【作者】 郑岩；

【导师】 李丽红； 王光；

【作者基本信息】 吉林大学 ， 儿科学， 2005， 硕士

【摘要】 目的:探讨病毒性心肌炎患儿微小病毒B19(HPVB19)感染的状况及其相关性。方法:应用巢式聚合酶链反应的方法对60 例病毒性心肌炎患儿(观察组)及30 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 检测,并对观察组中HPCB19-DNA 检测阳性的与阴性的两组中血CK、CK-MB 及心功能指标进行比较。统计方法采用X2和T 检验。结果:60 例病毒性心肌炎(VMC)患儿中16 例B19-DNA 检测阳性,30 例健康儿童B19-DNA 检测均为阴性,阳性检出率为26.7%(16/60),两组比较有显著差别(P<0.01)。观察组中HPCB19-DNA 检测阳性的与阴性的两组中血CK、CK-MB 值变化无显著性差异,P>0.05。但心功能指标LVSF 比较有明显差异(P<0.01),SV 比较亦有明显差异(P<0.005)。结论:儿童病毒性心肌炎与HPVB19 感染有关,HPVB19 可能是病毒性心肌炎主要病原之一,HPVB19 感染在儿童病毒性心肌炎病原学地位不容忽视,而且HPVB19 感染所致病毒性心肌炎的心功能改变中左室功能受累程度较重。更多还原

【Abstract】 Myocarditis is common and frequent disease in pediatrics, the scholars believed that Coxsackie virus was the main etiological factor of myocarditis. In recently years, it is reported that Microvirusb B19 can cause erythema infectiosum bone marrow malfunction acute hepatic injury acute polyarthropathy intrauterine infection, but there are not report about the relationship on myocarditis and Microvirusb B19 in our country, our investigation detect B19-DNA in plasm of the patients in order to find correlation between myocarditis and Microvirusb B19. Myocarditis is local or diffuse inflammatory lesion of myocardium. Its character is inflammatory cell infiltration、myocardium necrosis and degeneration. Recently, using polymerase chain reaction to detect virogene increased etiological diagnosis about myocarditis. In 1952, neonate myocarditis coxsackie virus infected was found in South African. the virus that cause myocarditis are quite extensive, coxsackie virus B3 is the most common pathogen. The pathogenesis of myocarditis is stil unknown, people usually believed that in the initial stage of virus infection, virus often directly invade cardiac muscle cell that cause inflammatory reaction to inflammatory cell infiltration、myocardium necrosis and degeneration. but severe and chronic myocardium lesion was immune mediated. clinical situation is difference, the light case may be absence of symptoms or chronic clinic process, but the severe may be fulminant cardiogenic shock and congestive heart failure, and die suddenly within several hours or days. At present, microvirus is minimus and the most simple DNA virus. Microvirus B19 and adeno-associated virus can infecte human. Microvirus B19 consiste of one mono-chain DNA, The protein of virus shell VP1、VP2、VP3 is constitutional protein; the chain of DNA is about 5.5kb, including 50% positive strand and negative strand, respectively. The acid rank of aniso-source separated strain is different slightly. Microvirus B19 can duplicate independently in myelocyte and Liver cells in human. Microvirus B19 infection is existed extensively, and the infectional rate is above 60% in human being. After the infection, about 2/3 manifest the different clinical procedure. Commonly, the most show lightly acute infection. In the group with hemopoietic dysfunction and immunodeficiency, Microvirus B19 infection show severe disease and chronic process. In 1980, The Microvirus B19 is separated in serum of two cases with Fever. Through electron microscope, pepolefound microvirus-like-Particles, and neutralization test between the serum and Microvirus B19 antigenis positive. In 1981, The Microvirus B19 was separated in the serum of patients of temporary aplastic anemia (TAC) of sickle cell anemia1, From then on, one after another report of TAC erythema infectiosum and Peliosis in Canada、Japan、British and USA that microvirus B19 or its DNA and anti-B19 IgM wereseparated from the plasm, preliminarily confirmed the relationship of microvirus B19 and these diseases. In 1984, it was reported firstly that microvirus B19 infected fetus through placent and cause abortion、premature birth and stillbirth. In 1985, A nderson inoculate microvirus B19 in nasal cavit in volunteer,after seven days the volunteers showed symptom of viremia 、erythema exanthem 、arthrodynia and ferrohemoglobin descent. In a word, microvirus B19 is the most etiological factor of diseases of human. Molecular biology technique that is nucleic acid hybridization and polymerase chain reaction; Nucleic acid hybridization include in situ hybridization dot blot hybridizationSouthrn blotting. this technique has high specificity and sensibitity, and may locate lesion constitutions and cells. PCR is the most sensitive and special method of diagnosis microvirus B19 infection, its sensibitity is 100-1000 times than molecular hybridization. Recently, The nested PCR was created, which the sensibitity is higher than the Mono-PCR, the specific inter-primer was equal to probe of nucleic acid hybridization, therefore, this technique bebome the common method in the developed countries. In our study, the aim is to find out the situation and relationship of microvirus B19 and viral myocarditis. The method of experiment is as following: sixty children with VMC serve as observing group, Thirty normal children serve as control group. using the nested-PCR detect microvirus B19-DNA in plasma. and in the observing group, we compared the data of CK、CK-MB in serum and cardiac function更多还原