120例儿科患儿微小病毒B19感染的近期研究

目的 探讨人类微小病毒B19（HPVB19）在儿科疾病中的感染状况.方法 应用巢式聚合酶链反应的方法（PCR）以及ELISA法,对120例患儿（观察组）及40例随机挑选本院门诊健康体检儿童（对照组）血浆中微小病毒B19-DNA以及B19-VP2-IgM检测.结果 120例患儿（观察组）B19-DNA检测总阳性检出率为31.7%（38/120）,40例健康儿童（对照组）B19-DNA检测均为阴性,两组比较有显著差别（P＜0.005）.其中特发性血小板减少性紫癜（ITP）和心肌炎阳性检出率最高,分别为40%（12/30）和37.1%（13/35）.120例患儿（观察组）B19-VP2- IgM总阳性检出率31.7% （38/120）,40例健康儿童（对照组）B19-DNA检测均为阴性,两组比较有显著差别（P＜0.005）,B19 DNA和B19 VP2 IgM一致率为100%.40例健康儿童（对照组）B19-VP2- IgM均为阴性,两组比较有显著差别（P＜0.005）.结论 儿童对B19有较高的感染率,尤其ITP和心肌炎患儿与B19感染关系更为密切.     

乌鲁木齐地区孕妇人细小病毒B19与TORCH感染的比较

目的了解我区孕早期妇女TORCH及人细小病毒B19的感染情况.方法用ELISA法检测185例孕早期妇女血清中特异性 TORCH/HPVB19-IgM抗体.结果感染率分别为弓形体(TOX)2.16%,风疹病毒(RV)1.62%,巨细胞病毒(CMV)1.62%,单纯疱疹病毒Ⅱ型(HSV-Ⅱ)1.08%,人细小病毒B19(HPVB19)8.11%,其HPVB19-IgM抗体阳性率与TORCH各项相比,差异有显著的统计学意义(P＜0.01).结论我区孕妇中人细小病毒B19新近感染率明显高于其它TORCH各项病原体的新近感染率,有必要把HPVB19列入TORCH监测项目中,以提高妊娠质量.     

肌钙蛋白I与磷酸肌酸同功酶在病毒性心肌炎检测中的临床诊断价值探讨

目的了解肌钙蛋白I(cTnI)和磷酸肌酸同功酶(CK-MB)检测在病毒性心肌炎中的临床应用价值.方法对临床确诊为柯萨奇B组病毒感染的48例病毒性心肌炎患者检测cTnI和CK-MB.结果cTnI阳性37例(77.08%),而CK-MB阳性13例(27.08%)(p<0.001).结论cTnI是心肌细胞受到病毒性损伤的可靠的特异性诊断指标.     

肌钙蛋白I与磷酸肌酸同功酶在病毒性心肌炎检测中的临床诊断价值探讨

目的了解肌钙蛋白I(cTnI)和磷酸肌酸同功酶(CK-MB)检测在病毒性心肌炎中的临床应用价值.方法对临床确诊为柯萨奇B组病毒感染的48例病毒性心肌炎患者检测cTnI和CK-MB.结果 cTnI阳性37例(77.08%),而CK-MB阳性13例(27.08%)(p＜0.001).结论 cTnI是心肌细胞受到病毒性损伤的可靠的特异性诊断指标.     

育龄妇女TORCH感染的诊断指标及其临床意义

目的　探讨TORCH血清学检测各指标在诊断TORCH感染中的应用。方法　收集 10 80例育龄妇女外周血血清标本分别应用ELISA捕获法检测TORCH -IgM、ELISA双抗体夹心法定量检测TORCH -IgG以及PCR技术检测 2 0 6例HCMV -IgM阴性且HCMV -IgG阳性标本的HCMV -DNA。结果　TOXO -IgM阳性率为 1.76 % (16 /90 9) ,RV -IgM阳性率为 0 .33% (3/90 2 ) ,HCMV -IgM阳性率为 1.6 4 % (16 /930 )。TOXO -IgG为 3.74 % (34/90 8) ;RV -IgG为 6 7.0 7%(6 0 5 /90 2 ) ;HCMV -IgG为 91.0 6 % (84 5 /92 8)其阳性率接近国内有关文献报道。HCMV -IgG(+)组和HCMV -IgG(++)组的DNA阳性率分别为 1.39%和 1.5 0 % ,HCMV -IgG(+++)组的DNA阳性率为 7.35 % ,HCMV -IgG阳性 (+)组和HCMV -IgG阳性 (++)组HCMV -DNA的阳性率无显著性差异 (P >0 .0 5 ) ;HCMV -IgG阳性 (+)组和HCMV -IgG阳性(++)组与HCMV -IgG阳性 (+++)组HCMV -DNA的阳性率均有显著性差异 (P <0 .0 5 )。结论　捕获法检测血清TORCH -IgM特异性高 ,假阳性率低 ,是可靠的辅助的诊断指标之一。在HCMV -IgG滴度较高时 ,提示有HCMV近期感染的可能。     

