医药学论文：再次麻疹的发病特点和免疫学机制

【摘要】 目的 研究再次麻疹的发病特点和免疫学机制。方法 对连续诊治的36 例再次麻疹患者做流行病学及免疫情况调查，分析其临床特点。据临床表现分典型（TY）、轻型典型(MT)及轻型非典型(MAT)3型。用ELISA法检测患者急性期及25名有麻疹病史的麻疹密切接触者血清抗-麻疹病毒（MV） IgM、IgG和抗-风疹病毒IgM。结果 36例再次麻疹患者年龄12.5～27（16.1）岁，以13～16岁为多，占61.1%；其第一次患麻疹年龄1岁以内者27例（75.0%），而25名健康者中仅2例在1岁以内，差异有显著性（P< 0.01）。性别间无明显差别。36例中MT 18例（50.0%），MAT 18例（50.0%），无TY麻疹，首诊均误诊。抗-MV IgM均阳性，抗-风疹病毒IgM均阴性。抗-MV IgG 滴度在1:200，1：300，1：400和1：600阳性者分别为7，14，12和3例，其中抗-MV IgG 水平≤1：300患者69.6%为MT麻疹；≥1：400阳性者83.3%为MAT。抗-MV IgG水平与病情呈显著负相关（P< 0.05）。25名有麻疹病史者抗-MV IgG ≤1:400阳性者9例（36.0%），显著低于患者组（94.4%）（P< 0.01）。结论 (1)1周岁内患麻疹者13年后抗体衰减至可再患麻疹。(2)再次麻疹患者因临床表现不典型及有麻疹病史而极易误诊，需检测抗-MV IgM阳性方可诊断。(3)发病及病情轻重主要取决于体内抗-MV IgG水平。
【关键词】 麻疹；临床表现；免疫
Clinical manifestations and immunological mechanism in patients with second measles
【Abstract】 Objective To study the clinical manifestations and immunological mechanism of second measles.Methods 36 cases with second measles were consecutively collected，and were investigated and observed for immunological condition and clinical manifestations.The patients were divided into the typical(TY)，the mildly typical (MT)and the mildly atypical (MAT) measles.Anti-measles virus (MV) IgM，IgG and anti-rubella IgM in serum were tested using ELISA in all patients and 25 normal people who had measles history contacted closely with measles patients.Results (1)The age were 12.5～25(16.1) years old，of them 13～16 yrs were in 61.1%.The age of first measles within age of 12 months were in 27 cases(75.0%)in the patients and 2 case in 25 normal people respectively，and differentiation was marked between them(P< 0.01). Of 36 MT and MAT measles were 50.0% and 50.0% respectively;and all were misdiagnosed when they saw doctor first. Anti-MV IgM were positive and anti-rubella IgM were negative in all subjects.The patients whose anti-IgG levels were in 1:200 ，1:300，1:400 and 1:600 positive were 7，14，12 and 3 cases，respectively ;of them whose anti-IgG levels were ≤1:300 positive were 69.6% with MT measles，and ≥1:400 were 83.3% with MAT.A significant negative correlation was found between anti-IgG level and severity of the disease(P< 0.05).Anti-IgG level ≤1:400 in the patients and the normals were in 34 (94.4%)and 9 cases(36.0%)，respectively (P< 0.01).Conclusion (1)The people who caught measles within age of 12 months may catch second after 13 years old. (2)Second measles is very easy to be misdiagnosed because atypical manifestation and have a measles history，and a anti-MV IgM test is necessary for the diagnosis.(3)Catch measles and degrees of the disease mainly dependent on anti-MV IgG level.
【Key words】 measles；clinical manifestation；immune
麻疹，这一对人类危害大而持久的传染病，在广泛实施计划免疫的今天，其发病率已明显下降［1］，但成人及不典型麻疹的发病比例则明显增加［2］，尤其是再次麻疹，因其曾患过麻疹及临床表现不典型而每造成误诊或漏诊［3］。然而，人们对再次麻疹的发病特点所知甚少，对再次麻疹患者的临床表现与抗-麻疹病毒（MV）IgG水平的关系亦鲜有所知。本文分析了36例再次麻疹患者的临床表现及其与抗-MV IgG水平的关系，以期了解再次麻疹的发病特点及其免疫学机制，进而为及时诊断和采取防控措施、减少因麻疹引起的其他疾病［4］提供理论依据。