新型冠状病毒肺炎患者抗体变化:一项为期10月的前瞻性研究  

Changes of antibodies in COVID-19 patients:A 10-month prospective study

作　　者：加明明 刘兰[1] 蔡璇[2] 吴小军[1] JIA Mingming;LIU Lan;CAI Xuan;WU Xiaojun(Dept.of Respiratory and Critical Medicine,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China;Dept.of Clinical Laboratory,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China)

机构地区：[1]武汉大学人民医院呼吸与重症医学科,湖北武汉430060 [2]武汉大学人民医院检验科,湖北武汉430060

出　　处：《武汉大学学报（医学版）》2021年第6期861-866,共6页Medical Journal of Wuhan University

摘　　要：目的:探索新型冠状病毒肺炎(COVID-19)确诊患者发病后抗体变化规律。方法:招募湖北省武汉市武昌区215例经RT-PCR核酸检测确诊为COVID-19患者为研究对象,分别对每位患者在发病后的(10±3) d、(100±3) d、(190±3) d、(280±3) d内进行胶体金法抗体检测。结果:从抗体类别来看,215例患者中,IgM抗体在确诊后(10±3) d时抗体阳性率为36.7%,(100±3) d下降为22.5%,(190±3) d及(280±3) d分别为5.0%及4.7%。IgG抗体阳性率偏高,确诊后(10±3) d内阳性率为87.0%,(100±3) d下降为80.8%,(190±3) d及(280±3) d分别为49.7%及46.5%。IgM、IgG抗体同阳的样本数随时间延长,占比逐渐下降,IgM、IgG抗体同阴的样本数占比逐渐上升。按临床分型来看,在疾病早期,IgM抗体阳性率在不同严重程度的COVID-19患者中表现不同。临床症状越重,IgM抗体阳性率越高。在症状发生后190 d左右,IgG抗体阳性率在轻型和普通型患者中下降缓慢;在280 d随访时,IgM抗体在重症及危重症患者中表现为较高的阳性率。从同一患者抗体变化趋势分析,10个月内,170例患者中IgG抗体持续阳性的有55例(32.4%),阳转阴组77例(45.3%),阳转阴复阳组21例(12.4%),阴转阳3例(占比1.8%),持续阴性组14例(8.2%)。而IgM抗体,持续阴性有97例(57.1%),阴转阳组5例(2.9%),阳转阴组65例(38.2%),暂未观察到IgM抗体在10个月内持续阳性病例,阳转阴复阳组3例(1.8%)。结论:感染新型冠状病毒后,其血清学反应是不稳定的;疾病早期,抗体检测对诊断疾病具有重要辅助价值,在晚期,诊断价值不大;IgM抗体反应与疾病的严重程度可能呈现一定的正相关;近50%的患者在10个月内IgG抗体可保持阳性,表明近一半新冠康复患者可以获得较为持久的免疫力。但部分患者IgG抗体持续或最终转为阴性,这类病人是否可获得免疫有待观察和研究。Objective:To explore the law of antibody changes in patients diagnosed with COVID-19 after the onset of the disease.Methods:A total of 215 patients who were diagnosed with COVID-19 by RT-PCR in Wuchang District,Wuhan City,Hubei Province were recruited as the research subjects.The rapid colloidal gold immunochromatography assay was performed on every newly diagnosed patient at the time points of(10±3) d,(100±3) d,(190±3) d,and(280±3) d after the onset of the disease.Results:In terms of antibody types,among the 215 patients,the positive rate of IgM antibodies was 36.7% at(10±3) d.The antibody levels were 22.5%,5.0%,and 4.7% at(100±3) d,(190±3) d,and(280±3) d respectively.In general,the levels of IgG antibody were high.The positive rate of antibody within(10±3) days was 87.0%,and the rate decreased to 80.8% at(100±3) d,49.7%and 46.5% at(190±3) d and(280±3) d,respectively.The number of IgM and IgG antibodies homo-positive samples gradually decreased over time.At the meantime,the proportion of IgM+IgG antibodies both negative samples gradually increases.According to the clinical classification,in the early stage of the disease,the positive rate of IgM antibody was different in patients with different severity of clinical symptoms.The more severe the clinical symptoms,the higher the positive rate of IgM antibodies.Around 190 days after the onset of symptoms,the positive rate of IgG antibodies decreased more slowly in mild and common patients.At the 280-day during follow-up,IgM antibodies showed a higher positive rate in severe and critical patients.From the trend of antibody changes in the same patient within 10 months,among the 70 patients,only 55 cases(32.4%) showed continuous positive in IgG antibody,with 77 cases(45.3%) in the IgG antibody positive-to-negative group,and21 cases(12.4%) in the IgG antibody positive-to-negative-to-positive group.Three cases(1.8%)showed IgG antibody negative converting to positive.However,there were 14 cases(8.2%) remaining with negative IgG antibody.For IgM antibodies,97 c

关 键 词：新型冠状病毒肺炎 前瞻性研究 抗体 

分 类 号：R512.99[医药卫生—内科学]