缺血修饰白蛋白与血清心肌肌钙蛋白I对小儿病毒性心肌炎的诊断价值

目的：探讨缺血修饰白蛋白与血清心肌肌钙蛋白I对小儿病毒性心肌炎的诊断价值。方法选择2012年1月~2013年12月在我院收治的小儿病毒性心肌炎患儿73例作为观察组。选取同期健康体检小儿70例作为对照组。入院后30 min内与治疗7 d内测定cTnI、CK-MB及IMA。结果观察组血清cTnI、血清CK-MBI显著高于对照组,且有显著性差异(<0.05);观察组IMA高于对照组,且有显著性差异(>0.05);IMA灵敏度较cTnl、CK-MB高,cTnI特异度较IMA、CK-MB高。结论 cTnI在小儿病毒性心肌炎诊断中具有一定特异性的一项重要指标,而检测IMA对于早期诊断以及疗效判断病毒性心肌炎患儿具有重要的临床价值,值得研究推广。     

儿童抽动障碍与微小病毒B19感染和免疫功能

目的:探讨抽动障碍(TD)与人微小病毒B19(HPV-B19)、巨细胞病毒(CMV)、A型链球菌感染和免疫功能的关系及其临床意义。方法:采用酶联免疫吸附法测定60例TD患儿血清HPV-B19-IgM,CMV-IgM,采用凝集反应测定抗链球菌溶血素“O”抗体滴度(ASO),并行血常规、免疫功能检查。对照组为20例正常儿童。结果:60例TD患儿中有14例(23·3%)HPV-B19-IgM阳性,而健康儿童均为阴性(χ2=5·67,P<0·05)。两组儿童CMV-IgM阳性率、ASO滴度及外周血血红蛋白、白细胞计数和血小板数及体液免疫(IgA、IgG、IgM)比较差异无统计学显著性。细胞免疫功能检测CD4 细胞百分比、CD4 /CD8 细胞比值及NK阳性细胞百分比HPV-B19-IgM阳性组(25·76±10·21%,0·78±0·42,8·77±5·64%)与HPV-B19-IgM阴性组(26·89±9·08%,0·88±0·35,9·61±6·45%)均较对照组(38·31±6·95%,1·58±0·29,14·83±4·16%)明显降低,而CD8 细胞百分比(HPV-B19-IgM阳性组为32·98±10·3%,HPV-B19-IgM阴性组为32·58±9·04%)较对照组(24·82±5·54%)明显升高(P<0·01)。结论:抽动障碍患儿HPV-B19感染率较高。细胞免疫功能紊乱可能是各种原因导致儿童TD发生的一个共同途径。     

