麻疹感染的临床特征及诊断

Clinical Characteristics and Diagnosis of Measles Virus Infection in Children

目的研究广泛麻疹疫苗接种后儿童麻疹的临床特点及诊断。方法研究对象来自2001年4～7月我院隔离门诊的可疑麻疹病例。所有病例就诊时静脉采集全血2.0 mL,分离血清,-20℃保存。用间接ELISA方法检测血清麻疹IgM抗体.若麻疹IgM抗体阴性,同时检测风疹IgM抗体。结果本文共收集85份临床可疑病例,男56例,女29例;年龄46 d～8个月13例.>8个月72例。85份血清麻疹抗体IgM阳性44例,阳性率51.76%,其中年龄46 d～8个月10例,占22 7%;>8个月34例,占77.3%。41份麻疹IgM阴性血清中检测风疹IgM,阳性9例,阳性率为21.95%:占总病例的10. 59%.麻疹和风疹皆阴性32例,占37.65%。麻疹44例中,出疹前发热<3 d 28例(63.6%),≥3 d为16例(36.4%);有Koplik斑35例; 95.5%麻疹病例有结膜炎。风疹9例中,出疹前发热<3 d 8例(89.9%).≥3 d 1例(11.1%):全部风疹病例无Koplik斑;而22.2%风疹病例有结膜炎。结论小儿麻疹的发病年龄及临床表现己发生变化,单凭临床特征易造成较多的漏诊和误诊,血清麻疹IgM抗体检测麻疹病例实用、特异、敏感。

Objective To study clinical characteristics and diagnostic methods of measles in children Methods Eighty five doubtful measles cases were enrolled in this study from April to July in 2001, which came from the infectious department of Beijing Children's Hospital. Serum IgM antibodies against measles and rubella viruses were detected by utilizing enzyme - linked immunosorbent assay (ELISA). Results Of 85 patients. 56 (65.88% ) were male and 29 (34. 12% ) were female. Thirteen patients were of age from 46 days to 8 months, and 72 patients were of age over 8 months. Forty four patients were diagnosed as measles by serology. The positive rate of serology is 51 76% Of 44 measles cases, 10 (22. 7% ) were younger than 8 months and 35 (77. 3% ) were older than 8 months. Nine patients (21. 95% ) were positive of IgM against rubella virus among 41 patients with negative IgM against measles virus. Thirty two patients (37.65%) were negative of IgM antibodies against measles or rubella. Of 44 measles cases, there were 28 patients (63 6% ) that fever time before rash were less than 3 days, and 16 patients (36. 4% ) had fever time before rash over or equal 3 days. Of 9 rubella cases, 8 patients had fever time before rash less than 3 clays, and only one patient had fever time before rash over or equal 3 days. Incidence of Koplik spot in measles patients was 89 9% ,and rubella patients had no Koplik spot Incidence of conjunctivitis in measles patients was 95 5% ,and 22. 2% rubella cases complicated conjunctivitis. Conclusions The epidemiological and clinical characteristics of measles in children have changed. Misdiagnasis would be possible if diagnosis was made only according to clinical manifestation. Detection of IgM antibodies against measles virus is a method for diagnosing measles with high sensitivity and specificity.