中华皮肤科杂志 ›› 2013, Vol. 46 ›› Issue (11): 771-774.

• 论著 •    下一篇

评价在辅助生育中检测单纯疱疹病毒2抗体对诊断生殖器疱疹的意义

文佩军1,廖绮曼2,李文静3,陈木开2,马春光3,韩建德1   

  1. 1. 中山大学附属第一医院皮肤科
    2. 中山大学附属第一医院
    3. 广州市中山大学第一医院皮肤科
  • 收稿日期:2012-11-28 修回日期:2013-07-10 出版日期:2013-11-15 发布日期:2013-11-01
  • 通讯作者: 文佩军 E-mail:251472621@qq.com

Value of detection of anti-herpes simplex virus type 2 antibodies in the diagnosis of genital herpes before in vitro fertilization

  • Received:2012-11-28 Revised:2013-07-10 Online:2013-11-15 Published:2013-11-01

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摘要： 【摘要】 目的 在分析生殖器疱疹患者单纯疱疹病毒（HSV）流行株的基础上，探讨HSV-2 IgM抗体、型特异HSV-2 IgG抗体的敏感性、特异性、阴性预测值和阳性预测值，评价辅助生育中二种抗体检测在诊断生殖器疱疹上的意义。 方法 对2009—2011年中山大学附属第一医院皮肤科193例生殖器疱疹患者临床分离病毒株培养并鉴定分型，了解主要的流行病毒型。生殖中心术前筛查HSV-2 IgM和（或）IgG阳性、疑诊生殖器疱疹的女性，丈夫同时抽血检查，共57对为临床观察组；选取HSV培养阳性生殖器疱疹患者68例作为阳性对照组；8 ~ 10岁儿童120例为阴性对照组。血清标本采用酶联免疫吸附法（ELISA）检测HSV-1 IgM和HSV-2 IgM抗体及型特异HSV-1 IgG、HSV-2 IgG抗体，对结果进行比对分析。 结果 阳性对照组68例中，HSV-1 IgM 14例（20.59%）、HSV-2 IgM 9例（13.24%）、HSV-1 IgG 61例（89.71%）、HSV-2 IgG 62例（91.18%）阳性；阴性对照组120例，分别为26例（21.70%）、16例（13.30%）、49例（40.80%）和0例阳性；两组HSV-1 IgM及HSV-2 IgM阳性率差异均无统计学意义（P > 0.05），但HSV-1 IgG及HSV-2 IgG阳性率差异均有统计学意义（P < 0.01）。临床观察组57例女性中，HSV-1 IgM 46例（80.70%）、HSV-2 IgM 52例（91.23%）、HSV-1 IgG 48例（84.21%）、HSV-2 IgG 8例（14.04%）阳性；男性（配偶）分别为11例（19.30%）、5例（8.77%）、50例（87.71%）和7例（12.28%）阳性；两性的HSV-1 IgM及HSV-2 IgM阳性率差异均有统计学意义（P < 0.01），而HSV-1 IgG及HSV-2 IgG阳性率差异均无统计学意义（P > 0.05）。HSV-2 IgM诊断生殖器疱疹的敏感性为13.24%，特异性为86.67%，阳性预测值36.00%，阴性预测值63.80%；HSV-2 IgG诊断生殖器疱疹的敏感性91.18%，特异性100.00%，阳性预测值100.00%，阴性预测值95.24%。 结论 该地区生殖器疱疹主要流行病毒型为HSV-2，仅5.18%是HSV-1。HSV-2 IgM诊断生殖器疱疹的敏感性、阳性预测值以及特异性、阴性预测值均低于HSV-2 IgG；辅助生育中型特异性HSV-2 IgG检测在诊断生殖器疱疹上的意义大于HSV-2 IgM。 【关键词】 疱疹，生殖器； 单纯疱疹病毒属； 免疫球蛋白G； 免疫球蛋白M

关键词: 疱疹，生殖器, 单纯疱疹病毒属, 免疫球蛋白G, 免疫球蛋白M

Abstract: WEN Pei-jun, LIAO Qi-man, LI Wen-jing, CHEN Mu-kai, MA Chun-guang, HAN Jian-de. Department of Dermatology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 051080, China 【Abstract】 Objective To determine the prevalent herpes simplex virus （HSV） strain in patients with genital herpes （GH）, and to evaluate the sensitivity, specificity, positive predictive value （PPV） and negative predictive value （NPV） of anti-herpes simplex virus type 2 （HSV2） IgG and IgM antibodies in the diagnosis of genital herpes （GH） before in vitro fertilization （IVF）. Methods Totally, 193 HSV2 clinical strains isolated in cell culture from the lesions of patients with GH in the Department of Dermatology, First Affiliated Hospital, Sun Yat-sen University between 2009 and 2011 were typed by using type-specific fluorescein isothiocyanate （FITC）-labelled anti-HSV monoclonal antibodies. Serum samples were obtained from 57 anti-HSV2 IgM/IgG antibody-positive females with suspected GH as well as their husbands （clinical observation group）, 68 HSV culture-positive patients diagnosed with GH （positive control group）, and 120 children aged 8－12 years （negative control group）. Enzyme-linked immunosorbent assay （ELISA） was performed to detect anti-HSV1/HSV2 IgG/IgM antibodies in these serum samples. Statistical analysis was carried out using chi-square test. Results There was a significant difference between the positive control group and negative control group in the positivity rate of anti-HSV1 IgG （89.71% （61/68） vs. 40.80% （49/120）, P < 0.01） and anti-HSV2 IgG （91.18% （62/68） vs. 0, P < 0.01）, but not in that of anti-HSV1 IgM （20.59% （14/68） vs. 21.70% （26/120）, P > 0.05） or anti-HSV2 IgM （13.24% （9/68） vs. 13.30% （16/120）, P > 0.05）. In the clinical observation group, the positivity rate of anti-HSV1 and anti-HSV2 IgM antibodies, anti-HSV1 and anti-HSV2 IgG antibodies was 80.70% （46/57）, 91.23% （52/57）, 84.21% （48/57） and 14.04% （8/57） respectively in the females, 19.30% （11/57）, 8.77% （5/57）, 87.71% （50/57）, 12.28% （7/57）respectively in the males, with significant differences in the positivity rate of anti-HSV1 and -HSV2 IgM antibodies （both P < 0.01）, but not in that of anti-HSV1 or -HSV2 IgG antibodies （both P > 0.05）. The sensitivity, specificity, PPV and NPV were 13.24% （9/68）, 86.67% （104/120）, 36.00% （9/25） and 63.80% （104/163） respectively for anti-HSV2 IgM antibody in the diagnosis of GH, 91.18% （62/68）, 100.00% （120/120）, 100.00% （62/62）, and 95.24% （120/126） respectively for anti-HSV2 IgG antibody. Conclusions HSV2 prevails in the patients with GH in this region, while HSV1 only amounts to 5.18%. The type-specific anti-HSV2 IgG antibody shows a higher specificity, sensitivity, PPV and NPV in the diagnosis of GH than anti-HSV2 IgM antibody, hence, the type-specific anti-HSV2 IgG antibody is superior to anti-HSV2 IgM antibody in diagnosing GH before assisted reproduction. 【Key words】 Herpes genitalis; Simplex virus; Immunoglobulin G; Immunoglobulin M

Key words: Immunoglobulin M