摘要
目的通过检测新生儿血清中B族溶血性链球菌(group B streptococcus,GBS)表面蛋白C5a肽酶(streptococcal C5a peptidase from group B Streptococcus,SCPB)抗体,观察新生儿血清中SCPB抗体滴度,如检出阳性标本,则可明确新生儿血清中存在GBS表面蛋白SCPB抗体,而且检测出阳性结果亦可证实孕妇血中该表面蛋白抗体存在,为围生期B族链球菌感染的免疫预防提供临床依据。
方法收集2007年2月～12月107例住院新生儿血清,包括早产儿27例。所有新生儿于入院当天,未做治疗前采集静脉血,分离血清后低温保存。同时立即送检血培养,或咽试子培养。采用间接酶联免疫实验(ELISA)检测新生儿血清中GBS表面蛋白SCPB抗体。
结果107例新生儿血清标本中有21例SCPB抗体阳性,阳性率为19.63%;其中早产儿(＜37周)SCPB抗体阳性率为3.7%,足月儿(≥37周)阳性率为25%,二者差异有统计学意义(P＜0.05)。SCPB抗体阳性组与阴性组的新生儿产科危险因素比较如新生儿窒息、低体重儿(体重〈2500g)、胎膜早破(＞18小时)、母亲妊高症、母孕期感染等及其感染率的比较差异均无统计学意义(P＜0.05)。107例新生儿中,咽试子培养出GBS阳性病例3例,GBS培养阳性率为2.8%(3/107)
结论新生儿血清中存在GBS表面蛋白SCPB抗体,且早产儿(＜37周)SCPB抗体阳性率低于足月儿(P＜0.05),表明SCPB抗体系IgG抗体,育龄期妇女自然感染GBS后可产生该蛋白抗体并通过胎盘传递给新生儿,SCPB抗体在孕妇及新生儿GBS感染中作用有待进一步研究。母亲体内SCPB抗体水平低,则新生儿发生GBS感染的可能性则大。
Objectives SCPB is a surface-exposed protein of group B streptococcus(GBS), one of the beta-Hemolytic streptococci,which elicits a protective immune response in mice.In order to find out whether neonates have SCPB antibodies,which was evidenced by The positive serum specimen from we detected the antibodies of SCPB in neonates' serum,and demonstrate the existence of SCPB antibody in pregnant women after natural GBS infection.To provide clinical prevention for immunoprophylaxis of perinatal group B streptococcal infection.
Methods Serum were collected from 107 neonates(80 term infants and 27 premature infant),cultures for GBS simultaneously were carded out,and The antibodies of SCPB were detected using ELISA method.
Results 21(19.6%) newborns had SCPB antibodies,including 20 term infants and 1 premature infant,The positive ratio in term and premature infant were 25%and 3.7%, respectively.3(2.8%) neonates had cultured were positive.The presence of Obstetric risk factors was analyzed not significantly.
Conclusions The existence of SCPB antibody that were examined in neonatal serum indicated that pregnant women could produce SCPB antibody by immune response, which transmitted through the placenta to the infant.Confirming that SCPB antibody was exclusive immunoglobulin which transmitted through the placenta in postconceptual age by Premature infants SCPB-positive rate of less than full-term infants.The effect of SCPB antibody in expectant mother and newborn with GBS infection need more study. Mothers with low SCPB antibody levels in vivo,then the possibility of neonatal with GBS infection are major.
引文
[1]Cheng Q,Stafslien D,Purushothaman SS,et al.The group B streptococcal C5a peptidase is both a specific protease and an invasin[J].Infection and Immun,2002,70(5):2408-2413.
[2]马延敏,吴连方,黄醒华.孕妇B族溶血性链球菌带菌与母婴预后的关系[J].中华妇产科杂志,2000,35:32-35.
[3]朱敏,范建霞,程利南.围产期B族链球菌感染的研究进展[J].中华妇产科杂志,2005,40(2),137-141.
[4]Smith JM,Rexroth JA,Chaffin DG,et al.Serotyping group B streptococci in a small community hospital an analysis of distribution and site of isolation[J].Infect Dis Obstet Gynecol,2002,10:165-169.
