发热伴血小板减少综合征患者血清中核蛋白抗体的动态变化

Dynamic Changes of Nucleoprotein-specific Antibodies in the Serum of Patients with Sever Fever With Thrombocytopenia Syndrome

目的:观察新发传染病发热伴血小板减少综合征(SFTS)的病原体新型布尼亚病毒(SFTSV)核蛋白(NP)IgM和IgG型抗体在SFTS患者外周血中的变化规律,为疾病的早期诊断和发病机制的认识提供依据。方法:用ELISA方法检测28例SFTS患者不同病程阶段血清中NP特异性IgM、IgG抗体。结果:①28例SFTS患者中,IgM阳性检出率为89.3%(25/28),IgG阳性检出率为85.7%(24/28)。②IgM和IgG均在发病5天后开始出现,随着病程延长血清中抗体水平逐渐上升,其峰值出现在发病2周左右。③死亡组患者的抗体检出时间迟于痊愈组患者,且抗体水平低下。结论:①在SFTSV感染早期,SFTS患者血清中NP特异性抗体IgG和IgM的变化趋势一致,NP特异性抗体IgG和IgM一样是SFTS早期诊断的重要指标。②因疾病严重而死亡的患者,抗体出现延迟、抗体水平低下可能与患者细胞免疫系统严重受损及多脏器功能障碍有关,致使机体体液免疫应答减退或应答无能。③抗体出现延迟且抗体水平低下可能是病情严重患者预后不良的预测指标。

Objective：To observe the change of IgM and IgG antibodies against nucleoprotein（NP） of severe fever with thrombocytopenia syndrome virus（SFTSV） in the peripheral blood of patients with severe fever with thrombocytopenia syndrome（SFTS）,which is an emerging infectious disease,aiming to provide the basis for the early diagnosis and mechanism of the disease.Methods：NP-specific IgM,IgG antibodies were tested by ELISA.Results：① In 28 cases of SFTS patients,IgM-positive rate was 89.3 %（25/28）,and IgG-positive rate was 85.7 %（24/28）.② IgM and IgG appeared around the fifth day after the onset of the disease.A clear upward trend was observed with the extended duration of disease,and the antibodies level reached a peak in about two weeks after disease onset.③Compared with the cured groups,both positive rate and antibody level of IgM and IgG were lower and the detection time of positive IgM or IgG is latter.Conclusion：① NP-specific IgG showed the similar trend with IgM in the early days of disease,and NP-specific IgG is also the early diagnostic indicators of SFTS as NP-specific IgM.② NP-specific IgM and IgG in critically ill patiens might appear in a delayed way or in a low level,which may be related to diminished humoral immunoresponse or immune anergy resulted from the severely damaged cellular immune system and multiple organ dysfunction.③ Delayed-appearing antibody and low antibody levels may be a predictor of poor prognosis in patients with serious SFTS.