自身免疫病患者血清中传染性非典型肺炎冠状病毒抗体阳性原因分析  

Analysis of the false-positive results associated with antibody tests for SARS-CoV in autoimmune disease patients

作　　者：汪运山 [1] 申红  孙善会 [1] 姜莉华  朱之炜  肖东杰 [1] 刘洋  黄平 [1] 杨博 [1] 杜希燕 [1] 张源潮 [4] 

机构地区：[1]250013,山东大学临床医学院济南市中心医院中心实验室 [2]山东省移植与组织工程技术研究中心 [3]济南市分子医学研究中心 [4]山东省立医院风湿免疫科

出　　处：《中华检验医学杂志》2004年第5期281-285,共5页Chinese Journal of Laboratory Medicine

摘　　要：目的 探讨传染性非典型肺炎又称严重急性呼吸综合征(SARS),冠状病毒(SARS-CoV)抗体在SARS病原学诊断中的特异性及其在系统性红斑狼疮(SLE)、类风湿性关节炎(RA)、干燥综合征(SS)和混合结缔组织病(MCTD)患者中的假阳性问题。方法 应用酶联免疫吸附试验(ELISA)和荧光定量RT-PCR技术检测了111名正常对照和58例SLE、20例RA、10例SS、16例MCTD患者做血清中SARS-CoV抗体的检测。结果 在111名正常对照中,IgM抗体均阴性,IgG抗体的阳性率为3.6％;IgG抗体诊断SARS的特异性为96.4％,两种抗体同时阳性诊断SARS的特异性为100％。58例SLE患者中,IgM抗体和IgG抗体阳性率分别为8.6％和32.8％,IgG抗体和IgM抗体同时阳性为19％;在10例SS患者中只有1例两种抗体同时阳性(10％);在16例MCTD患者中,IgG抗体阳性6例(37.5％),两种抗体同时阳性1例(6.3％);在20例RA患者中只有1例IgG抗体阳性(5％)。经RT-PCR检测,上述自身免疫病患者中的阳性病例血清SARS-CoV抗体均为阴性。结论用非纯化抗原制备的ELISA试剂盒测定自身免疫病患者的SARS-CoV抗体,可能出现假阳性,两种抗体同时测定可降低诊断的假阳性率,提高诊断的特异性。在自身免疫病患者中出现假阳性的原因可能与包被的抗原有关。Objecttive To investigate the specificity of serology diagnostic testing for anti coronavirus antibody in patients with severe acute respiratory syndrome (SARS) and discuss the fasle-positive of SARS-associated coronavirus (SARS-CoV) antibody in patients with systemic lupus erythematosus(SLE) , Sjogren's syndrome (SS) , rheumatoid arthritis (RA) and mixed connective tissue disease (MCTD). Methods 111 normal controls,including 10 SS,16 MCTD,20 RA and 58 SLE with non-SARS patients were detected for anti SARS-CoV antibody and RNA by enzyme-linked immunosorbent assays ( ELISA) and reverse transcriptase-polymerase chain reaction ( RT-PCR) respectively. Results The result showed 4/111 cases (3. 6% ) were positive of SARS-CoV-IgG antibody and 111 cases were negative of SARS-CoV-IgM antibody. The specificity of both SARS-CoV-IgG and IgM antibody for was 100%. in 58 cases with SLE. The positive rates of SARS-CoV-IgG and IgM antibodies were 32. 8% (19/58) and 8. 6% (5/58) Respectively, in which 11 cases( 19% ) were positive of both SARS-CoV-IgG and IgM antibody. In 10 cases with SS, The positive rate of both SARS-CoV-IgG and IgM antibody was 10% (1/10). In 16 cases with MCTD, the positive rate of SARS-CoV-IgG was 37. 5% (6/16), the positive rate of both SARS-CoV-IgG and IgM antibodies was 6. 3% (1/16). in 20 cases with RA,one case was positive(5% ). All samples of positive SARS-CoV-IgG and IgM antibodies were negative by RT-PCR. Conclusion The results suggested that the ELISA kit coated by non-purified SARS-CoV antigen may induce the false-positive results of SARS-CoV antibody in patients with autoimmune disease. The specificity of ELISA tests for SARS was excellent and has low fasle-positive rates when using SARS-CoV-IgG and IgM antibody tests, the false-posotive results of SARS-CoV-IgG and IgM antibody may be related to coated antigens with SARS-CoV and Vero-E6 cells in patients with autoimmune disease.

关 键 词：自身免疫病 血清 传染性非典型肺炎 冠状病毒 抗体 阳性 原因分析 

分 类 号：R593.2[医药卫生—内科学] R563.1[医药卫生—临床医学]