严重急性呼吸综合征病毒基因检测和特异性抗体检测的诊断意义分析

Investigation on diagnostic significance of antibody and SARS-cov gene of SARS patients

目的探讨严重急性呼吸综合征病毒基因检测和特异性抗体检测的诊断意义和价值。方法采用巢式反转录PCR和ELISA法分别检测健康人、普通发热患者、SARS密切接触医务人员及不同时期SARS患者痰标本中SARS病毒核酸和血清标本中特异性抗体IgG和IgM。结果SARS患者住院1～58d期间,采用巢式RT-PCR检测痰SARS病毒基因,52例患者中33例阳性,阳性率63.5%;而采用间接ELISA检测血清抗SARS病毒抗体,52例患者中30例阳性,阳性率为57.7%。2种方法均阳性的有15例,均阴性的有6例。2种病原学诊断方法检测20例正常人、15例发热非SARS患者和20例SARS密切接触医务人员,结果均为阴性。住院1～13d组(92.9%)巢式RT-PCR基因阳性率明显高于ELISA特异性抗体阳性率(7.1%);住院37～58d组巢式RT-PCR基因阳性率(47.4%)则明显低于ELISA特异性抗体阳性率(94.7%)(P<0.01)。结论痰中SARS病毒基因检测可用于SARS的早期诊断,这对于提前确诊和治疗SARS患者,尽早排除疑似病例具有非常关键和现实的意义。血清特异性抗体检测可用于流行病学调查,但对SARS早期诊断和鉴别没有意义。

[Objective] To investigate the diagnostic significance of detecting the specific antibody and the SARS-cov gene of SARS patients. [Methods] The specific IgG,IgM antibody in the serum and the SARS-cov RNA in the sputum of the SARS patients in different period,the healthy,feverous patients without SARS and medical personnel who closely contacted with SARS patients were detected by ELISA and Nested RT-PCR respectively. [Resuits] During 1-58 days of hospitalization, the SARS-cov.gene in the sputum of 52 SARS patients Were detected by nested RT-PCR,33 of 52 cases were positive, and the positive rate was 63.5%, the specific antibodies in 30 of 52cases were positive by indirect ELISA, and the positive rate was 57.7%. 15 cases were positive and 6 cases were negative by two pathogen diagnostic methods. 20 cases of the healthy, 15 cases of general fever patients and medical personnel who closely contacted with SARS patients were all negative by two pathogen diagnostic methods. During 1-13days of hospitalization, the positive rate of SARS-cov RNA in the sputum of SARS by the nested RT-PCR （92.9%） was markedly higher than that of the specific antibodies in the serum of the SARS patients by the Indirect ELISA （7.1%）; during 37-58 days of hospitalization, the positive rate of SARS-cov RNA in the sputum of SARS by the nested RT-PCR （47.4%） was markedly lower than that of the specific antibodies in the serum of the SARS patients by the Indirect ELISA（94.7%） （P 〈0.01）. [Conelusion] The early SARS patents are diagnosed by detecting the SARS-cov gene in the sputum of SARS patients. It is very key and practical significance for diagnosing and curing the SARS patients, and excluding the dubitable cases infected with SARS early. It is no sense for diagnosis and identification of SARS to detect the specific antibody in the serum of SARS patients.