克山病患者心肌肠道病毒VP1结构蛋白检测

Detection of enteroviral VP1 structure protein in myocardial specimens from patients with Keshan disease

目的 探讨肠道病毒感染与克山病发病的关系。方法 应用抗柯萨奇B5病毒(Coxsackie B5 virus,CVB5)VP1蛋白单克隆抗体,采用免疫组化方法,检测黑龙江、山东、云南省克山病病区急型、亚急型、慢型、潜在型克山病死亡病例心肌标本83例,风心病10例,冠心病10例,心肌炎21例,扩张型心肌病29例,非病区非正常死亡的正常人10例,病区发病季节非克山病死亡病例13例。结果 克山病83例心肌标本中有74例VP1结构蛋白阳性,阳性率89.2％;风心病、冠心病、非正常死亡健康人VP1阳性检出率均为10％;心肌炎、扩张型心肌病VP1阳性检出率分别为66.7％和70％;病区发病季节非克山病死亡病人VP1阳性检出率为38.5％。结论 来自3省份的各型克山病死亡病例心肌标本中均能检出肠道病毒VP1结构蛋白,克山病的发生与肠道病毒感染高度相关。

Objective To further investigate the relation between enteroviral infections and Keshan disease (KD). Methods The autopsy myocardium was examined with anti-VP1 of Coxsackie virus B5 antibody by immunohistochemistry. The samples were taken from KD patients (83 cases) which were from KD endemic areas of Heilongjiang, Shandong and Yunnan, rheumatic heart disease patients (RHD 10 cases), coronary heart disease patients (CHD,10 cases), viral myocarditis patients (VMC, 21cases), dilated myocardiopathy patients (DMC,29 cases), accidental death persons (10 cases), and 13 cases coming from endemic area but not dying from KD (non-KD). Results Enteroviral VP1 structure protein was detected in myocardium of 74/83 patients, with the positive rate 89.2%, while 10% in RHD, CHD and control, respectively, 66.7% in VMC, 70% in DCM, 38.5% in patients not dying from KD, but coming from endemic area. Conclusions The enterovirus structure protein VP1 is detected in all types of KD myocardium from 3 provinces demonstrated that there is closely relation between the occurrence of KD and enteroviral infections.