新型冠状病毒肺炎特异性IgM抗体假阳性患者的临床特点分析  

Clinical characteristics of patients with serologically false positive SARS-CoV-2 IgM results in diagnosis of coronavirus disease-19

作　　者：高杨[1] 张雪冬[2] 刘双[3] 王艳[1] 朱晨曦[1] 肖瑶[1] 朱光发[1] 陈如冲[4] GAO Yang;ZHANG Xuedong;LIU Shuang;WANG Yan;ZHU Chenxi;XIAO Yao;ZHU Guangfa;CHEN Ruchong(Department of Pulmonary and Critical Care Medicine,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所呼吸与危重症医学科,100029 [2]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所感染科,100029 [3]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所检验科,100029 [4]广州医科大学附属第一医院呼吸疾病国家重点实验室、广州市呼吸健康研究院

出　　处：《心肺血管病杂志》2021年第10期1025-1029,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：呼吸疾病国家重点实验室开放课题(SKLRD-OP-201909)。

摘　　要：目的:分析我院新型冠状病毒肺炎(COVID-19)特异性IgM抗体假阳性患者的临床特点及预后,为疫情防控提供参考。方法:回顾分析2020年1月至2020年12月,首都医科大学附属北京安贞医院的COVID-19特异性IgM抗体假阳性的17例门、急诊及住院患者的流行病学病史、临床表现、辅助检查结果及预后,并与我院6例确诊的COVID-19感染患者相关临床资料进行对比。结果:17例COVID-19 IgM抗体假阳性患者均住院或居家隔离观察,间隔至少24 h的2次COVID-19核酸检测均为阴性,间隔至少1周的3次IgM抗体检测结果均阳性。COVID-19 IgM抗体结果采用胶体金和化学发光两种方法核验均为阳性。其中16例患者为IgM阳性IgG阴性,1例为IgM阳性IgG阳性,5例有自身抗体阳性,7例合并慢性炎症。均否认COVID-19流行病学病史(P<0.001),2例有发热表现,平均体温低于COVID-19的确诊患者(P<0.001)。17例胸部CT均无新冠肺炎影像学特征(P=0.002),17例均预后良好。结论:COVID-19特异性IgM抗体假阳性可能与慢性炎症、自身免疫因素相关,此类患者无COVID-19的流行病学病史、典型临床及影像学表现。Objective:To analysis the clinical features of patients with false positive SARS-CoV-2 IgM tests in diagnosis of coronavirus disease-19(COVID-19).Methods:Patients tested with false positive SARS-CoV-2 IgM in diagnosis of COVID-19 were enrolled in clinic and isolation ward in Beijing Anzhen Hospital from January 2020 to December 2020.Epidemiological characteristics,clinical manifestations,laboratory examination and prognosis were analyzed and compared with the patients diagnosed with COVID-19(n=17).Results:COVID-19 nucleic acid tests were negative at least twice and SARS-CoV-2 IgM antibody tests were positive three times in all 17 patients with an interval of over 24 hours and 1 week respectively.In 17 cases,16 cases were SARS-CoV-2 IgM positive and IgG negative,1 case was IgM and IgG double positive.All cases denied epidemiological exposure of COVID-19(P<0.001),2 cases had fever,and the highest body temperature was lower than that diagnosed with COVID-19(P<0.001).Chest CT showed no typical manifestation of COVID-19 pneumonia in 17 cases(P=0.002).5 cases had positive result of autoantibodies,7 cases had chronic inflammation diseases,and all cases had good prognosis.Conclusions:It indicated that patients with false positive SARS-CoV-2 IgM result had no epidemiological exposure,no typical clinical and imaging manifestations of COVID-19,however chronic inflammation disease and autoimmune factors were present.

关 键 词：新型冠状病毒肺炎 IgM假阳性 自身免疫 慢性炎症 

分 类 号：R56[医药卫生—呼吸系统]