北京协和医院就诊儿童EB病毒血清流行病学研究

发布时间：2018-12-30 13:05

【摘要】：EB病毒感染与许多肿瘤的发生密切相关。目前,我国缺乏关于人群EB病毒感染,尤其是儿童初次感染的血清流行病学资料；而了解儿童感染EB病毒的概貌,对于病毒学基础研究、EB病毒相关疾病的治疗和预防等,都具有参考意义。本研究以2013年1月-3月在北京协和医院就诊,且进行过任意一种血清学检查的0-9岁儿童作为研究样本,通过酶联免疫吸附试验(ELISA)的方法检测EB病毒的4种标记性抗体,即抗VCA (viral capsid antigen) IgM及IgG抗体、抗EA(early antigen) IgG抗体和抗NA(nuclear antigen) IgG抗体,所测抗体的结果构成了研究样本的抗体谱。这种联合检测抗EB病毒抗体谱的实验方法在国内并不多见,在北京地区则为首次采用。由抗体谱的结果将所有研究样本区分为急性感染、既往感染和未感染三大类,按照年龄分布,统计了各年龄组的阳性率。除此以外,本研究还提取了研究样本的血清游离DNA,通过实时荧光定量PCR的方法检测了EB病毒DNA的阳性率和阳性标本的DNA拷贝数。研究结果显示,在所有754份符合设定要求的研究样本中,有583例(80.1%)样本的抗体谱提示EB病毒感染,其中急性感染和既往感染分别有65例(8.92%)和518例(71.2%)。在年龄分布上,根据抗VCA IgM抗体的结果(该抗体不会经过胎盘从母体进入婴儿体内),并结合DNA检测的结果,0岁(0-6m)的感染阳性率为0;根据4种抗体的抗体谱结果,从0岁(7-11m,42.3%)起到9岁(91.9%)的感染阳性率呈现逐渐升高的趋势,其中从0岁(7-11m)到2岁是增长率最快的阶段；而感染阳性率在8岁年龄组首次超过900%,达到与成年人相当的水平。参考以往类似的研究资料,将本研究提示的感染阳性率与北京地区20世纪70年代及2006年的数据结合分析,其感染高峰呈现出延后的趋势,逐渐向发达国家的感染高峰靠近,与我国现阶段的经济社会发展水平相符合。在754份研究样本中,血清病毒DNA阳性的样本为39例,占5.17%,明显低于抗体谱的阳性率。由于血清EB病毒DNA仅在病毒活跃复制时才能检测到,使用实时荧光定量PCR的方法检测血清病毒DNA拷贝数更适合于在具有一定感染风险的患儿中进行EB病毒感染相关疾病的诊断或评价疾病的严重性时使用。在以无症状的病毒携带者为主要人群的正常人中进行筛查,其对病毒感染状态的提示意义是较为有限的。
[Abstract]:EB virus infection is closely related to the occurrence of many tumors. At present, there is a lack of seroepidemiological data about EB virus infection in population, especially in children. Understanding the general profile of EB virus infection in children is of great significance for virology basic research, treatment and prevention of EB virus related diseases and so on. In this study, a sample of children aged 0-9 who had undergone any serological examination from January to March 2013 at Peking Union Hospital was used as the study sample. Enzyme linked immunosorbent assay (ELISA) was used to detect four kinds of labeled antibodies of EB virus, that is, anti-VCA (viral capsid antigen) IgM and IgG antibodies, anti-EA (early antigen) IgG antibodies and anti-NA (nuclear antigen) IgG antibodies. The results of the antibody test constitute the antibody spectrum of the study sample. This method of combined detection of anti-EB antibody spectrum is rare in China and is first used in Beijing area. According to the results of antibody spectrum, all the study samples were divided into three groups: acute infection, past infection and no infection. According to the age distribution, the positive rate of each age group was counted. In addition, serum free DNA, was extracted from the study samples to detect the positive rate of EB virus DNA and the DNA copy number of positive samples by real-time fluorescence quantitative PCR. The results showed that the antibody profile of 583 (80.1%) of all 754 study samples that met the set requirements indicated EB infection. There were 65 cases (8.92%) and 518 cases (71.2%) of acute infection and previous infection respectively. In terms of age distribution, according to the results of anti VCA IgM antibody (the antibody does not pass through the placenta into the infant) and combined with the results of DNA test, the positive rate of 0 years old (0-6 m) infection was 0; According to the results of antibody spectrum of the four antibodies, the positive rate of infection from 0 years old (7-11m 42.3%) to 9 years old (91.9%) showed an increasing trend, and the fastest growth rate was from 0 years old (7-11m) to 2 years old. The positive rate of infection exceeded 900 for the first time in the 8-year-old group, reaching the same level as adults. Referring to the similar research data in the past, the positive rate of infection suggested by this study was combined with the data from the 1970s and 2006 in Beijing area. The infection peak showed a trend of delay and gradually approached the peak of infection in developed countries. With our country's present stage of economic and social development level in line with. Of the 754 samples, 39 (5.1717) were positive for serovirus DNA, which was significantly lower than the positive rate of antibody spectrum. Because the serum EB virus DNA can be detected only when the virus is active in replication, The method of real-time fluorescent quantitative PCR is more suitable to detect the copy number of serum virus DNA in children with a certain risk of infection for the diagnosis of EB virus infection related diseases or the evaluation of the severity of the disease. Screening in normal subjects with asymptomatic carriers is of limited significance in indicating the status of viral infection.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R725.1

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