[5]胡亚美,江载芳.诸福棠实用儿科学[M].7版.北京:人民卫生出版社,2002:415-416.
[6]金汉珍,黄德珉,官希吉.实用新生儿学[M].3版.北京:人民卫生出版社,2002:915-919.
[7]Yossuck P,Preedisripipat K.Neonatal group B streptococcal infection:incidence and clinical manifestation in Siriraj Hospital[J].Med Assoc Tha,i 2002,85:479-487.
[8]贺晶,韩秀君.B族链球菌感染的母婴传播及其预后[J].中国实用妇科与产科杂志,2005,21(6):343-345.
[9]Center for Disease Control and Prevention(CDC).Decreasing incidence of perinatal group B streptococcal disease--United States,1993-1995.MMWR Morb Mortal Wkly Rep,1997,46(21):473-477.
[10]Ke D,Bergeron MG.Molecular methods for rapid detection of group B streptococci[J].Expert Rev Mol Diagn,2001,1(2):175-181.
[2]El-Kersh TA,Al-Nuaim LA,Kharfy TA.Detection of genita colonization of group B streptococci during late pregnancy[J].Saud Med J,2002,23:56-61.
[12]Williams-Bouyer N,Reisner BS,Woods GL.Comparison of genprobe Accu Probe group B streptococcus culture identification test with conventional culture for the detection of group B streptococci in broth cultures of vaginal-anorectal specimens from pregnant women[J].Diagn Microbiol InfectDis,2000,36:159-162.
[13]Artz LA,Kempf VA,Autenrieth IB.Rapid screening for Streptococcus agalactiae in vaginal specimens of pregnantwomen by fluorescent in situ hybridization[J].Clin Microbio,1 2003,41:2170-2173.
[14]Centers for Disease Control and Prevention.Prevention of perinatal group B streptococcal disease:a public health perspective.MMWR Recomm Rep,1996,45(RR-7):1-24.
[15]Schrag S,Gorwitz R,Fultz-Butts K,et al.Prevention of perinatal group B streptococcal disease.Revised guidelines from CDC[J].MMWR Recomm Rep,2002,51(RR-11):1-22.
[16]Law MR,Palomaki G,Alfirevic Z,et al.The prevention of neonatal goup B streptococcal disease:a report by a working group of the Medical Screening Saciety[J].J Med Screen,2005,12(2):60-68.
[17]王咏红,申阿东,佟月娟.12种抗生素对B族链球菌体外抗菌活性研究[J].中华儿科杂志,2001,39:85-87.
[18]陈敏,史久华.静脉注射用免疫球蛋白的生产、应用和副作用.国际生物制品学杂志,2007,30(1):34-36.
[19]Baker CJ,Rench MA,Femandez M,et al.Safety and Immunogenicity of a Bivalent Grwp B Streptococcal Conjugate Vaccine for Serotypes Ⅱ and Ⅲ[J].J Infect Dis,2003,188(1):66-73.
[20]Heath PT,Feldman RG.Vaccination against group B streptococcus[J].Expert Rev Vaccines,2005,4(2):207-218.
[21]Sezgin E,Fagan PK,Susarme R,et al.Molecular analysis of group B protective surface protein,a new cell surface protective antigen of group B streptococc[J].Infecti and Immun,2002,70(2):803-811.
[22]C Larsson,M Lindroth,P Nordin,M Stalhammar-Carlemalm,G Lindahl,I Krantz.Association between low concentrations of antibodies to protein a and Rib and invasive neonatal group B streptococcal infection[J].Arch Dis Child Fetal Neonatal Ed 2006;91:F403-F408.
[23]Pannaraj PS,Kelly JK,Madoff LC,et al.Group B Streptococcus bacteremia elicits beta C protein-specific IgM and IgG in humans[J].Infect Dis,2007,195(3):353-356.
[24]Shannon D.Manning,Stephen Wood,Katherine Kasha,Denis Martin,St'ephane Rioux,Bern,Brodeur,H.Dele Davies.Naturally occurring antibodies for the group B streptococcal surface immunogenic protein(Sip) in pregnant women and newborn babies[J]. Vaccine 2006(24) 6905-6912.