妊娠期妇女人细小病毒B19感染与异常流产及胎儿畸形关系的研究

目的分析妊娠期妇女感染人细小病毒B19(HPVB19)与异常流产及胎儿畸形的关系,为妊娠期妇女孕期保健随访方案制定提供参考,提升优生优育水平。方法选择2010年1月-2017年1月在我院行孕期保健、分娩符合纳入条件的的妊娠期孕妇608例。所有孕妇均于入组后行HPVB19筛查,将患者按照HPVB19筛查结果分为阳性组(118例)和阴性组(490例)。统计两组孕妇妊娠结局(异常流产率、剖宫产率、终止妊娠率、自然分娩剖宫产率)、新生儿妊娠结局(畸形率、死胎率、新生儿窒息率)并比较。统计HPVB19阳性孕妇筛查结果为阳性妊娠周期分布,不同妊娠周期检出HPVB19阳性孕妇及新生儿妊娠结局并比较。采用spearson相关性分析程序分析妊娠期妇女感染HPVB19与异常流产、胎儿畸形间的相关性。结果两组孕妇年龄、入组时孕周、体重、体质量指数(BMI)、孕次、产次比较差异无统计学意义(P0.05)。所有产前即37-41w检出HPVB阳性孕妇,经治疗后,HPVB19IGM转阴。HPVB19阳性组孕妇异常流产率、剖宫产率、自然分娩转剖宫产率、终止妊娠率明显高于阴性组(P0.05)。HPVB19阳性组孕妇新生儿胎儿宫内畸形率、新生儿畸形率、死胎率、新生儿窒息率均明显高于阴性组孕妇新生儿(P0.05)。118例HPVB19阳性孕妇检出阳性孕周分布较为均匀。孕18-24w检出HPVB19阳性孕妇异常流产率即胎儿畸形率明显高于其它时段检出HPVB19阳性孕妇(P0.05)。妊娠期妇女发生HPVB19感染与孕妇异常流产率、胎儿畸形间的相关性系数均0.5,有较强的相关性。结论妊娠期妇女感染HPVB19与异常流产和胎儿畸形呈较高相关性,做好孕前筛查及健康宣教,孕期HPVB19筛查及相应对策,尽可能降低异常流产及胎儿畸形风险,提升优生优育水平具有重要意义。     

类风湿关节炎患者CMV、B19和HCV抗体的检测及临床意义

目的:检测巨细胞病毒(CMV)IgG和IgM抗体、细小病毒B19 IgG和IgM抗体及丙型肝炎病毒(HCV)抗体在中国南方类风湿关节炎(RA)患者外周血中的表达,探讨CMV、B19、HCV在RA中的作用。方法:采用酶联免疫吸附试验(ELISA)法检测CMV-IgG和CMV-IgM抗体,B19-IgG和B19-IgM抗体以及HCV抗体;CMV-IgM抗体阳性者利用实时定量PCR法检测外周血单个核细胞中的CMV载量;B19-IgM抗体阳性者利用实时定量PCR法检测血清中的B19载量。同时分析这些病毒抗体与RA患者的实验室活动指标如抗环瓜氨酸肽(CCP)抗体、类风湿因子(RF)、红细胞沉降率(ESR)的相关性。结果:70例RA患者中,69例为CMV-IgG抗体阳性(98.57%),7例CMV-IgM抗体阳性(10.00%),49例B19-IgG抗体阳性(70.00%),16例B19-IgM抗体阳性(22.86%),无一例HCV抗体阳性;92例健康对照者中91例CMV-IgG抗体阳性(98.91%),1例CMV-IgM抗体阳性(1.10%),42例B19-IgG抗体阳性(45.65%),19例B19-IgM抗体阳性(20.65%),仅1例HCV抗体阳性;RA患者CMV-IgM抗体阳性率明显高于对照组(P<0.05),CMV-IgM抗体阳性RA患者外周血单个核细胞未检测到CMV载量;RA患者B19-IgG抗体阳性率明显高于对照组(P<0.01),而两组间B19-IgM抗体阳性率无差别(P>0.05),B19-IgM抗体阳性RA患者血清中未检测到B19载量;CMV-IgM抗体阳性、B19-IgG抗体阳性与抗CCP抗体、RF、ESR等RA活动性指标不相关。结论:中国南方人群普遍感染CMV,但CMV重新激活与RA有关;B19感染在RA患者中有更高的流行率;HCV在中国南方人群感染率低。     

