肾综合征出血热特异性抗体的检测与中西医结合治疗的研究

目的探索一种更为简便、快速、特异、灵敏的肾综合征出血热(hemorrhagic fever with renal syndrome, HFRS)抗体的检测方法及更为有效的中西医结合治疗手段.方法559例HFRS患者血清同时采用免疫滴金法(colloidal gold immuno-dot assay,CGIDA)与酶联免疫吸附法(enzyme linked immunosorbent assay,ELISA)对比检测特异性免疫球蛋白M抗体(抗HFRS-IgM),间接免疫荧光法(indirect fluorescent antibody test,IFAT)对比检测特异性免疫球蛋白G抗体(抗HFRS-IgG).101例HFRS患者分组进行中西医结合治疗,治疗组50例用苦黄注射液、参麦注射液联合黄芪口服液,对照组51例用利巴韦林注射液联合甘利欣注射液,针对老年患者的临床特点,及早采用综合性防治措施.结果559例HFRS患者血清,以CGIDA法检测抗HFRS-IgM,阳性396例(70.8%);以CGIDA法检测抗HFRS-IgG,阳性489例(87.5%).治疗组与对照组用药后退热天数、主要症状和体征缓解天数相似(P＞0.05);肾功能恢复天数,对照组优于治疗组(P<0.01);在越期方面,治疗组越休克期数明显高于对照组(P<0.01). 结论CGIDA法检测HFRS特异性抗体分别与ELISA法及IFAT法对照,均有简便、快速、特异、灵敏之优点,检测抗HFRS-IgM,CGIDA法敏感性差于ELISA法,但是无假阳性;检测抗HFRS-IgG,CGIDA法的灵敏度高于IFAT法.苦黄注射液、参麦注射液联合黄芪口服液与利巴韦林注射液联合甘利欣注射液相比较,疗效无明显差别,但前者优于改善休克情况,后者强于改善肾功能.

A study on detecting specific antibodies of hemorrhagic fever with renal syndrome and treatment with integrated traditional Chinese and western medicine

Objective:To explore a simple,speedy,specific and sensitive method to detect specific IgM (sIgM) and IgG (sIgG) antibodies of hemorrhagic fever with renal syndrome (HFRS),and to study the therapeutic effects of integrated traditional Chinese and western medicine on HFRS. Methods:The serum of 559 patients with HFRS were tested with colloidal gold immuno-dot assay (CGIDA) for sIgM and sIgG antibodies and compared with enzyme linked immunosorbent assay (ELISA) or indirect fluorescent antibody test (IFAT). One hundred and one patients with HFRS were randomized into treatment group ( n=50,treated with Kuhuang Injection, Shenmai Injection and Huangqi Liquid) and control group (n=51,treated with Ribarvirin and Ganlixin Injection). Results:The positive rate of sIgM detected with CGIDA was 70.8% and the positive rate of sIgG detected with CGIDA was 87.5%. The days for fever decline,symptoms alleviation and sign relief between the treatment group and control group were similar(P>0.05). The days for recovery of kidney function in the control group was less than that in the treatment group (P<0.01).The rate of crossing shock stage in the treatment group was higher than that of the control group(P<0.01). Conclusion:CGIDA was more simple, speedy, specific and sensitive than ELISA or IFAT in detecting the sIgM or sIgG antibodies in serum of patients with HFRS. Although the sensitivity of CGIDA was lower than that of ELISA,the CGIDA had no false positive reaction;the sensitivity of CGIDA was higher than that of IFAT on detectings IgG. The effect of the treatment group was similar to that of the control group. But the crossing shock stage rate in the treatment group was higher than that of the control group,while the control group was better than the treatment group in recovering the kidney function.