肠道病毒特异性抗体和RNA检测对心肌炎的诊断价值  

A STUDY ON THE ETIOLOGICAL DIAGNO-SIS OF ENTEOVIRAL MYOCRDITIS INCHILDREN

作　　者：王雪梅[1] 叶鸿瑁[1] 何小玲[1] 尹智民 朱晖[1] 韩玲[1] 刘晓晔[1] 

机构地区：[1]北京医科大学第三临床医学院,中国预防医学科学院病毒研究所,北京市安贞医院

出　　处：《中华儿科杂志》1995年第5期271-273,共3页Chinese Journal of Pediatrics

摘　　要：用间接酶联免疫吸附试验（ＥＬＩＳＡ）和抗体捕捉ＥＬＩＳＡ（ＭａｃＥＬＩＳＡ）分别检测６４例急性心肌炎、２０例疑似心肌炎、２０例非心肌炎和５２例正常儿血柯萨奇病毒Ｂ（ＣＶＢ）特异ＩｇＧ和ＩｇＭ。其中４９例心肌炎及２３例先天性心脏病同时用聚合酶链反应（ＰＣＲ）检测其血清中肠道病毒ＲＮＡ。结果：心肌炎组ＩｇＧ阳性３８例（５９．４％），ＩｓＭ阳性３３例（５１．６％），ＰＣＲ检测阳性２６例（５３．１％），均明显高于非心肌炎组及正常小儿组。病程早期（２周内）ＰＣＲ检测ＩｇＭ阳性率较高，二者下降较快，约６周后降至接近正常水平；ＩｇＧ则出现较晚，约２～６周达高峰，持续１０～２２周后降至接近正常水平。本研究表明：ＣＶＢ是引起心肌炎的主要病原；三种方法检测均敏感、特异；ＭａｃＥＬＩＳＡ检测特异ＩｇＭ比间接ＥＬＩＳＡ检测ＩｇＧ更有早期诊断价值。Indirect enzyme-linked immunosorbent assay(ELISA)and u-antibody-capture ELISA(MacELISA)was employed to detect Coxsackie virus B(CVB )-spe-cific IgG and IgM antibodies in 64 cases diagnosed asacute viral mvocarditis(AVM),20 cases with diseasesother than AVM and 52 healthy children ,respectively。Polymerase chain reaction(PCR)was used to detectenterovirus RNA(EV-RNA)in sera of 49 cases withAVM and 23 healthy children。Paired or more sera wereexamined for 49 cases of AVM。The sera of 59.4%of patients with AVM were positive for CVB-specific IgG,51.6%for IgM and 53.1%for EV-RNA。All were sig-nificantly higher than those of healthy children andcases of other diseases,respectively(P< 0. 001 ).Thepositive rates(PR )of IgM and EV-RNA were highwithin 2 weeks,then declined to nearly normal level inabout 6 weeks。The PR of IgG was low within 2 weeks,reached its peak in 2-6 weeks,and sustained for alonger period.It declined to its nearly normal level in10-22 weeks.The results showed that CVB were mainetiological organisms of myocarditis and the three detec-tive methods were of high sensitivity and specificity。Mac-ELISA for IgM detection was of a higher value forthe diagnosis of AVM at its acute stage than indirectELISA for IgG detection。

关 键 词：心肌炎 柯萨奇病毒B 免疫酶技术 聚合酶链反应 

分 类 号：R542.210.4[医药卫生—心血管疾病] R446.61[医药卫生—内科学]