目的 探讨住院儿童呼吸道合胞病毒(RSV)感染血清特异性抗体IgM,IgG和IgA表达的相关性,筛选具有早期辅助诊断意义的抗体指标.方法 运用荧光定量聚合酶链反应技术(FQ-PCR)筛选出2015～2017年50例咽拭子RSV阳性的住院患儿;采用酶联免疫吸附试验(ELISA)检测患儿血清中的特异性抗体IgM,IgG和IgA;同时以95例无呼吸道感染症状的儿童血清标本作为对照组;采用卡方检验对结果进行统计学分析.结果 50例咽拭子RSV阳性患儿血清中IgM,IgG,IgA及三者同时出现阳性率分别为24.00％,60.00％,22.00％和16.00％,差异有统计学意义(x2=28.19,P＜0.01);同一性别患儿的IgM,IgG和IgA阳性率在实验组和对照组中差异有统计学意义(x2=9.16,P＜0.01),不同性别在同一实验组或对照组中各抗体阳性率差异无统计学意义(x2=0.10,P＞0.05);急性喉气管支气管炎中未检出IgM,IgG和IgA,仅在急性上呼吸道感染中检测到1例IgG,支气管肺炎及急性支气管炎中以IgG的检出率41.38％和23.53％最高,且均未单独检测到IgA;＜6个月年龄组患儿在7天和21天内均未检出IgM和IgA,1～5岁年龄组患儿在7天内产生IgM阳性率为50.00％最高,且在21天内均能检出IgM,IgG和IgA,5～10岁年龄组患儿在7天内产生IgG和IgA的阳性率为100％和66.67％.结论 RSV特异性抗体IgM,IgG和IgA不能单独作为早期感染RSV的诊断指标,特异性抗体产生不受性别因素影响,上呼吸道感染RSV较难产生IgM,IgG和IgA,患儿年龄越小产生IgM和IgA的速度越慢,同时IgG存在母婴垂直传播且对机体无保护作用,RSV感染人体引起临床呼吸道症状可能与自身免疫力有关;IgA产生最早且不单独出现.%Objective To explore the correlation between the expression of serum specific antibody IgM,IgG and IgA in the respiratory syncytial virus (RSV) in hospitalized children,and the antibody indexes with early auxiliary diagnostic signifi cance were screened.Methods Using fluorescent quantitative polymerase chain reaction (FQ-PCR) to screen 50 cases of throat swabs which RSV RNA were positive in hospitalized children from 2015 to 2017 and using enzyme linked immunosorbent assay (ELISA) detected specific antibodies IgM,IgG and lgA in the children's serum.Meanwhile 95 cases of children's serum specimens without respiratory symptoms were taken as the control group.The results were analyzed by chi-square test.Results In the 50 cases of serum from children who's RSV RNA were positive from throat swabs,the positive rates of IgM,IgG,IgA and the three forms coming together were 24.00％,60.00％00,22.00％ and 16.00％ respectively.And the difference was statistically significant (x2 =28.19,P＜0.01).About the serums which were the same gender child patient in the experimental group and the control group,the positive rates of IgM,IgG and IgA had significant differences (x2 =9.16,P＜0.01).There was no significant difference in the positive rate of each antibody in the same experimental group or control group or control group (x2 =0.10,P＞0.05).IgM,IgG and IgA were not detected in acute laryngotracheal bronchitis.Only 1 case with IgG was detected in the acute upper respiratory infection.It was the highest that the detection rates of IgG in bronchial pneumonia and acute bronchitis were 41.38％ and 23.53％,and IgA was not been detected alone.In the group of ＜6 months,IgM and IgA were not detected within 7 days and 21 days.In the group of 1～5 years old,the positive rate of IgM within 7 days was 50％,which was the highest in all groups.And IgM,IgG and IgA could be detected in 21 days also.The positive rates of IgG and IgA in the age group of 5～10 years old were 100％ and 66.67％ respectively.Conclusion Specific antibodies of RSV-IgM,IgG and IgA cannot be used as a diadynamic criteria alone in early RSV infection.The spe cific antibody was not affected by gender.Upper respiratory tract infection RSV was difficult to produce IgM,IgG and IgA.The younger the child,was the slower the IgM and IgA were produced.At the same time,IgG was able to vertical transmis sion and it had no protective effect on body.That RSV could infect the body and cause clinical respiratory symptoms would be related with immunity.Finally,IgA was the earliest specific antibody and could not be alone.
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