SARS-CoV-2 IgG和IgM抗体在诊治新型冠状病毒肺炎的应用价值

Application value of SARS-CoV-2 IgG and IgM antibodies in diagnosis and treatment of new coronavirus pneumonia

目的探讨化学发光法检测SARS-CoV-2 IgM/IgG抗体在辅助诊疗新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)中的应用价值。方法将203例COVID-19确诊患者作为确诊组,158例其他科室的非COVID-19患者和50例正常献血者共208例作为对照组,采用化学发光的方法进行检测。结果SARS-CoV-2 IgG抗体检测的临床灵敏度、特异性、阳性预测值、阴性预测值分别为85.7%、99.0%、98.8%、87.6%;SARS-CoV-2 IgM抗体检测的临床灵敏度、特异性、阳性预测值、阴性预测值分别为66.5%、98.0%、97.1%、75.0%;SARS-CoV-2 IgG和IgM抗体联合检测的临床灵敏度、特异性、阳性预测值、阴性预测值分别为89.6%、96.8%、97.3%、87.9%;SARS-CoV-2 IgG和IgM抗体在检出率无统计学差异的情况下,重症组距离发病日期的平均检测时间为10.8(10.8±4.1)d,早于轻症组的13.3(13.3±6.4)d,差异有统计学意义(P=0.017);IgG阴性组的中位检测时间为发病后7.0(5.0~12.0)d,早于IgG阳性组的13.5(10.0~17.0)d,差异具有统计学意义(P=0.0001);IgM阴性组的中位检测时间为发病后11.0(6.0~16.0)d,早于IgM阳性组的14.0(10.0~17.0)d,差异具有统计学意义(P=0.016)。结论化学发光法检测新型冠状病毒IgM和IgG抗体的方法具有较好的特异性和敏感性,可辅助诊断COVID-19,弥补病毒核酸检测的不足;检测时间是影响抗体结果的主要因素,较早检出SARS-CoV-2 IgM/IgG抗体可能预示着病情更加严重。

Objective To explore the application value of chemiluminescence detection of SARS-CoV-2 IgM/IgG antibodies in the adjuvant diagnosis and treatment of coronavirus disease 2019(COVID-19).Methods A total of 208 COVID-19-confirmed patients admitted in the Acute Pneumonia Section of Chongqing Three Gorges Central Hospital from January 23 to March 3,2020 were recruited and served as the confirmed group,and another 208 cases,including 158 non-COVID-19 patients from other departments and 50 health volunteers as blood donors were subjected as the control group.Chemiluminescence assay was used for detection of the antibodies.Results The results showed that the clinical sensitivity,specificity,positive predictive value,and negative predictive value for SARS-CoV-2 IgG antibody were 85.7%,99.0%,98.8%,and 87.6%,respectively.While the above values for SARS-CoV-2 IgM antibody were 66.5%,98.0%,97.1%,and 75.0%,respectively.And these values were 89.6%,96.8%,97.3%,and 87.9%,respectively,when the 2 antibodies combined together.There was no statistical difference in the detection rate of SARS-CoV-2 IgG and IgM antibodies.The average detection time from the date of onset was 10.8(10.8±4.1)d in the severe group,statistically earlier than that in the mild group[13.3(13.3±6.4)d,P=0.017].The median detection time of the IgG negative group was 7.0(5.0~12.0)d after onset,earlier than 13.5(10.0~17.0)d of the IgG positive group,with statistical difference(P=0.0001);while,the median time of the IgM negative group was 11.0(6.0~16.0)d after onset,earlier than 14.0(10.0~17.0)d in the IgG positive group(P=0.016).Conclusion Chemiluminescence assay for detection of SARS-CoV-2 IgM and IgG antibodies has good specificity and sensitivity,and can help diagnose COVID-19,by making up the shortcomings of viral nucleic acid test.The detection time is the main factor affecting the results of antibody test,and early detection of SARS-CoV-2 IgM/IgG antibodies may indicate a more serious illness.