[25]Mavenyengwa RT,Maeland JA,Moyo SR.Distinctive features of surface-anchored proteins of Streptococcus agalactiae strains from Zimbabwe revealed by PCR and dot blotting[J].Clin Vaccine Immunol,2008,15(9):1420-1424.
[26]Cheng Q,Debol S,Lam H,et al.Immunization with C5a peptidase or peptidase-Type Ⅲpolysaccharide conjugate vaccines enhances learance of group B streptococci from lungs of infected mice[J].Infect Immun,2002,70(11):6409-6415.
[27]Cheng Q,Carlson B,Pillai S,et al.Antibody against surface-bound C5a peptidaseis opsonic and initiates macrophage killing of group B streptococci[J].Infect Immun,2001,69(4):2302-2308.
[28]Santillan DA,Andracki ME,Hunter SK.Protective immunization in mice against group B streptococci using encapsulated C5a peptidase.Am J Obstet Gynecol[J].2008,198(1):1-6.
[29]JiY,McLansborough L,KondaguntaA,et al C5a peptidase alters clearance and trafficking of group A streptococci by infected mice[J].Infect Immun,1996,64:503-510.
[30]于丽华,沈叙庄.B族链球菌疫苗的研究进展[J].国际儿科学杂志,2007,34(1):43-46.
[31]胡亚美,江载芳.诸福棠实用儿科学[M].7版.北京:人民卫生出版社,2002:567-568.
[32]岳丽琴,沈叙庄,周育森,等.B族链球菌C5a肽酶蛋白表位的克隆、表达和免疫学分析[J].中华微生物学和免疫学杂志,2006,26(12):1080-1084.
[33]Berner R.Group B streptococci during pregnancy and infancy[J].Curr Opin Infect Dis,2002,15(3):307-313.
[34]Baker CJ,Rench MA,Mclnnes P.Immunization of pregnant women with group B streptococcal type Ⅲ capsular polysaccharide-tetanus toxoid conjugate vaccine.Vaccine.2003,21(24):3468-3472
[35]Larsson C,Lindroth M,Nordin P,et al.Association between low concentrations of antibodies to protein a and Rib and invasive neonatal group B streptococcal infection[J].Arch Dis Child Fetal Neonatal Ed 2006,91(6):F403-F408.
[36]Pannaraj PS,Kelly JK.,Madoff LC.,et al.Group B Streptococcus Bacteremia Elicits b C Protein-Specific IgM and IgG in Humans[J].The Journal of Infectious Diseases 2007,195:353-356.
[37]Manning SD.,Wood S,Kasha K,et al.Naturally occurring antibodies for the group B streptococcal surface immunogenic protein(Sip) in pregnant women and newborn babies[J].Vaccine 2006,24(47-48):6905-6912.
[38]Martin D,Rioux S,Gagnon E,et al.Protection from group B streptococcal infection in neonatal mice by maternal immunization with recombinant Sip protein[J].Infect Immun,2002,70(9):4897-4901.
[39]Maeland JA,Bevanger L,Lyng RV.Antigenic determinants of alpha-like proteins of Streptococcus agalactiae[J].Clin Diagn Lab Immunol,2004,11(6):1035-1039.
[40]钟雁,吴明昌,佟月娟,等.新生儿B组链球菌感染性疾病的研究[J].中华围产医学杂志,2002,5(1):38-41.
[41]Dmitriev A,Suvorov A,Shen AD,et al.Clinical diagnosis of group B streptococci by scpB gene based PCR[J].Indian J Med Res.2004:119 Suppl:233-236.
[42]Karmarkar MG,Santosh K,Vineetha V,et al.Human immune response to streptococcal C5a peptidase in Indian children and adults[J].International Congress Series,2006,1289:54-57.
[43]Cleary PP,Matsuka YV,Huynh T,et al.Immunization with C5a peptidase from either group A or B streptococci enhances clearance of group A streptococci from intranasally infected mice[J].Vaccine,2004,22(31-32):4332-4341.