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目的探讨血清抗SARS-CoV特异性LgG、lgM;外周血单核细胞、漱口液以及粪便SARS-CoV特异性套式RT-PCR检测SARS-Cov RNA在SARS确诊中的意义,并通过研究其系列标本,进一步探讨SARS-Coy特异性IgG、IgM出现规律及病毒传播规律。方法临床诊断SARS患者28例。1周采集2次血清、大便及漱口液系列标本。ELISA测定血清抗SARS-CoV特异性lgG、lgM,套式RT-PCR检测外周血单核细胞、漱口液以及粪便SARS-CoV RNA。结果血清SARS-COV-lgM阳性率为50％(14/28);SARS-COv-lgG阳性率为78.6％(22/28)。早期(-10天)lgG可出现;4周阳性率最高;lgG出现晚(11天-)。2-3周阳性率最高;持续时间短(11天-),4周后大部分患者阴转。PBMC SARS-COVRNA阳性率为32.1％(9/28),病程10-14天阳性率最高;漱口液SARS-COVRNA阳性率为57.1％(16/28),大便SARS-COVRNA阳性率为60.7％(17/28);病程2-3周阳性率最高。85.7％(24/28)可确诊SARS;14.3％不能确诊SARS。结论 SARS诊断必须加入病原学诊断标准。而且必须结合特异性抗体、外周血单核细胞、漱口液以及大便SARS-CoV RNA检测,综合判断。由于SARS患者特异性抗体出现晚等特点。因此,SAPS特异性抗体不能作为早期诊断。SARS患者病程2-3周传染性可能最强,而早期(10天内)传染性可能弱。
Objective To investigate the significance of SARS-CoV specific anti-SARS-CoV LgG, lgM in peripheral blood mononuclear cells, gargle and stool SARS-CoV specific nested RT-PCR in the diagnosis of SARS-CoV RNA. Series of specimens to further explore SARS-Coy specific IgG, IgM appearance and the law of transmission of the virus. Methods Clinical diagnosis of 28 cases of SARS patients. 1 week collected 2 serum, stool and mouthwash series of specimens. Serum anti-SARS-CoV specific lgG, lgM was detected by ELISA. Peripheral blood mononuclear cells, gargle and stool SARS-CoV RNA were detected by nested RT-PCR. Results The positive rate of serum SARS-COV-lgM was 50% (14/28). The positive rate of SARS-COV-lgG was 78.6% (22/28). Early (-10 days) lgG can occur; 4 weeks the highest positive rate; lgG appeared late (11 days -). 2-3 weeks the highest positive rate; short duration (11 days -), 4 weeks after the majority of patients overcast. The positive rate of SARS-COV RNA in PBMC was 32.1% (9/28), and the positive rate of SARS-COV RNA in mouthwash was 57.1% (16/28) and the positive rate of SARS-COV RNA was 60.7% (17/28); duration of 2-3 weeks the highest positive rate. 85.7% (24/28) confirmed SARS; 14.3% could not confirm SARS. Conclusion SARS diagnosis must be added to the etiological diagnostic criteria. And must be combined with specific antibodies, peripheral blood mononuclear cells, gargle and stool SARS-CoV RNA detection, comprehensive judgment. Due to the SARS patient-specific antibodies appear late characteristics. Therefore, SAPS-specific antibodies can not be used as an early diagnosis. The course of SARS patients 2-3 weeks may be the most contagious, and early (within 10 days) may be infectious.