亚临床型生殖器疱疹脱排病毒及药物干预的临床研究

Relationship between the asymptomatic shedding of subclinical genital herpes virus, serum antibodies test and medication interventions

目的:探讨亚临床型生殖器疱疹患者不同状态下无症状排毒情况及与药物干预的相关性。方法:收集亚临床型生殖器疱疹患者580例,分别用酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)和荧光定量聚合酶链式反应(fluorescent quantitation polymerase chain reaction,FQ-PCR)检测亚临床型生殖器疱疹患者体内血清抗体(HSV-IIgG、IgM及HSV-II IgG、IgM)的分泌情况,分析比较患者不同病程、不同复发频率和有无抗体产生等多种状态下及药物干预后HSV病毒脱排情况。结果:入选的580例患者中,排毒阳性299例(51.6%),DNA质粒数为81-9.9×103copies/ml,平均3.8×103copies/ml。病程超过3年的患者与小于3年的患者比较,排毒阳性率的差异有统计学意义(χ2=6.7271,P<0.01)。频发患者(每年复发频率大于6次)与少发患者比较,差异有显著的统计学意义(χ2=11.4140,P<0.01)。血清抗体阳性组HSV脱排病毒阳性率明显低于血清抗体阴性组,差异有显著的统计学意义(χ2=37.8977,P<0.01)。对299例排毒阳性患者进行药物干预,盐酸伐昔洛韦片(A组)、阿昔洛韦咀嚼片(B组)与对照组比较均有显著性差异(P<0.01),停药后与对照组比较无统计学意义(P>0.05)。结论:亚临床型生殖器疱疹患者HSV病毒脱排率高达51.6%,病程越长者、复发频率越少者、血清中存在相关抗体者,其排毒检测阳性率越低,此时患者的传染性越小,且排毒阳性患者用药干预后能明显抑制HSV脱排。

Objectives： To study the relationship between the asymptomatic shedding of strbclinical genital herpes virus, serum antibodies test and medication interventions. Methods： We used enzyme -linked immunosorbent assay （ELISA） to detect the serum antibodies （HSV- I IgG, IgM, HSV -II IgG, IgM）, and fluorescent quantitation polymerase chain reaction （FQ - PCR） to detect the asymptomatic shedding of the 580 cases of subclinical genital herpes patients, which with different courses, different recurrence frequencies and presence of antibodies and the changes while treated with drugs. Results： Among the total 580 cases, 299 cases （51.6%） were HSV shedding positive, with DNA plasmids from 81 copies/ml to 9. 9 x l0s copies/ml and an average of 3. 8 ~ 103 copies/ml. There were significant differences between HSV shedding occurrence rates of patients who had been ill for over three years and of patients who had been ill for less than three years （X2 = 6. 7271, P 〈 0. 01 ）. There were sig- nificant difference between patients with more than six annual occurrence and patients with less than six annual occurrence （X2 = 11. 4140, P 〈 0. 01）. HSV shedding occurrence rate in those with serum antibodies positive was significant lower than that in those with serum antibodies negative （X2 = 37. 8977, P 〈 0. 01 ）. Conclusion： The asymptomatic shedding rate of subclinical genital herpes is up to 51.6%. Those who have longer duration, less frequency of recurrence, and positive antibodies are less likely to be HSV shedding test positive. Viruses in these patients are less likely to infect other people. Medication interventions can significantly inhibit the shedding of HSV.