注射用重组人干扰素α2b联合黄芪注射液治疗小儿病毒性心肌炎的疗效研究

目的 探讨注射用重组人干扰素α2b联合黄芪注射液治疗小儿病毒性心肌炎的临床疗效.方法 将我院收治的86例病毒性心肌炎患儿,随机分为对照组和观察组,每组各43例.对照组患儿给予常规治疗,观察组患儿在常规治疗的基础上使用注射用重组人干扰素α2b联合黄芪注射液治疗.结果 观察组总有效率为93.02％,对照组总有效率65.12％,其差异具有统计学意义(P＜0.01).观察组患儿症状、体征恢复时间均少于对照组患儿症状、体征恢复时间,其差异具有统计学意义(P＜0.01).治疗后,观察组患儿的LDH(57.48±10.37) U/L、CK(151.83±75.63) U/L、CK-MB(23.69±11.26) U/L都低于对照组患儿的LDH(70.53±14.51) U/L、CK(204.27±95.64) U/L、CK-MB(45.15±18.47) U/L,差异具有统计学意义(P＜0.01).观察组的心电图恢复率为95.35％,高于对照组心电图恢复率74.42％,差异具有统计学意义(P＜0.01).结论 注射用重组人干扰素α2b和黄芪注射液联合治疗小儿病毒性心肌炎疗效显著.     

Differential IgM response to conformational and linear epitopes of parvovirus B19 VP1 and VP2 structural proteins

The IgM immune response against conformational and linear epitopes of B19 structural proteins VP1 and VP2 was examined in serum samples with a suspect B19 infection to determine the most suitable antigen for use in IgM detection and also to evaluate a possible relationship between the course of B19 infection and the presence of epitope type-specific IgM. The detection of IgM against conformational epitopes was performed by ELISA using undenatured VP1 and VP2 antigens whereas the detection of IgM against linear epitopes was performed by Western blot assays using denatured VP1 and VP2. IgM immune response against VP1 conformational epitopes appeared dominant, being detected in all serum samples positive for specific IgM, whereas IgM against VP2 linear antigen were found less frequently, being identified in less than half of the B19 IgM positive sera. In the examination of the course of infection, IgM against VP1 conformational epitopes appeared in the active phase of B19 infection at the same time and with the same frequency as IgM anti VP2 conformational epitopes and anti linear VP1 epitopes. IgM against VP1 conformational epitopes were seen to be long-lasting because in the recent phase of infection they were still present when other specific IgM were absent. During the active phase of B19 infection, IgM against VP2 linear epitopes were less frequently found than other specific IgM and in the recent phase they underwent a rapid temporal diminution. The data demonstrate that a sensitive B19 IgM test needs to be performed in diagnostic laboratories by ELISA using conformational B19 antigens; Western blot assays can be used only as confirmatory tests using VP1 linear antigens.     

彩超评估病毒性心肌炎患者心功能准确性分析

目的 分析彩色多普勒超声评估病毒性心肌炎患者心功能的临床应用价值.方法 选取2012年11月-2015年8月于我院经临床确诊为病毒性心肌炎的62例患者,均接受彩超及实验室检查,选取同期来我院体检的50例健康人作为对照组,分析彩超评定病毒性心肌炎患者心功能的价值.结果 心肌炎组血清肌钙蛋白T(TnT)及心肌酶谱阳性率均高于对照组(P＜0.05),以TnT阳性率最高;心肌炎组柯萨奇病毒B组(CBV) IgM抗体阳性率为64.52％,高于对照组的4.00％(P＜0.05);两组LV-E/A、LV-EF、LV-FS、RV-EF、RV-FS对比均无差异(P＞0.05);心肌炎组左心室等容舒张间期(IRT)、等容收缩间期(ICT)、心室射血时间(ET)及Tei指数均明显高于对照组(P＜0.05),其中左室Tei超过正常范围者54例,阳性率为87.10％;心肌炎组右室ICT、Tei指数高于对照组(P＜0.05),其IRT、ET均低于对照组(P＜0.05),其中右室Tei超过正常范围者53例,阳性率为85.48％.结论 Tei指数与病毒性心肌炎患者心脏收缩、舒张功能有密切关联,可作为其心脏功能诊断的重要依据.     

