四例咽拭子检测阳性发热伴血小板减少综合征重症患者的临床特征分析?

Abstract

通过疑似发热伴血小板减少综合征（ Severe fever with thrombocytopenia syndrome， SFTS）病例咽拭子的新型布尼亚病毒（SFTSV）检出情况，探讨SFTSV通过呼吸道传播的可能性。按照国家卫生部颁发的《发热伴血小板减少综合征防治指南（2010版）》中疑似病例的纳入标准，于2013年5～9月在SFTS高发区河南信阳的监测哨点医院收集72例疑似 SFTS 病例的血清和咽拭子标本，采用实时 RT?PCR 方法和ELISA方法检测SFTSV。结果显示，在72例疑似SFTS病例中，52（72?2％）例检测是SFTSV阳性，其中46例核酸RT?PCR检测阳性，6例血清ELISA检测阳性。在52例SFTSV阳性病例中，4（7?7％）例咽拭子核酸检测SFTSV阳性；在20例SFTSV阴性病例中，咽拭子核酸均未检测到SFTSV。4例咽拭子SFTSV阳性病例均为重症，同时都伴有咳嗽症状，其病毒载量最高可达108 copies／mL。 SFTSV在患者的咽拭子中可以检测到，咽拭子核酸检测SFTSV阳性检出率远低于血清标本，其作为检测SFTSV的可行性值得商榷。咽拭子检测SFTSV阳性患者体内病毒载量高且伴有咳嗽症状，加大了SFTSV通过呼吸道传播的风险。

The suspected severe fever with thrombocytopenia syndrome ( SFTS) cases of pharyngeal swab detection of severe fever with thrombocytopenia syndrome virus ( SFTSV) , to discuss the possibility of spread of respiratory tract. According to the suspected cases of inclusive criteria from national Ministry of Health issued " National guideline for prevention and control of severe fever with thrombocytopenia syndrome (2010)". May to September in 2013, we collect serum and throat swab of 72 suspected SFTS cases from the sentinel surveillance hospital in SFTS high?incidence area ( Xinyang, He′nan Province) . Real?time RT?PCR and ELISA methods for the detection of SFTSV were used in this study. In 72 suspected SFTS cases, 52 (72?2%) were detected positive, 46 were positive for RT?PCR, 6 were positive for ELISA. In 52 SFTSV positive cases, 4 ( 7?7%) cases were found with positive nuclei acid of SFTSV in throat swab samples. in 20 SFTSV negative cases, all the throat swab samples from the patients were also negative. The 4 SFTSV positive cases were severe, with cough and the highest viral load of up to 108 copies/mL. SFTSV can be detected in the throat swabs from patients, and the positive rate of throat swabs is much lower than that of serum samples. The feasibility of detecting SFTSV is disputable. SFTS patients with positive throat swab samples possessed the high viral load and cough symptoms, which may increase the risk of SFTSV transmission through the respiratory tract.