上海市2012年第2、3季度成人麻疹患者临床及免疫学特点分析

Analysis of clinical and immunological features of adult measles patients in Shanghai during second and third quarter of 2012

目的:探讨上海市2012年第2、3季度成人麻疹患者的临床及免疫学特点。方法:采集本中心感染二科收治患者的年龄分布、接种史、接触史等一般资料,对主要症状、体征、并发症及免疫学指标[出疹至麻疹免疫球蛋白(Ig)M抗体阳性时间间隔、细胞免疫和体液免疫等实验室检查]进行统计分析。结果:期间共收治79例成人麻疹患者,以有麻疹疫苗接种史(84%)、没有明确接触史(80%)者居多。大多数患者存在麻疹的典型临床表现,出疹至麻疹IgM抗体阳性时间间隔平均(5.8±0.2)d,部分患者存在咽炎、肺炎、肝功能损害等并发症,绝大多数患者为轻-中型,无死亡病例。患者平均白细胞总数为(5.0±0.2)×109/L,平均CD4+T淋巴细胞(CD4细胞)计数为(252.1±27.5)个/μL,平均CD4/CD8淋巴细胞比值为1.2±0.1,平均C反应蛋白(CRP)水平为(30.2±2.9)mg/L。相关性分析显示:年龄与白细胞总数呈负相关。CRP水平与白细胞总数呈正相关,与CD4细胞计数、CD4/CD8淋巴细胞比值呈负相关。CRP明显升高、白细胞总数的升高、CD4细胞计数明显降低、CD4/CD8淋巴细胞比值明显降低,均提示病情较严重。结论:目前上海市成人麻疹流行以散发为主。患者存在不同程度的实验室指标异常,突出表现在体液免疫指标CRP水平的上升及细胞免疫指标CD4细胞的下降。

Objective To analyze the clinical and immunological features of adult measles patients hospitalized in Shanghai Public Health Clinical Center during second and third quarter of 2012.Methods All adult measles patients hospitalized were surveyed and analyzed with respect to epidemiological features such as age distribution,vaccination history and contact history,clinical features such as main clinical signs,symptoms and complications,and immunological features such as the interval between occurrence of rash and appearance of Immunoglobulin（Ig）M antibody,cellular immunity and humoral immunity parameters.Results A total of 79 adult patients with measles were hospitalized in department of infectious disease.Most of the cases（84%） had a vaccination history and the majority（80%） denied a clear contact history.Typical clinical manifestations of measles were seen in the majority of cases.The average rash to IgM antibody interval was（5.8±0.2） d,some patients suffered from complications such as pharyngitis（22%）,pneumonia（41%）,conjunctivitis（66%） and liver function damage（57%）.Most of the patients suffered from a mild to moderate disease,and there were no deaths.Average leucocyte count was（5.0±0.2）×109/L,average CD4 lymphocyte count was（252.1±27.5） cell/ mL,average CD4/CD8 lymphocyte ratio was 1.2±0.1 and average C reactive protein（CRP） level was（30.2±2.9） mg/L.Correlation analysis showed that a negative correlation was seen between age and leucocyte counts,CRP level and CD4 lymphocyte counts,CRP level and CD4/CD8 lymphocyte ratio,and a positive correlation was seen between CRP level and leucocyte count.Elevated CRP level,elevated leucocyte count,decrease in CD4 lymphocyte counts and decrease in CD4/ CD8 positive lymphocyte ratio denoted a more severe disease course.Conclusions Most of the adult measles patients in Shanghai found during second and third quarter of 2012 were sporadic cases.The main abnormalities in laboratory index were elevation of CRP level denoting an activated humoral immunity and decrease of CD4 lymphocyte counts denoting impaired cellular immunity.