新型冠状病毒特异性抗体IgM、IgG的临床意义  

Detection of antibodies against SARS-CoV-2 as a serologic marker of infection in patients with COVID-19

作　　者：鲁双艳 吴琳 刘成宇 喻晶 陈会欣[1] 高嘉嘉 张艳红 谭璐[1] 李鹏程 刘娟[1] 郑瑶 王顺[1] LU Shuangyan;WU Lin;LIU Chengyu;YU Jing;CHEN Huixin;GAO Jiajia;ZHANG Yanhong;TAN Lu;LI Pengcheng;LIU Juan;ZHENG Yao;WANG Shun(Department of Blood Transfusion,Wuhan First Hospital,Wuhan 430022,China;Laboratory Department,Wuhan First Hospital,Wuhan 430022,China;Hubei University of Chinese Medicine)

机构地区：[1]武汉市第一医院输血科,湖北武汉430022 [2]武汉市第一医院检验科,湖北武汉430022 [3]湖北中医药大学

出　　处：《中国输血杂志》2021年第8期861-864,共4页Chinese Journal of Blood Transfusion

基　　金：湖北省卫生健康委2021年~2022年度面上项目(WJ2021M003)。

摘　　要：目的分析新型冠状病毒(SARS-CoV-2,简称新冠病毒)特异性抗体IgM、IgG对新型冠状病毒肺炎(COVID-19,简称新冠肺炎)的诊断价值。方法1)收集2020年3月上旬在本院发热门诊就诊的全部145名患者的新冠病毒IgM、IgG抗体(胶体金法)和核酸(荧光定量PCR法)检测结果(发热组),做配对卡方检验;2)收集3月5日当天做新冠病毒IgM、IgG抗体检测的612名新冠肺炎确诊患者(来自本院2月~3月作为新冠肺炎定点治疗医院收治的1500名新冠肺炎患者)的新冠病毒IgM、IgG抗体检测结果(新冠肺炎组),并跟踪随访患者出院后30、60 d的新冠病毒IgM、IgG抗体和核酸检测结果;通过对各组(间)的统计分析,明确抗体检测阳性率及抗体变化趋势等。结果1)发热组:新冠病毒抗体IgM阳性、IgG阳性及IgM合并IgG双阳性的比例分别为26.21%(38/145)、54.48%(79/145)及26.21%(38/145)(P<0.01);核酸检测阳性率4.14%(6/145)低于抗体阳性率(P<0.01);IgM和IgG均为阴性而核酸检测阳性的比例为0.69%(1/145)。2)新冠肺炎组:以2~98 d为观察时段,抗体阳性率由5%(1/20)逐渐增至97.8%(87/89);>56 d阳性率平缓下降。2~14 d的IgM阳性率5%(1/20)、IgG阳性率65%(13/20),≥14~56 d IgM阳性率47.68%(277/581)、IgG阳性率94.15%(547/581),≥56 d IgM、IgG阳性率均下降。所有患者住院期间IgM抗体阳性率45.8%(280/612),IgG抗体阳性率93.1%(570/612)。出院后(其中15名患者因转入他院治疗无后期复查数据)1和2个月的新冠病毒核酸检测均为阴性,出院后2个月IgG阳性率≥80%(487/597)、IgM阳性率≥40%(240/597)。结论胶体金法能很好地检测新冠病毒IgM、IgG抗体,阳性率高于核酸检测,其中IgG抗体产生早,阳性率高,持续时间长;联合应用胶体金抗体检测与核酸检测方法有助于提高新冠肺炎确诊和疑似病例的排除诊断。Objective To investigate the diagnostic value of severe acute respiratory syndrome coronavirus 2(SARSCoV-2) specific antibodies IgM and IgG on coronavirus disease 2019(COVID-19). Methods 1) The test results of SARS-CoV-2 IgM/IgG antibodies and nucleic acid(NAT), which were tested by colloidal gold test and fluorescent quantitative PCR respectively, were collected from 145 febrile outpatients during early March, 2020, named Fever group, in which retrospective analysis and paired chi-square test were performed. 2) 612 cases of SARS-CoV-2 IgM/IgG antibodies test results, which were done on March 5,2020, were collected. They were named COVID-19 group(Our hospital was provisionally assigned as a specialized hospital for COVID-19, and 1500 COVID-19 patients admitted to our hospital from February 12, 2020 to March 18, 2020). The SARS-CoV-2 IgM/IgG antibodies and NAT were respectively tested on the 30 th and the 60 th day after the date of discharge. The clinical application values of the antibodies was clarified by statistical analysis. Results 1) In the fever group, the positive rate of SARS-CoV-2 IgM, IgG and IgM+IgG antibodies were 26.21%(38/145), 54.48%(79/145) and 26.21%(38/145), respectively(P<0.01), and the positive rate of NAT was 4.14%(6/145), which was lower than that of antibody(P<0.01). One(1/145, 0.69%) positive NAT was implicated in initially negative IgM and IgG antibodies samples. 2) In the COVID-19 group, the positive rate of IgM antibody was low(5%) and IgG antibody was high(65%) during 2~14 days after infection, and stably increased during the 15~56 days [IgM 47.68%(277/581) vs IgG 94.15%(547/581) ], then both decreased after 57 days. The positive rates of IgM antibody and IgG antibody were 45.8%(280/612) and 93.1%(570/612) in 612 patients during hospitalization. 15 patients′ data after dischange were not collected as they were later transferred to Huoshenshan Hospital for treatment. The coronavirus NAT results of the rest 597 COVID-19 patients, tested on the 30 th and 60 th days after the date of d

关 键 词：新型冠状病毒肺炎 新冠病毒抗体检测 IGM IGG 核酸检测 抗体变化趋势 

分 类 号：R446.62[医药卫生—诊断学] R373.1[医药卫生—临床医学]