天津地区新冠病毒肺炎患者特异性IgM和IgG动态变化研究

目的　通过动态检测重症与非重症新冠病毒肺炎（COVID-19）患者血清特异性IgM和IgG水平，评估两者在不同患者群体的变化规律。方法　收集天津地区2020年1月—2020年3月确诊的30例新冠病毒肺炎患者血清，重症20例，非重症10例，动态检测严重急性呼吸综合征冠状病毒2（SARS-CoV-2）特异性IgM和IgG抗体，进行纵向分析。结果　1.患者发病0～6天，IgM和IgG阳性率分别为42.86%、28.57%，随着病程的进展，两种抗体的阳性率逐步增高。两者从发病大约5周后阳性率开始下降。重症与非重症组患者在发病后约28 d内IgM、IgG水平逐步升高，此后开始下降，重症患者IgM、IgG水平下降明显。2.重症组患者在发病后28～33 d IgG水平较非重症组高，差异有统计学意义(P＜0.05)。3.重症患者发病后28～33 d、34～42 d自身IgG水平显著高于IgM，差异有统计学意义(P＜0.05)。4.恢复期重症组IgG水平较非重症组高(P＜0.05)；重症组患者自身恢复期IgG水平较IgM高(P＜0.05)。结论　COVID-19患者特异性IgM和IgG抗体水平随病程进展先升高后下降。重症较非重症组患者特异性IgG抗体水平高。高水平的IgG可能是病情危重的预警指标。

Kinetics of Specific IgM and IgG Antibodies in Patients with COVID-19 in Tianjin

Objective　Through dynamic detection on COVID-19?specific IgM and IgG levels to understand the changes of specific antibodies in critical and non-critical patients with COVID-19. Methods　Sera of 30 COVID-19 patients, among whom 20 critical and 10 non-critical, confirmed in Tianjin, China from January 2020 to March 2020 were collected consecutively, tested for SARS-COV-2 specific IgM and IgG antibodies and analyzed vertically. Results　1. The positive rates of specific IgM and IgG in 0-6 days after symptom onset were 42.86% and 28.57%, respectively. As the disease progressed, the positive rate of both antibodies gradually increased. The positive rate of both antibodies began to decrease around 5 weeks later after symptom onset. Within 28 days after the symptom onset, the IgM and IgG level of both critical and non-critical patients were increasing and started to decrease . Especially for the critical patients, the IgM and IgG decreased obviously. 2. The IgG of critical patients were higher than that of non-critical patients and the difference was statistically significant in 28-33 days after the symptom onset(P＜0.05). 3. In 28-33 days and 34-40 days later after the symptom onset, the difference between the two antibodies within critical patients was statistically significant(P＜0.05). 4. In the recovery phase, the IgG level of critical patients was higher than non-critical patients, with statistical significance(P＜0.05); during their own recovery phase, within critical patients themselves, the IgG was higher than IgM, with statistical significance(P＜0.05). Conclusion　The specific IgM and IgG antibodies level of COVID-19 patients takes on the trend of increasing first and decreasing later as the disease progresses. Compared with non-critical patients, the specific IgG in critical patients is higher. Continuous high level of IgG might be the warning index of critical situation.