重症甲型H1N1流感病毒基因与特异性抗体检测的诊断意义

Clinical diagnostic significance of tests of viral genes and specific antibodies for severe H1N1influenza A

目的：探讨重症甲型 H1N1流感患者中甲型H1N1流感病毒RNA和特异性抗体的诊断价值。方法收集2009年10月－2010年3月医院45例甲型 H1N1流感住院患者的鼻咽拭子和血清各64份，采用巢式 RT‐PCR、血凝抑制法检测不同时期甲型 H1N1流感患者咽拭子中的甲型 H1N1 RNA、血清中的特异性抗体。结果甲型H1N1流感患者咽拭子中新型甲型 H1N1流感病毒、通用病毒IV‐NP、流感通用病毒IV‐MRNA阳性率，分别为51．11％、88．89％、93．33％，特异性抗体的阳性率为68．89％，抗体效价均＞1∶320，其中14份样品抗体效价＞1∶5120；两种方法检测均阳性占20．00％，单独抗‐甲型 H1N1阳性48．89％，单独甲型 H1N1 RNA阳性31．11％，两者联合会提高H1N1检出率；45例甲型 H1N1流感患者不同时期采取的血清及咽拭子数共有64份，在发病1～7 d组抗‐甲型H1N1、甲型H1N1RNA检出率RNA阳性率分别为26．09％、86．96％，在发病8～13 d组及14～30 d组抗‐甲型 H1N1、甲型 H1N1RNA 检出率 RNA 阳性率分别为64．00％、4．00％及87．50％、12．50％。结论甲型H1N1流感病毒RNA和抗‐甲型 H1N1流感病毒特异性抗体均可用于甲型 H1N1流感的诊断，甲型H1N1流感病毒RNA多存在于感染早期，抗‐甲型H1N1多在病后1周检测出，两者相结合可提高甲型H1N1流感病毒的检出率。

OBJECTIVE To explore the diagnostic significance of RNA of H1N1 influenza A virus and specific antibodies for H1N1 influenza A .METHODS Totally 64 nasopharyngeal swab samples and 64 serum samples from 45 patients with severe H1N1 influenza A during Oct .2009 to Mar .2010 were collected .The specific antibody in the serum samples and the H1N1 RNA in the nasopharyngeal swab at different stages were detected by the blood clots suppression method and the nest‐RT‐PCR assay .RESULTS The detection rate of H1N1 influenza virus A , universal virus IV‐NP ,and influenza universal IV‐MRNA was 51 .11% ,88 .89% and 93 .33% respectively .The positive rate of the specific antibody was 68 .89% and all the antibody titer was more than 1∶320 .The antibody titer was more than 1∶5120 in 14 of the total samples .The positive rate for tests by both methods was 20 .00% , the positive rate for single test of H1N1 influenza A antibody was 48 .89% and the positive rate for single test of H1N1 influenza A RNA was 31 .11% .The combination use of the two test methods would increase the H1N1 detection rate .Totally there were 64 samples of serum and nasopharyngeal swabs from the 45 patients with H1N1 influenza A at different periods .For these samples ,the positive rate of H1N1 influenza A antibody and RNA was 26 .09% and 86 .96% respectively at 1-7 d of onset ,64 .00% and 4 .00% respectively at 8-13 d ,87 .50% and 12 .50% respectively at 14 -30 d .CONCLUSION The detection of RNA of H1N1 influenza A virus and the detection of the specific antibody could be used in the diagnosis of H1N1 influenza A .The RNA of H1N1 influenza A virus mainly exists in the early stage of influenza infection and the serum antibody is mainly detected at 1 week after onset .Combination use of the two detections could increase the detection rate of H 1N1 influenza virus .