儿童原发性传染性单核细胞增多症中血清EBV抗体与DNA载量检测的诊断意义

Diagnostic Significance of Detection of Antibodies Anti-EBV and EBV-DNA Load in Serum of Pediatric Patients with Primary Infectious Mononucleosis

目的探讨EB病毒（EBV）抗体及血清EBV—DNA载量检测在诊断儿童EB病毒感染传染性单核细胞增多症中的意义。方法收集2007年1月～2008年10月间入住北京儿童医院住院治疗的130例EBV感染传染性单核细胞增多症患儿，采用间接免疫荧光法检测EBV特异性抗体及抗体亲和力，荧光定量PCR方法检测血清中EBV-DNA载量。结果在130例儿童EBV感染传染性单核细胞增多症病例中，入院时血清EBV抗体反应存在多种类型，抗EBV-CA-IgM阳性率达95．4％，随着时间推移，EBV特异性抗体及抗体亲和力出现相应的变化。77例进行血清EBV—DNA检测，总阳性率为15．6％（12／77），平均拷贝数为1．5×10^4copies／ml，动态监测提示EBV—DNA载量亦随时间变化而变化。结论血清EBV—CA—IgM结合EBV—CA—IgG亲和力检测，可以提高原发性EBV感染传染性单核细胞增多症诊断的敏感度。血清中EBV—DNA检测在原发性EBV感染传染性单核细胞增多症诊断中的作用有待进一步研究。

Objective To explore the significance of detecting Epsteln-Barr virus （EBV） specific antibodies and EBV DNA load in serum in the diagnosis of infectious mononucleosis （IM） associated with EBV. Methods Hospitalized patients with EBV-IM were enrolled during January 2007 to October 2008 in Beijing Children＇s Hospital Affiliated to Capital Medical University. EBV specific antibodies and the avidity of EBV-CA-IgG were detected by indirect immunofluorescent assay and EBV DNA load in serum was determined by real-time PCR. Results There existed many types of EBV-specific antibodies in the 130 patients with EBV-IM. The positive rate of EBV-CA-IgM was 95.4% and changing with time,so was the avidity of EBV-CA-IgG. EBV-DNA load was detected in 77 inpatients with positive rate 15.6% （12/77） and the average copies were 1.5× 10^4 copies/ml. Dynamic response of EBV-DNA load revealed the variance with time. Conclusion Combination of EBV-CA-IgM and low-avidity IgG anti-VCA may enhances the sensitivity of diagnosis of patients with infectious mononucleosis associated with primary EBV infection. But the diagnostic value of EBV-DNA load in serum is still uncertain and need advanced investigation.