登革热不同病程中核酸、NS1抗原及IgM/IgG抗体测定的价值

Significance of viral nucleic acid,NS1 antigen and Ig M / Ig G antibody detection in different stages of dengue fever

目的探讨核酸、NS1抗原和IgM／IgG抗体在登革热（DF）不同病程中的检测价值，为合理选择DF检测项目提供科学依据。方法以开始发热为病程第1天，收集138例DF住院患者不同病程的血清标本共254例，以实时荧光PCR法检测登革病毒核酸，免疫层析法分别检测登革病毒特异性NS1抗原和IgM／IgG抗体，分析这4个指标在DF不同病程中的诊断价值。结果核酸总阳性率为78．7％，其中第1-5天核酸阳性率均为100％，第6天开始下降；NS1总阳性率为85．4％，第1～8天均大于80％，第9天开始降低；IgM抗体总阳性率为68．9％，从第3天开始检出，第5天以后大于80％；IgG抗体总阳性率为28．7％，第1～7天阳性率均低于20％，第8天开始迅速升高。第1～8天核酸联合NS1检测阳性率均为100％，第7天开始NS1联合IgM／IgG检测阳性率为100％。结论核酸、NS1和IgM／IgG抗体分别适用于病程早期、中期和后期的检测，而病程早中期核酸联合NS1、后期NS1联合IgM／IgG可以实现100％的检出率。

Objective To investigate the significance of viral nucleic acid （vRNA）, NS1 antigen and IgM/IgG antibody detection in different stages of dengue fever （DF）, and then provide the evidence for selecting reasonable detection markers to diagnose DF. Meh- tods Presumed day of onset was defined from the first day of presenting fever. 254 serum samples from different courses of 138 hospi- talized DF patients were collected, and vRNA, NS1 antigen and IgM/IgG antibody in serum were detected by real-time PCR and an im- munochromatographic method, respectively. The diagnostic value of each marker was evaluated. Results Total positive rate of vRNA was 78.7% , and it was 100% before day 5 and decreased at day 6. Total positive rate of NS1 antigen was 85.4% , and it was above 80% before day 8 and decreased at day 9. Total positive rate of IgM was 68.9%, and it was detected at day 3, and increased quickly to over 80%. Total positive rate of IgG was 28.7%, and it was below 20% before day 7 and increased at day 8 quickly. Positive rate of combinational detection of NS1 antigen and vRNA was 100% between day 1 and day 8, and positive rate of combinational detection of IgM/IgG and NS1 antigen was 100% at day 7. Conclusion vRNA, NS1 and IgG/IgM are suitable for the early, middle and late stage diagnosis of DF, respectively. Combinational detection of NS1 and vRNA may be used for the early and middle stages diagnosis of DF and combinational detection of NS1 and IgM/IgG for the late stage diagnosis of DF.