严重急性呼吸综合征患者相关病毒的随访监测及意义

Follow up study on viruses associated with SARS among the SARS patients

目的随访监测确诊SARS患者,研究SARS-CoV、新型呼肠病毒和脊髓灰质炎病毒在患者体内的存在状况及与SARS的可能相关性。方法采集8例SARS患者痊愈2年后的咽拭子、唾液(或痰液)、尿液、血清及连续3天的粪便标本,用RT-PCR的方法分别扩增SARS-CoV、呼肠病毒和脊髓灰质炎病毒;采用ELISA的方法检测患者血清中的SARS-CoV抗体和脊髓灰质炎病毒IgG抗体。结果8例患者中有4例的粪便中脊髓灰质炎病毒RNA阳性,均为Sabin1毒株,在5′端非编码区的第480nt及VP1蛋白编码区的第2795nt两个重要的减毒位点上均发生了回复突变;SARS-CoV和新型呼肠病毒均阴性。对照组标本中均未检测到上述三种病毒。3例随访患者血清中SARS-CoV抗体阳性;4例患者血清中脊髓灰质炎IgG抗体阳性。25例健康体检者的血清中SARS-CoV抗体均阴性,其中23例的血清中脊髓灰质炎病毒抗体阳性。结论SARS患者痊愈2年后的血清中特异性脊髓灰质炎病毒抗体与健康人有显著差异,其粪便标本中仍有较高的脊髓灰质炎病毒阳性率,而且病毒核酸在两个重要的减毒位点上均发生了回复突变。

Objective To study the existence status of the SARS-CoV, reovirus, and the poliovirus in the bodies of the patients with SARS and the possible relationship between the throe viruses and SARS. Methods The clinical specimens of the nasopharyngeal swabs, sputum （or saliva） ,urine, fecal specimen were collected on three consecutive days from 8 patients with SARS 2 years after the recovery of SARS. SARS-CoV, reovirus and poliovirus RNA was detected by using reverse transcription （ RT）-PCR; IgG antibody to the poliovirus type 1 to 3 and the antibody to SARS-CoV were determined using enzyme linked immunosorbent assay （ELISA）. Results All the specimens were negative for SARS-CoV and reovirus by RT-PCR, but the fecal specimens from 4 persons were positive for poliovirus. The sequences of these poliovirus were highly homologous to that of human poliovirus type 1 strain sabin 1 genome at nucleotide level, but back mutations have occurred in the primary attenuating mutation sites at nucleotide position 480（G→A） in the 5′ UTR and the nucleotide position 2795 （A→ G）. No SARS-CoV, reovirus, and poliovirus were found in the normal controls. Three serum specimens were positive for the antibody to SARS-CoV. The IgG antibody to poliovirus were detected in 4 SARS patients and 23 healthy persons. No positive results for antibody to SARS-CoV were detected in the 25 healthy persons. Conclutions The positive rate of the poliovirus antibody in the serum of SARS patients 2 years after recovery was significantly different from that of the normal controls, and the positive rate of poliovirus in the fecal specimens was still very high, and more importantly back mutations have occurred in the attenuating mutation sites at nucleotide position which plays an important role in the poliomyelitis.