suspected EBV infection were detected by using Liaison chemiluminescence analyzer.The stages of EBV infection were analyzed according to clinical symptoms,and the EBV-DNA content was determined by means of PCR fluorescence probe.RESULTS Totally 1799 children showed positive for EBV,with the positive rate 42.3%,1769(41.6%)of whom were positive for VCA-IgG,1719(40.4%)were positive for NA-IgG,329(7.7%)were positive for VCA-IgM,and 136(3.2%)were positive for EA-IgG.The result of the joint detection of four antibodies indicated that the children without infection accounted for 57.6%,the children with previous infection 30.7%,the children with recurrent infection 9.8%,the children with primary infection 1.9%.Of the 80 children with primary infection,38.8% had infectious mononucleosis,and27.5% had bronchitis and pneumonia.There was no significant difference in the positive rate between the VCAIgM detection and the EBV-DNA detection.CONCLUSION The joint detection of the four types of antibodies,in cluding EA-IgG,VCA-IgG,NA-IgG and VCA-IgM,in combination with clinical manifestations,may provide bases for early detection,diagnosis and treatment of the children with EBV infection,and it is worthy to be promoted.
引文
[1]Sun L,Che K,Zhao Z,et al.Sequence analysis of EpsteinBarr virus(EBV)early genes BARF1and BHRF1in NK/T cell lymphoma from Northern China[J].Virol J,2015,12:135.
[2]杨辅直,李伟生,张倩,等.小儿EB病毒感染的临床治疗分析[J].中华医院感染学杂志,2016,26(24):5707-5709.
[3]Dunmire SK,Hogquist KA,Balfour HH.Infectious mononucleosis[J].Curr Top Microbiol Immunol,2015,390(Pt 1):211-240.
[4]中华医学会儿科学分会感染学组|全国儿童EB病毒感染协作组.儿童主要非肿瘤性EB病毒感染相关疾病的诊断和治疗原则建议[J].中华儿科杂志,2016,54(8):563-568.
[5]谢正德,申昆玲.重视儿童非肿瘤性EB病毒感染疾病的研究[J].首都医科大学学报,2010,31(2):213-216.
[6]Robertson P,Beynon S,Whybin R,et al.Measurement of EBVIgG anti-VCA avidity aids the early and reliable diagnosis of primary EBV infection[J].J Med Virol,2003,70(4):617-623.
[7]CDC.Epstein-Barr virus and infectious mononucleosis[EB/OL].https://www.cdc.gov/epstein-barr/laboratory-testing.html,2016-09-14.
[8]严小梦,叶剑荣,杨芳慧.EB病毒IgG、IgA、IgM抗体和EBDNA检测在儿童呼吸道感染性疾病中的诊断价值[J].实用预防医学,2015,22(5):541-543.
[9]Sulik A,Oldak E,Kroten A,et al.Epstein-Barr virus effect on frequency of functionally distinct T cell subsets in children with infectious mononucleosis[J].Adv Med Sci,2014,59(2):227-231.
[10]陆萍,庄丹燕,潘婕文,等.8209例住院儿童EB病毒感染情况分析[J].中国微生态学杂志,2016,28(5):574-577.
[11]王培养,顾承萍,李珍,等.呼吸道感染性疾病患儿EB病毒抗体和EB-DNA表达分析[J].中华医院感染学杂志,2017,27(16):3798-3801.
[12]俞晓春,胡荣盛,汪金云,等.间接免疫荧光法检测EBV抗体谱在儿童EB病毒感染中的临床应用[J].实用预防医学,2013,20(10):1262-1265.
[13]Ruf S,Wagner HJ.Determining EBV load:current best practice and future requirements[J].Expert Rev Clin Immunol,2013,9(2):139-151.
[2]杨辅直,李伟生,张倩,等.小儿EB病毒感染的临床治疗分析[J].中华医院感染学杂志,2016,26(24):5707-5709.
[3]Dunmire SK,Hogquist KA,Balfour HH.Infectious mononucleosis[J].Curr Top Microbiol Immunol,2015,390(Pt 1):211-240.
[4]中华医学会儿科学分会感染学组|全国儿童EB病毒感染协作组.儿童主要非肿瘤性EB病毒感染相关疾病的诊断和治疗原则建议[J].中华儿科杂志,2016,54(8):563-568.
[5]谢正德,申昆玲.重视儿童非肿瘤性EB病毒感染疾病的研究[J].首都医科大学学报,2010,31(2):213-216.
[6]Robertson P,Beynon S,Whybin R,et al.Measurement of EBVIgG anti-VCA avidity aids the early and reliable diagnosis of primary EBV infection[J].J Med Virol,2003,70(4):617-623.
[7]CDC.Epstein-Barr virus and infectious mononucleosis[EB/OL].https://www.cdc.gov/epstein-barr/laboratory-testing.html,2016-09-14.
[8]严小梦,叶剑荣,杨芳慧.EB病毒IgG、IgA、IgM抗体和EBDNA检测在儿童呼吸道感染性疾病中的诊断价值[J].实用预防医学,2015,22(5):541-543.
[9]Sulik A,Oldak E,Kroten A,et al.Epstein-Barr virus effect on frequency of functionally distinct T cell subsets in children with infectious mononucleosis[J].Adv Med Sci,2014,59(2):227-231.
[10]陆萍,庄丹燕,潘婕文,等.8209例住院儿童EB病毒感染情况分析[J].中国微生态学杂志,2016,28(5):574-577.
[11]王培养,顾承萍,李珍,等.呼吸道感染性疾病患儿EB病毒抗体和EB-DNA表达分析[J].中华医院感染学杂志,2017,27(16):3798-3801.
[12]俞晓春,胡荣盛,汪金云,等.间接免疫荧光法检测EBV抗体谱在儿童EB病毒感染中的临床应用[J].实用预防医学,2013,20(10):1262-1265.
[13]Ruf S,Wagner HJ.Determining EBV load:current best practice and future requirements[J].Expert Rev Clin Immunol,2013,9(2):139-151.