免疫酶染色法快速诊断柯萨奇B病毒性心肌炎与核素检测的对比研究

Diagnostic Study of Coxsackie B virus Myocarditis with Immuno-enzyme Dye Process and Nuclide Imaging

目的探讨病毒性心肌炎早期快速病因诊断及病情评估的方法。方法130例心肌炎患者用免疫酶染色法测CBV-IgM抗体,微量板法测CBV中和抗体,并行99mTc-MIBI心肌显像;其中50例行平衡法核素心室造影测左心室功能。正常对照组40例。结果130例中,CBV-IgM抗体阳性68.5%,CBV中和抗体阳性63.8%,99mTc-MIBI心肌显像阳性80.8%,病例组50例平衡法核素心室造影测得左室总射血分数(EF)值降低21例(42.0%),节段EF值降低31例(62.0%),左室收缩功能(PER)降低22例(44.0%),左室舒张功能(PFR)降低23例(46.0%),室壁舒缩协调性下降18例(36.0%),以上各参数降低幅度与对照组比较,差异显著,P<0.01。比较分析显示,CBV-IgM抗体检测与中和抗体检测符合率为81.5%,99mTc-MIBI心肌显像与CBV-IgM抗体检测符合率为83.1%。左室总EF值或节段EF值下降与心肌放射性分布异常不均符合率为87.1%。结论免疫酶染色法测CBV-IgM抗体,结合核素心肌显像和心室造影,对病毒性心肌炎的病因诊断和病情评估有较高的价值。

Objective：To investigate the early rapid diagnosis and disease evaluation methods in viral myocarditis. Methods： The specific Coxsackie B virus IgM （CBV- IgM） was tested by inununoenzyme dye process, neutralization antibody was detected by micmcell neutralization and ^99mTc - MIBI myocardial perfusion was evaluated in 130 myocarditis cases. The left ventficular total EF. segmental EF and PER, PFR were. studied in 50 myoearditis cases by balanced radionuclide ventficulogram, The control group contains 40 healthy pemons. Results： Among 130 cases, CBV - IgM positive rate was 68.5%, the neutralization antibody positive rate was 63.8 % and 80.8 % cases had positive results in ^99mTc - MIBI myocardial perfusion. Radionuclide ventriculogram in 50 myocarditis patients revealed that 21 cases total EF decreased （42.0%）, 31 cases segmental EF deceased （62, 0%）, PER deceased in 22 cases （44.0%） and PFR decreased in 23 cases （46.0%）, the myocardial wall movement coordination was impaired in 18 cases （36.0%）. Comparing with control gruup, there was statistically significant difference between each parameter （P 〈 0.01）. The coincidence rate of CBV- IgM and neutralization antibody was 81.5%, The coincidence rate of ^99mTc- MIBI myocardial perfusion and CBV - IgM was 83.1%, the coincidence rate of myocmdial perfusion defects and abnormal EF was 87.1%. Conclusion：The combination of the immunoenzyme dye process to examine CBV - IgM with radionuclide myocardial perfusion and radionuclide ventriculogram has important clinical value in pathogenic diagnosis and evaluation of viral myocarditis.