发热伴血小板减少综合征临床误诊3例患者的病原及免疫学检测与鉴定.pdfVIP

江医学2013 年第35 卷第24 期 发热伴血小板减少综合征临床 误诊3 例患者的病原及免疫学 检测与鉴定 俞丹凤 王忠发 李世波 陈国水 王秋景 【摘要 】 目的 探讨发热伴血小板减少综合征易被误诊的原因。 方法 采用间接免疫荧光法检测患者急性期与恢复期血清 中新布尼亚病毒IgG 抗体，荧光RT-PCR 检测新布尼亚病毒RNA 及S、M、L 3 个特异性基因鉴定，新布尼亚病毒核酸测序及比对分 析。 结果 2 例误诊患者的血清中IgG 抗体效价恢复期较急性期增高4 倍以上，3 例患者的急性期血清中均能检测到新布尼亚病毒 核酸及3 个特异性基因，S 基因序列比对均为新布尼亚病毒，重症患者与轻症患者的基因序列有一定的差异。 结论 通过病毒特异 性基因鉴定、序列比对分析以及双份血清新布尼亚病毒IgG 抗体效价检测，3 例临床误诊的患者均为由新布尼亚病毒感染引起的发热 伴血小板减少综合征。 【关键词】 临床误诊 发热伴血小板减少综合征 病原学鉴定 同源性分析 Pathogenic identification for three misdiagnosed cases of fever with thrombocytopenia syndrome China 【Abstract 】 Objective To identify the pathogen of misdiagnosed cases of fever with thrombocytopenia syndrome. Methods Blood samples were collected from 3 misdiagnosed cases of fever with thrombocytopenia syndrome in acute and convalesce phases. The serum levels of virus-specific IgG antibody were detected with indirect immunofluorescence assay, and the viral RNA and three segments L(large), M(medium), and S(small) was detected with fluorescent reverse-transcription polymerase chain re- action (RT-PCR) assay. The pathogen was characterized by nucleic acid sequencing and comparative analysis. Results The serum IgG antibody titer in convalesce phase was increased more than 4 times than those of acute phase in 2 misdiagnosed cases. The virus nucleic acid and three specific genes were detected in acute phase serum of 3 cases. S gene sequence alignment was confirmed novel Bunia virus; there were some differences in gene sequences between severe cases and mild cases. Conclusion We confirmed that three misdiagnosed cases of fever with thrombocytopenia syndrome were infected with novel Bunia virus. 【Key words 】 Misdiagnosis Fever with thrombocytopenia syndrome Etiological identification Homology analysis 2010 年9 月至2011 年3 月我国先后有6 个省份 发热、血小板、血白细胞减少、腹痛等症状，2 例患者临 出现发热伴血小板减少综合征（severe fever with throm原 床表现为轻症，