多发性肌炎/皮肌炎患者肠道病毒核糖核酸和中和抗体的检测及其意义

Detection of Enterovirus RNA and Neutralizing Antibody in Patients with Polymyositis/Dermatomyositis and Its Clinical Significance

目的 探讨肠道病毒感染在多发性肌炎 /皮肌炎 (PM/DM)发病机理中的作用和意义。方法 用逆转录聚合酶链反应 (RT PCR)和中和试验分别检测 16例 PM/DM患者和 10例正常人对照组外周血中肠道病毒核糖核酸 (RNA)和抗体滴度。结果 16例 PM/DM患者中肠道病毒核糖核酸检出率为 50.0％，病毒中和试验中和抗体阳性率为 12.5％。正常人对照组中，仅 1例测到肠道病毒 RNA，中和试验均阴性。在有肌肉酸痛症状的患者 (11例 )中，肠道病毒 RNA的阳性率为 72.73％，明显高于中和抗体的阳性率 (18.18％ )；肠道病毒 RNA阳性组肌酸磷酸激酶 (CPK)升高率显著高于阴性组 (P0.05)；中和抗体阳性组与阴性组上述指标相比，差异均无显著性 (P >0.05)。结论 肠道病毒核糖核酸在 PM/DM患者中检出率高；并且在肌肉酸痛和 CPK升高的患者中，其阳性率也高，两者之间有一定内在联系。

Objective To investigate the role of enterovirus ribonucleic acid (RNA) and its neutralizing antibody in the pathogenesis of polymyositis/dermatomyositis (PM/DM) and the clinical significance of it. Methods Applying reverse transcriptase polymerase chain reaction (RT PCR) to semiquantitatively analyse the enterovirus RNA and using neutralization test to detect the neutralizing antibody in peripheral blood from 16 PM/DM patients and 10 normal individuals. Results The positive rates of enterovirus RNA and neutralizing antibody in 16 PM/DM patients were 50.0％ and 12.5％ respectively, and in 10 normal individuals were 10.0％ and 0 respectively. In 11 patients of PM/DM with muscular pain , the positive rates of enterovirus RNA were 72.73％ , higher than that of neutralizing antibody test (18.18％ ). The elevated creatine phosphokinase (CPK) were seen more frequently in those patients with positive enterovirus RNA than those with negative enterovirus RNA (P=0.012). And there were no statistically significant difference between positive neutralizing antibody test group and the negative group in CPK、 AST、 LDH and electromyography (P >0.05). Conclusions the positive rates of enterovirus RNA in PM/DM patients are high, which is related to the elevation of CPK and muscular pain. These suggest that the infection of enterovirus may play a role in the pathogenesis of PM/DM.