Acute myocarditis. Serologic diagnosis, clinical findings and follow-up

In a prospective study, 57 patients with a preliminary diagnosis of myocarditis were investigated. Twenty-four patients were considered to have an acute myocarditis, 14 had a suspected myocarditis, while in 19 patients myocarditis was excluded. Episodes of frequent supraventricular and/or ventricular extrasystoles during hospital stay were seen in 8/24 cases (33%) with myocarditis and in 1/19 cases (5%) without myocarditis. On follow-up 1 month later, no supraventricular extrasystoles were observed in either group. Echocardiographic signs consistent with left ventricular insufficiency were noted in 7/24 cases (29%) with myocarditis, in 1/14 cases (7%) with suspected myocarditis and in no case without myocarditis. With a "routine" serologic test battery covering influenza viruses A and B, adenovirus, Coxsackie virus group B, ECHO viruses, Chlamydia psittaci, Mycoplasma pneumoniae and hemolytic streptococci group A, a possible etiology could be documented in 9/24 cases (38%) with myocarditis and in 4/19 cases (21%) without myocarditis. Enterovirus-specific IgM was detected with solid-phase reverse immunosorbent test (SPRIST) in 12/23 (48%) cases with myocarditis and in 3/16 cases (19%) without myocarditis. In SPRIST-IgM-positive cases, IgM antibodies were detected in 15/20 (75%) of the sera taken on admission. The overall serological results indicated a recent infection in 16/24 cases (67%) with myocarditis and in 5/19 cases (26%) without myocarditis (p less than 0.05).     

Human parvovirus B19 infection during pregnancy--value of modern molecular and serological diagnostics.

BACKGROUND: Over 95% of fetal complications (fetal hydrops and death) occur within 12 weeks following acute parvovirus B19 (B19) infection in pregnancy. Therefore, weekly fetal ultrasound monitoring is generally recommended for this time period. However, in the majority of women, typical symptoms of acute infection (rash or arthropathy) are absent, and during epidemics, B19 infection may be diagnosed incidentally by antibody screening of women at risk. OBJECTIVE: To assess the diagnostic value of currently available molecular and serological methods for reliable diagnosis of primary B19 infection in pregnancy. STUDY DESIGN: Large panels of well-characterized acute-phase or convalescent sera were used to investigate the ability of a VP2 IgM EIA, a Light-Cycler-based B19-DNA PCR, a VP1-IgG avidity EIA and two VP2-IgG epitope-type specificity [ETS] EIAs to pinpoint the time of primary B19 infection in pregnancy. RESULTS: The duration of low-level IgM positivity varied greatly (range 4-26 weeks). Samples collected within the first 2 weeks of infection showed high-level viremia (mean 1.75 x 10(8) geq/ml). During follow-up, low-level DNAemia (mean 9.7 x 10(4)geq/ml) persisted for at least 18 weeks in 91% (20/22) of patients. Considering the first 12 weeks after onset of disease the window of greatest risk for fetal complications, the "acute" phase was extended to cover this full period. In this case, performing the avidity and ETS-EIA sequentially, the positive predictive value was 100% in patients showing concordant avidity and ETS-EIA results. CONCLUSIONS: In the presence of low IgM titres and/or low-level DNAemia the use of supplementary serological assays such as VP1-IgG avidity EIA and VP2-ETS-EIA is advisable for restriction or avoidance of unnecessary fetal ultrasound examinations or invasive diagnostics; and in general for strengthening the reliability of B19 serodiagnosis of pregnant women.     

柯萨奇B组病毒IgM抗体特性研究

目的 研究柯萨奇B组病毒（CVB）感染后患者急性期CVB－IgM抗体的反应特性。方法 对临床确诊为CVB感染的患者急性期血清用免疫印迹法检测CVB－IgM抗体。结果 患者的急性期血清IgM抗体均仅针对CVB的VP1抗原反应。经ELISA与免疫印迹方法的比较表明：用免疫印迹法检测的CVB－IgM抗体可对CVB各型病毒抗原反应,具有CVB各型病毒之间的交 叉反应性。而同时,在16例ELISA检测反应阴性的健康人血清中未见有CVB的VP1特异性的IgM抗体存在。结论 临床感染CVB的患者急性期,其血清中的特异性的IgM抗体是针对CVB的VP1抗原,而且,此类抗体对各型的CVB抗原具有交叉反应性。     

Acute parvovirus B19 infection associated with myocarditis in an immunocompetent adult

