发热伴血小板减少综合征患者核衣壳蛋白特异性IgM水平与病情严重程度的相关性  

Correlation between level of nucleocapsid protein specific IgM antibody and severity of fever with thrombocytopenia syndrome

作　　者：常海燕 严晓敏[1] 张昭萍 吴卫华 贾蓓 吴超[1] CHANG Hai-yan;YAN Xiao-min;ZHANG Zhao-ping;WU Wei-hua;JIA Bei;WU Chao(Clinical College of Nanjing Medical University,Nanjing Drum Tower Hospital,Nanjing 210008,China)

机构地区：[1]南京医科大学鼓楼临床医学院,江苏南京210008

出　　处：《中国感染控制杂志》2018年第12期1065-1069,1074,共6页Chinese Journal of Infection Control

摘　　要：目的探讨核衣壳蛋白(N蛋白)特异性Ig M抗体水平与发热伴血小板减少综合征(SFTS)疾病病情严重程度的相关性。方法回顾性分析某三甲医院30例SFTS患者的临床特点及实验室检查结果,比较N蛋白特异性Ig M(+)组与N蛋白特异性Ig M(-)组患者的临床特点及预后转归;根据患者疾病严重程度分为轻症组和重症组,比较轻症组患者与重症组患者Ig M抗体滴度与发热伴血小板减少综合征病毒(SFTSV) RNA载量的相关性;从而观察分析N蛋白特异性Ig M抗体滴度、SFTSV-RNA载量与患者病情严重程度的相关性。结果 N蛋白特异性Ig M(-)组中有神经症状、死亡及病重例数均明显较Ig M(+)组多(均P <0. 05); N蛋白特异性Ig M抗体水平与SFTSV-RNA载量、凝血酶原时间(PT)、乳酸脱氢酶(LDH)、天门冬氨酸氨基转移酶(AST)均呈负相关(r值分别为-0. 495、-0. 440、-0. 367、-0. 280,均P <0. 05);而与血小板(PLT)呈正相关(r=0. 335,P=0. 002)。SFTSVRNA载量与PT、LDH、AST均呈正相关(r值分别为0. 606、0. 604、0. 587,均P <0. 001);而与PLT呈负相关(r=-0. 384,P <0. 001)。发病第10～13天时轻症组患者N蛋白特异性Ig M抗体滴度高于重症组患者(P <0. 05)。结论N蛋白特异性Ig M抗体的出现及滴度的升高有助于SFTSV的清除,且对患者凝血功能及肝损伤、心肌损伤有修复作用; N蛋白特异性Ig M抗体可能是预测患者预后的重要因素。Objective To evaluate the correlation between level of specific IgM antibody of nucleocapsid protein(N protein)and severity of severe fever with thrombocytopenia syndrome(SFTS).Methods Clinical characteristics and laboratory detection results of 30 patients with SFTS in a tertiary first-class hospital were analyzed retrospectively,clinical characteristics and prognosis between patients in N protein specific IgM(+)group and N protein specific IgM(-)group was compared;patients were divided into mild disease group and severe disease group according to the severity of disease,correlation between IgM antibody titer and RNA load of SFTS virus(SFTSV)in patients in mild disease group and severe disease group was compared;correlation between N protein specific IgM antibody titer,SFTSV-RNA load,and severity of disease in patients were analyzed.Results The numbers of patients with neurological symptoms,death,and serious disease in N protein specific IgM(-)group were significantly higher than IgM(+)group(allP<0.05);N protein specific IgM antibody level was negatively correlated with SFTSV-RNA load,prothrombin time(PT),lactate dehydrogenase(LDH),and aspartate aminotransferase(AST)(r=-0.495,-0.440,-0.367,-0.280,respectively,all P<0.05);while was positively correlated with platelets(PLT)(r=0.335,P=0.002).SFTSV-RNA load was positively correlated with PT,LDH,and AST(r=0.606,0.604,0.587,respectively,all P<0.001);while was negatively correlated with PLT(r=-0.384,P<0.001).On the 10-13 day of onset,the titer of N protein specific IgM antibody in patients in mild disease group was higher than that in patients in severe disease group(P<0.05).Conclusion The presence and increase of N protein specific IgM antibody are helpful for clearance of SFTSV,and has a repairing effect on damage of coagulation function,liver and myocardial damage;N protein specific IgM antibody may be an important factor for predicting prognosis of patients.

关 键 词：发热伴血小板减少综合征 核衣壳蛋白特异性IgM抗体 发热伴血小板减少综合征病毒 

分 类 号：R558.2[医药卫生—血液循环系统疾病]