EB病毒血清学联合DNA定量检测在诊断婴儿传染性单核细胞增多症中意义.docVIP

EB病毒血清学联合DNA定量检测在诊断婴儿传染性单核细胞增多症中意义 　　[摘要] 目的 评估EB病毒抗体VCA-IgM、VCA-IgG、EA-IgG、EBNA-IgG及EBV-DNA载量检测在婴儿传染性单核细胞增多症（IM）中的诊断意义。 方法 用ELISA法检测78例IM患儿血清中EBV四种抗体及PCR荧光定量法检测外周血单个核细胞EBV-DNA载量。 结果 在IM急性期VCA-IgM阳性率在1岁患儿中为27.8%，而≥4岁组患儿中为83.3%。有近20% 1岁患儿所有EBV抗体均阴性，需重复做抗体测定。EBV-DNA载量检测总阳性率为70.5%，1岁患儿中阳性率为61.1%，1岁组患儿中有5例，在1岁组患儿中3例早期检测VCA-IgM抗体是阴性，而EBV-DNA载体是阳性的，但在后来的VCA-IgG检测均是阳性的。结论 在婴儿期IM急性阶段，只用血清学方法来诊断不够灵敏，建议在VCA-IgM阴性的患儿中联合EBV-DNA载量检测，以提高婴幼儿IM临床诊断的敏感性。 　　[关键词] EB病毒；传染性单核细胞增多症；EBV抗体；EBV-DNA 　　[中图分类号] R466.6 [文献标识码] B [文章编号] 1673-9701（2014）11-0056-03 　　[Abstract] Objective To evaluation the diagnosis sensitivity of Epstein-Barr virus（EBV） DNA load and four antibodies（VCA-IgM、VCA-IgG、EA-IgG、EBNA-IgG） in infantile infectious mononucleosis（IM）. Methods EBV DNA loads of peripheral blood samples from 78 pediatric IM patients were analyzed by fluorescence quantitative polymerase chain reaction（PQ-PCR） as well as Elias method to detect the four antibodies in the serology. Results The anti-viral capsid antigen-IgM（anti-VCA-IgM） positive rate in the acute phase was only 27.8% in infants but 83.3% in patients ≥4 years of age. Nearly twenty percent of the infants were negative for all anti-EBV antibodies and required repeated serologic tests. The total positive rate of EBV-DNA load was 70.5% and the positive rate of the infants of 1 year old was 61.1%.Five of 1 year old and three of 1 year old seronegative infants with IM symptoms were positive in EBV - DNA load during acute phase were eventually considered as having IM on anti-VCA-IgG seroconversion thereafter. Conclusion It is not sensitive enough to diagnose IM in the infants with serologic test alone. It is proposed that the EBV-DNA load is also evaluated in peripheral blood mononuclear cells when infants presenting with IM symptoms which are negative for anti-EBV antibodies during the acute phase to increase the diagnostic sensitivity of IM in infants. 　　[Key words] Epstein-Barr virus； Infectious mononucleosis； Epstein-Barr virus an