EV71-IgM抗体检测在婴幼儿肠道病毒感染早期诊治和防控中的意义

Clinical significance of EV71-IgM antibody in early diagnosis,treatment and control of enterovirus infection in infants and young children

目的探讨EV71-IgM抗体检测在婴幼儿肠道病毒感染早期诊治和防控中的意义。方法对2017年4月1日—9月30日来蚌埠医学院第一附属医院就诊的发热和(或)皮疹的101例婴幼儿行血清胶体金法EV71-IgM抗体检测。据检测结果进行快速分诊,对阳性患儿进行消毒隔离,保护易感患儿,防止院内交叉感染;据阳性检测结果,并结合病史、临床表现等进行诊断;对确诊的病例行针对性治疗,并及时填报传染病报告卡行网络直报。对101例患儿按性别、年龄段和检测月份的不同进行分组,比较各组间EV71-IgM抗体阳性检出率有无差异。结果 101例患儿中EV71-IgM抗体阳性者17例,阳性检出率为16.83%。男性阳性检出率为20.69%(12/58),女性阳性检出率为11.63%(5/43),差异无统计学意义(χ~2=1.448,P>0.05);各年龄段间阳性检出率差异有统计学意义(χ~2=9.166,P<0.05);各月份均检出阳性病例,阳性检出率折线图呈现季节性趋势。对EV71-IgM抗体阳性患儿快速分诊和隔离,及时安排就诊,14例被确诊为EV71感染的手足口病;3例被确诊为EV71感染的疱疹性咽峡炎。3例较重患儿住院治疗,13例行门诊对症治疗,所有患儿均治愈,并均获门诊或电话随访,预后佳。14例确诊EV71感染的手足口病患儿的传染病疫情信息通过接诊医生工作站上传至医院预防保健科,完成网络直报,无漏报现象。结论 EV71-IgM抗体检测对早期诊断手足口病病原体有良好的应用价值,实现了早期识别肠道病毒EV71感染、早期预检分诊、早期诊断治疗和早期干预。

Objective To explore the significance of diagnostic kit for IgM antibody to human EV71 in early diagnosis, treatment and control of enterovirus infection in infants and young children. Methods The colloidal gold method EV71- IgM antibody test was performed in 101 infants and young children with fever and/or rash in our hospital between April and September, 2017. According to the test result, the triage, disinfection and isolation was conducted to control the source of infection, cut off the means of transmission, protect susceptible children, and avoid nosocomial cross infection. The targe- ted treatment was performed to the confirmed cases on the basis of test results, medical history and clinical manifestation. And the direct network reporting of infectious disease was also finished. A total of 101 cases were also grouped by ge, der, age of the patients and test month, the positive rate of EV71-IgM antibody was compared between each groups. Results There were 17 cases of EV71-IgM antibody positive in 10l patients, and the EV71 infection rate was 16.83% ; positive de- tection rate in male patients was 20.69% （12/58）, and in female patients was 11.63% （5/43）, with no statistically sig- nificant difference （χ2 = 1. 448 ,P 〉 0.05）. There was significant difference in positive detection rate between age groups （χ2 = 9. 166,P 〈 0. 05）. Positive cases were detected in each month, and the positive detection rate was a seasonal trend. The patients with positive EV71-IgM antibody were immediately separated and isolated. Fourteen cases were diagnosed as HFMD with EVT1 infection; 3 cases of herpes simplex laryngitis with EVT1 infection. Thirteen patients were treated in the outpatient clinic and 3 patients were hospitalized. All the positive children were cured and received outpatient or telephone follow-up, with good prognosis. The infectious disease epidemic situation of this 14 EVT1 infected children was uploaded to the hospital preventive and health department. The cases were classified as laboratory confirmed cases. Conclusion EV71-IgM test can promote the early identification of EV71 infection, early screening, early diagnosis and treatment and early intervention, which shows a good application value for early diagnosis of HFMD.