【摘要】 目的探讨核衣壳蛋白(N蛋白)特异性Ig M抗体水平与发热伴血小板减少综合征(SFTS)疾病病情严重程度的相关性。方法回顾性分析某三甲医院30例SFTS患者的临床特点及实验室检查结果,比较N蛋白特异性Ig M(+)组与N蛋白特异性Ig M(-)组患者的临床特点及预后转归;根据患者疾病严重程度分为轻症组和重症组,比较轻症组患者与重症组患者Ig M抗体滴度与发热伴血小板减少综合征病毒(SFTSV) RNA载量的相关性;从而观察分析N蛋白特异性Ig M抗体滴度、SFTSV-RNA载量与患者病情严重程度的相关性。结果 N蛋白特异性Ig M(-)组中有神经症状、死亡及病重例数均明显较Ig M(+)组多(均P <0. 05); N蛋白特异性Ig M抗体水平与SFTSV-RNA载量、凝血酶原时间(PT)、乳酸脱氢酶(LDH)、天门冬氨酸氨基转移酶(AST)均呈负相关(r值分别为-0. 495、-0. 440、-0. 367、-0. 280,均P <0. 05);而与血小板(PLT)呈正相关(r=0. 335,P=0. 002)。SFTSVRNA载量与PT、LDH、AST均呈正相关(r值分别为0. 606、0. 604、0. 587,均P <0. 001);而与PLT呈负相关(r=-0. 384,P <0. 001)。发病第10～13天时轻症组患者N蛋白特异性Ig M抗体滴度高于重症组患者(P <0. 05)。结论N蛋白特异性Ig M抗体的出现及滴度的升高有助于SFTSV的清除,且对患者凝血功能及肝损伤、心肌损伤有修复作用; N蛋白特异性Ig M抗体可能是预测患者预后的重要因素。更多还原

【Abstract】 Objective To evaluate the correlation between level of specific Ig M antibody of nucleocapsid protein (Nprotein) and severity of severe fever with thrombocytopenia syndrome (SFTS). Methods Clinical characteristics and laboratory detection results of 30 patients with SFTS in a tertiary first-class hospital were analyzed retrospectively,clinical characteristics and prognosis between patients in Nprotein specific IgM (+) group and Nprotein specific Ig M(-) group was compared; patients were divided into mild disease group and severe disease group according to the severity of disease,correlation between Ig M antibody titer and RNA load of SFTS virus (SFTSV) in patients in mild disease group and severe disease group was compared; correlation between Nprotein specific Ig M antibody titer,SFTSV-RNA load,and severity of disease in patients were analyzed. Results The numbers of patients with neurological symptoms,death,and serious disease in Nprotein specific IgM(-) group were significantly higher than IgM (+) group (all P < 0. 05); Nprotein specific Ig M antibody level was negatively correlated with SFTSV-RNA load,prothrombin time (PT),lactate dehydrogenase (LDH),and aspartate aminotransferase (AST) (r =-0. 495,-0. 440,-0. 367,-0. 280,respectively,all P < 0. 05); while was positively correlated with platelets (PLT) (r = 0. 335,P = 0. 002). SFTSV-RNA load was positively correlated with PT,LDH,and AST (r = 0. 606,0. 604,0. 587,respectively,all P < 0. 001); while was negatively correlated with PLT (r =-0.384,P < 0. 001). On the 10-13 day of onset,the titer of Nprotein specific IgM antibody in patients in mild disease group was higher than that in patients in severe disease group (P < 0. 05). Conclusion The presence and increase of Nprotein specific IgM antibody are helpful for clearance of SFTSV,and has a repairing effect on damage of coagulation function,liver and myocardial damage; Nprotein specific IgM antibody may be an important factor for predicting prognosis of patients.更多还原