肠病毒EV71-IgM抗体与核酸检测在手足口病诊断中的价值

Value of detection of enterovirus EV71-IgM and EV71-RNA in diagnosis of hand-foot-mouth Disease

目的对2010年本院手足口病病例进行EV71核酸与EV71-IgM抗体检测,比较两方法的阳性符合率,评价抗体与核酸检测的临床诊断价值和两检测方法在诊断手足口病的互补性与意义。方法分别用RT-PCR方法与酶联免疫方法检测EV71-RNA和EV71-IgM抗体,选取其中住院60例核酸阳性并已同时进行血清学抗体检测的患者进行研究,结合病历资料,分析临床症状出现与抗体产生的时间关系。结果对临床320例病例分别进行抗体与核酸检测,两方法的阳性率分别为15.8%和32.9%;60例核酸阳性的患者,有49例检出抗体阳性,两种方法的阳性符合率是81.7%(49/60);此49例患者临床症状均较轻,多在出现低热、部分皮疹后2～3d才入院;而核酸阳性抗体阴性的11例病例,均为出现手、足、口、臀皮疹12h～1d入院的患者,多以高热病重急诊入院,此时抗体尚未产生,入院后2～3d均进行了抗体检测为阳性。结论核酸与抗体检测在EV71型手足口病中有重要临床诊断价值,两种方法同时检测具有较好的互补效果。对未能开展核酸检测的基层医院,可选用血清学方法检测抗体,对诊断和防控EV71型肠病毒感染引起的手足口病有重要意义。

Aim To explore the evaluation of EV71-IgM and EV71-RNA in diagnosis of hand-foot-mouth Disease （HFMD）and compare the coincidence rate of positive rate of RT-PCR an ELISA.Methods RT-PCR methods and the ELISA method were used for detection of EV71-RNA and EV71-IgM antibodies in 60 nucleic acid-positive inpatients with known serum antibody results at the same time were detected.In addition,the correlation of appearance time clinical symptoms time with the time of antibody production was also anlayzed.Results There 320 clinical cases were detected by ELISA and RT-PCR respectively with the positive rate of 15.8%and 32.9%.Out of the 60 DNA-positive patients,49 were positive for EV71-IgM and the coincidence rate of the two methods was 81.7%（49/60）.The clinical symptoms of the 49 cases were mild,mostly with low fever,part of the hospitalized ones were admitted 2～3days after appearance of rash. There were 11 and nucleic acid-positive antibody-negative cases and they were admitted to hospital 12～24hours after appearance of rash on hand,foot,mouth,hip rash and most of them had high fever and at serious condition when antibody did not generate but they were all positive for antibody2-3days after admission.Conclusion Detection of DNA and antibody in type EV71 HFMD patients is of important clinical value and simultaneous detection of EV71-IgM and EV71-RNA by two methods can enhance the positive rate,especially suitable for hospitals at grassroots level without capacity for DNA test.