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的意义

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IN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.

EB virus serology and DNA quantitative detection in the diagnosis of infantile infectious mononucleosis

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 re- action （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 I〉4 years of age. Nearly twenty percent of the infants were negative for all anti-EBV antibodies and required repeated sero- logic 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. Con- dusion 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.