生殖器疱疹无症状排毒与血清抗体及药物干预的研究  

Relationship of herpes simplex virus shedding with serum anti-herpes simplex virus antibody levels and antiviral treatment in patients with asymptomatic genital herpes

作　　者：夏利[1] 蒙坚[1] 陈德华[1] 程培华[1] 黄熙[1] 罗婧莹[1] 刘群英[1] 杨凤元[1] 严文杰[1] 陶赞英[2] 孙文国[3] 

机构地区：[1]广西桂林医学院附属医院皮肤性病科,141001 [2]广西桂林医学院附属医院实验室,541001 [3]广西桂林医学院附属医院泌尿外科,541001

出　　处：《中华皮肤科杂志》2013年第4期244-247,共4页Chinese Journal of Dermatology

基　　金：广西自然科学基金（2010GXNSFA013249）

摘　　要：目的探讨生殖器疱疹患者无症状排毒与血清抗体及药物干预的相关性。方法收集生殖器疱疹患者650例，分别用荧光PCR和酶联免疫法（ELISA）测定排毒率、质粒数和不同病程、不同复发频率的生殖器疱疹患者元症状排毒阳性情况及血清抗体（IgG和IgM）的分泌情况，药物干预后的排毒情况和复发评价。结果人选的650例患者中，排毒阳性354例（54．5％），DNA质粒数为63—9400拷贝／ml，平均3100拷贝／ml。病程超过3年与小于3年的患者比较，排毒阳性率差异有统计学意义（X2=6．41，P〈0．05）。频发（每年复发频率〉6次）与少发患者比较，差异有统计学意义（r=9．46，P〈0．01）。排毒阳性与阴性患者HSV—I和ⅡIgG双阳性率、HSV—IIgG单阳性率比较，差异均有统计学意义（P〈0．01）；HSV—11IgM单阳性率比较，差异无统计学意义（P〉0．05）。对排毒阳性患者进行药物干预，伐昔洛韦组、阿昔洛韦组与对照组比较，干预后的排毒阳性率差异均有统计学意义（P〈0．01），停药后与对照组比较无统计学意义（P〉o．05）。药物干预能够明显降低患者复发次数，而药物干预组间没有差异（P〉0．05）。结论生殖器疱疹患者无症状排毒率高达54．5％，血清学检测提示，部分生殖器疱疹患者存在HSV—I及HSV—II混合感染。患者病程越长阳性检测率越低，排毒阳性患者用药干预后能明显降低患者复发，抑制患者排毒。Objective To estimate the relationship of herpes simplex virus （HSV） shedding with serum anti-herpes simplex virus （HSV） antibody levels and antiviral treatment in patients with asymptomatic genital herpes. Methods Totally, 650 patients with genital herpes were enrolled in this study. Swab samples were collected from urethral, genital, perianal mucosa and extragenital sites of previous HSV infection, and venous blood samples were also obtained from these patients. Fluorescence-based quantitative PCR was performed to detect HSV DNA and determine the copy number of HSV plasmid DNA, enzyme-linked immunosorbent assay （ELISA） to test the serum level of anti-HSV IgM and IgG antibodies. The patients positive for HSV DNA were classified into three groups to be treated with valaciclovir 0.3 g twice daily for 4 months （valaciclovir group, n = 152）, aciclovir 0.4 g thrice daily for 4 months （aciclovir group, n = 152）, or remain untreated （control group, n = 50）. Viral shedding was detected at 5 days, 10 days and 4 months after start of antiviral treatment, as well as at 1 and 4 months after termination of antiviral treatment. All the patients were followed for 1 year. Chi-square test was carried out to assess the differences in viral shedding rates among patients with different serum antibody levels, clinical course and recurrence frequency. Results Among the 650 patients, 354 （54.5%） shed HSV DNA, with the copy number of plasmid DNA ranging from 63 to 9.4 -103 copies/ml and averaging 3.1 x 103 copies/ml. The viral shedding rate statistically differed between patients with a clinical course of 〉 3 years and those 〈 3 years （X2 = 6.41, P 〈 0.05） as well as between patients with a high frequency of recurrence （〉 6 times per year） and those with a low frequency （〈 or = 6 times per year, X2 = 9.46, P 〈 0.01）. Statistical differences were observed between patients who shed HSV DNA and those who did not in the percentage of patients positive for both anti-HSV- I and anti- HSV- l

关 键 词：疱疹 生殖器 血清 抗体 药用制剂 

分 类 号：R7[医药卫生—临床医学]