Inflammatory heart disease is causally linked with progressive left ventricular dysfunction and congestive heart failure. In childhood, infection with parvovirus B19 (PVB19) is usually benign, causing erythema infectiosum. However, severe fetal PVB19 infection may be associated with hydrops fetalis and fetal death caused by myocarditis. Here we report a PVB19-induced myocarditis in a previously healthy 37-year-old patient admitted to the hospital because of chest pain and dyspnea due to left ventricular dysfunction. Four weeks after the onset of symptoms, we found lymphocytic infiltrates and PVB19 genome in left ventricular endomyocardial biopsy specimens. Consistently, acute PVB19 infection was indicated serologically by elevated IgM titers and the presence of PVB19 genome in peripheral blood lymphocytes. In conclusion, PVB19 infection may be complicated by acute myocarditis in immunocompetent adults. Because PVB19 myocarditis may progress to chronic dilated cardiomyopathy, early diagnosis by endomyocardial biopsy is important to initiate anti-inflammatory treatment.     

Investigation on the Maternal-Infantile Infection with Human Parvovirus B19

With the investigations on pregnant women and newbornsinfected withToxoplasma, rubella virus, cytomegalovirus,herpes simplex virus (TORCH), it was found that humanparvovirus B19 (B19 virus), which belongs to the familyParvoviridae and the genus Erythrovir…     

用Mac ELISA法检测病毒性心肌炎患者血清中柯萨奇B组病毒IgM抗体

目的 了解北京地区病毒性心肌炎的病毒感染状况。方法 用ＩｇＭ抗体捕捉ＥＬＩＳＡ（Ｍａｃ ＥＬＩＳＡ）,检测１９３例临床诊断为病毒性心肌炎患者血清中的Ｃｏｘ Ｂ１～６型病毒特异性ＩｇＭ抗体。结果 ＣｏｘＢ病毒ＩｇＭ抗体阳性检出率为６９．９％（１３５／１９３）,其中阳性检出率最高为Ｂ３型,占４０％（５４例）;其余依次为Ｂ２型,占２９．６％（４０例）;Ｂ４型占１８．５％（２５例）;Ｂ１型占７．４％（１０例）;Ｂ５型占３．０％（４例）;Ｂ６型占１．５％（２例）。而１８１例同年龄组非心肌炎患者ＩｇＭ抗体阳性检出率为２０．４％（３７／１９３）。病毒性心肌炎患者血清中的ＣｏｘＢ ＩｇＭ抗体阳性检出率明显高于非心肌炎患者,两者差异有显著性,Ｕ＝９．５６,Ｐ〈０．０１。结论 Ｃｏｘ Ｂ感染是病毒性心肌炎的主要病因。     

Identification of Past and Recent Parvovirus B19 Infection in Immunocompetent Individuals by Quantitative PCR and Enzyme Immunoassays: a Dual-Laboratory Study

Parvovirus B19 (B19V) is a member of the family Parvoviridae, genus Erythrovirus. B19V-specific IgG and IgM react differently against conformational and linear epitopes of VP1 and VP2 antigens, leading to the development of IgG avidity and epitope type specificity (ETS) enzyme immunoassays (EIAs) for distinguishing past from recent infection. Additionally, B19V viral load determination (by quantitative PCR [qPCR]) is increasingly used in the staging of B19V infection. In this study, the utility of these methods is compared. A panel of 78 sera was jointly tested by the Virus Reference Department (VRD), London, United Kingdom, and the Haartman Institute (HI), Helsinki, Finland, using a number of EIAs, e.g., B19V-specific IgG and IgM, IgG avidity, and ETS EIAs. At VRD, the sera were also tested by a B19V viral load PCR (qPCR). By consensus analysis, 43 (55.1%) sera represented past infection, 28 (35.9%) sera represented recent infection, and 7 (9.0%) sera were indeterminate. Both VRD B19V qPCR and HI B19V VP2 IgM EIA gave the highest agreement with consensus interpretation for past or recent infection, with an overall agreement of 99% (95% confidence interval [CI], 92 to 100) and positive predictive value (PPV) of 100% (95% CI, 87 to 100). Nine sera designated as representing past infection by consensus analysis were B19V IgM positive by a commercial VRD B19V IgM EIA and B19V IgM negative by a new HI in-house B19V VP2 IgM EIA. A new VRD B19V IgG avidity EIA showed good (>95%) agreement (excluding equivocal results) with consensus interpretations for past or recent infection. Correct discrimination of past from recent B19V infection was achieved through application of qPCR or by appropriate selection of EIAs.