住院儿童呼吸道合胞病毒A、B亚型与特异性抗体IgM、IgG和IgA的关系研究

Study on the relationship between respiratory syncytial virus subgroups A and B and specific IgM,IgG and IgA in hospitalized children

为探讨住院儿童呼吸道合胞病毒(respiratory syncytial virus,RSV)A、B亚型与特异性抗体IgM、IgG和IgA的相关性,以筛选具有早期辅助诊断意义的抗体指标,应用FQ-PCR筛选出50例住院儿童咽拭子RSV阳性标本。根据RSV的G蛋白编码基因核苷酸序列设计单管多重半巢式PCR引物进行基因分型(A、B亚型);采用ELISA检测患儿血清中的特异性抗体IgM、IgG和IgA并对结果进行分析。结果50例阳性患儿血清中IgM、IgG、IgA及三者同时出现阳性者百分率分别为24.0%(12/50)、60.0%(30/50)、22.0%(11/50)和16.0%(8/50),差异显著(P<0.05);RSV A、B亚型及混合感染率分别为82.0%(41/50)、14.0%(7/50)和4.0%(2/50),差异显著(P<0.05);A、B亚型及混合感染产生IgM的最快时间均为3d,7d内产生IgM阳性率分别为17.1%(7/41)、28.6%(2/7)和50.0%(1/2);IgA最快2d产生;A、B亚型及混合感染在急性喉气管支气管炎、支气管肺炎、急性支气管炎和急性上呼吸道感染中的感染率分别为100.0%(3/3)、100.0%(29/29)、47.1%(8/17)和100.0%(1/1),0.0%(0/3)、0.0%(0/29)、41.2%(7/17)和0.0%(0/1),0.0%(0/3)、0.0%(0/29)、11.8%(2/17)和0.0%(0/1),A亚型在4种疾病各组之间差异显著(P<0.05),B亚型在4种疾病各组之间差异显著(P<0.05),A、B混合感染在4种疾病各组之间差异不显著(P>0.05)。研究发现RSV A、B亚型与特异性抗体IgM、IgG和IgA无明显相关性;A、B亚型及混合感染最快产生IgM的时间较一致;IgA产生最早且不单独存在;RSV感染出现临床症状越久,3种抗体同时出现的概率越大,且均不适合作为早期辅助诊断的特异性指标;A亚型感染均能引起急性喉气管支气管炎、支气管肺炎、急性支气管炎和急性上呼吸道感染,混合感染并未加重临床症状,B亚型的致病力可能比A亚型弱。

To explore the correlation between respiratory syncytial virus（RSV）A,B subgroups and specific antibodies IgM,IgG and IgA in hospitalized children,we screened 50 cases of RSV-RNA positive patients through throat swab among hospitalized children by means of fluorescent quantitative polymerase chain reaction（FQ-PCR）.The genotyping was performed according to the nucleotide sequence of the gene encoding G protein of RSV,and a single tube multiplex semi nested PCR primers was designed for A,B subgroups.RSV specific antibodies IgM,IgG and IgA in the serum were detected by ELISA.This study found that there is no relationship between any subgroups of the virus and the three isotypes tested of the specific antibody.The time took for the onset of IgM was the same for infection by subgroup A and B alone or in combination.IgA was produced earliest and did not exist alone;the longer the clinical symptoms persist,the greater the probability of coexistence of the three isotypic antibodies.