不同类型样本在甲型H1N1流行性感冒诊断及研究中的意义

The significance of different sample types in study of pandemic A （H1N1） influenza diagnosis

目的 探讨咽拭子、粪便、血等不同类型标本在甲型H1N1流行性感冒（简称流感）诊断、排毒规律研究中的意义.方法 采集2009年5-6月期间23例甲型H1N1流感确诊患者的135份样本,其中包括13例患者的99份咽拭子、14份粪便、11份血、1份气管抽取物和另10例患者的10份血.分别应用RT-PCR（采用荧光定量PCR方法）、血凝抑制试验检测甲型H1N1流感病毒核酸、血清抗体.结果 13例患者的99份咽拭子中,首次RT-PCR检测阳性的时间为发病后0～7 d,中位数为1 d;咽拭子RT-PCR检测阳性持续时间为1～15 d,中位数为3 d.4例患者呈现间歇排毒现象.1份气管抽取物RT-PCR检测阳性.14份粪便标本中,8份为RT-PCR检测阳性,阳性率为57.14%,RT-PCR检测阳性的时间为发病后1～4 d,中位数为3 d.21份血标本采集时间为发病后2～9 d,RT-PCR检测阳性为1份,采集时间为发病后7 d,阳性率为4.76%.发病后2～9 d采集的21份血标本血清抗体检测结果均为阴性.结论 咽拭子、粪便可用于甲型H1 N1流感患者的早期诊断;咽拭子RT-PCR检测阳性的持续时间比粪便长,且呈现间歇排毒情况.甲型H1N1流感存在少量的病毒血症,早期血标本（发病后9 d内）不能检测到抗体.

Objective To explore the value of different types of samples, including throat swabs,stools,bloods in pandemic A（H1N1） influenza diagnosis and virus shedding patterns. Methods From May to June in 2009, 135 samples were collected from 23 confirmed eases of pandemic influenza A （H1N1）infection,including 99 throat swabs,14 stools,11 bloods, 1 respiratory tract washing from 13 confirmed cases and 10 blood samples from other confirmed cases. The virus was detected by real-time RT-PCR,the antibody was detected by haemagglutination inhibition assay. Results For 99 throat swabs of 13 patients,the median time of the first positive real-time RT-PCR was 1 day （ranged from 0 to 7 days） after the onset of the symptoms of illness; the median length of time duration of positive real-time RT-PCR results from throat swabs was 3 days （ranged from 1 to 15 days）. Four cases intermittently released virus. One respiratory tract washing sample was positive. In 14 stools,8 stools were real-time RT-PCR positive, the positive rate was 57. 14%. The median time of the positive real-time RT-PCR was 3 days （ranged from 1 to 4 days） after the onset of the symptoms of illness. In 21 blood samples collected at 2 to 9 days of onset,l blood sample was real-time RT-PCR positive, the positive rate was 4. 76%. All these 21 blood samples were antibody negative. Conclusion Throat swabs and stools samples can be used as A （H1N1） influenza early diagnosis. The length of time duration of positive real-time RT-PCR in throat swabs was longer than stool samples and intermittently releasing of virus were found in throat swabs. Influenza A H1N1 cases showed the presence of small amount of viremia and antibody was negative in early blood samples （〈9 days）.