再次麻疹的发病特点和免疫学机制.doc

文档介绍：1 再次麻疹的发病特点和免疫学机制作者:王凤莲,陈仕珠,许松杰【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 ~ 27( )岁,以 13~ 16 岁为多,占 % ;其第一次患麻疹年龄 1 岁以内者 27 例( % ),而 25 名健康者中仅 2 例在 1 岁以内,差异有显著性( )。性别间无明显差别。 36 例中 MT 18例( % ), MAT 18例( % ) ,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 % 为 MT 麻疹; ≥1: 400 阳性者 % 为 MAT 。抗-MV IgG 水平与病情呈显著负相关( )。 25 名有麻疹病史者抗-MV IgG ≤ 1:400 阳性者 9例( % ) ,显著低于患者组( % )( ) 。结论(1) 1 2 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 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 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 (1)The age were ~ 25() years old , of them 13~ 16 yrs were in %.The age of first measles within age of 12 months were in 3 27 cases(%)in the patients and 2 case in 25 normal people respectively , and differentiation was marked between them(). Of 36 MT and MAT measles were % and % respectively;and all were misdiagnosed when they saw doctor first. Anti-MV IgM were positive and anti-rubella IgM were negative in all patients whose anti-IgG levels were in 1:200 , 1:300 , 1:400 and 1:600 positive were 7, 14,