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郭桦, 马琳, 王钊, 刘长鑫, 张侃, 丁俊谕, 王博, 赵慧珺, 宋曼雅, 管希周. 新型冠状病毒肺炎患者特异性IgG和IgM的动态变化分析[J]. 解放军医学院学报, 2021, 42(12): 1263-1268. DOI: 10.3969/j.issn.2095-5227.2021.12.007
引用本文: 郭桦, 马琳, 王钊, 刘长鑫, 张侃, 丁俊谕, 王博, 赵慧珺, 宋曼雅, 管希周. 新型冠状病毒肺炎患者特异性IgG和IgM的动态变化分析[J]. 解放军医学院学报, 2021, 42(12): 1263-1268. DOI: 10.3969/j.issn.2095-5227.2021.12.007
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GUO Hua, MA Lin, WANG Zhao, LIU Changxin, ZHANG Kan, DING Junyu, WANG Bo, ZHAO Huijun, SONG Manya, GUAN Xizhou. Dynamic changes of specific IgG and IgM in patients with COVID-19[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2021, 42(12): 1263-1268. DOI: 10.3969/j.issn.2095-5227.2021.12.007
Citation: GUO Hua, MA Lin, WANG Zhao, LIU Changxin, ZHANG Kan, DING Junyu, WANG Bo, ZHAO Huijun, SONG Manya, GUAN Xizhou. Dynamic changes of specific IgG and IgM in patients with COVID-19[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2021, 42(12): 1263-1268. DOI: 10.3969/j.issn.2095-5227.2021.12.007
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新型冠状病毒肺炎患者特异性IgG和IgM的动态变化分析

Dynamic changes of specific IgG and IgM in patients with COVID-19

    摘要
  • 摘要:
      背景  随着对新型冠状病毒肺炎(corona virus disease 2019，COVID-19)诊断以及疾病分型的了解，血清抗体的临床价值进一步受到关注。
      目的  分析新型冠状病毒(2019 novel coronavirus，2019-nCoV)肺炎患者特异性抗体在病程中的动态变化及其在普通、重症、危重患者中的差异，进一步探究危重患者的免疫机制，为COVID-19患者的诊断、早期分型治疗提供参考。
      方法  对武汉市火神山医院2020年2月2日- 2020年4月15日收治的1 921例COVID-19患者(男性952例，女性969例)进行回顾性分析，根据《新型冠状病毒肺炎诊疗方案》中的临床分型标准，将患者分为普通型(n=1 280)、重型(n=591)和危重型(n=50)三组，比较其基线特征与实验室指标，观察患者住院期间抗体水平与阳性率随病程进展的动态变化。并分析2019-nCoV特异性抗体表达与各实验室指标以及核酸结果之间的关系。
      结果  IgM阳性率在患者发病后第6周达到高峰(80.9%)，之后呈下降趋势。IgG阳性率在第4周达到90.69%，第9周达到100%，且一直维持在较高水平。普通与重症组患者IgM阳性率均呈现先上升后下降的趋势，危重患者IgM出现时间延迟但抗体滴度水平最高，且IgM阳性率持续下降，IgM的中位滴度值方面重症组＞普通组＞危重组53.18(27.44，105.13)＞46.48(23.39，91.08)＞38.54(19.66，64.23)，P＜0.05。危重组IgG出现最晚，中位滴度值显著低于其他两组102.59(66.48，172.34) vs 154.08(86.25，184.87)、153.1(87.88，184.6)，P＜0.05，三组IgG均呈持续上升趋势。随着病情严重程度的加重，中性粒细胞计数、白细胞计数以及降钙素原均显著升高；三组患者核酸转阴时间差异无统计学意义36.0(27.0，45.0) d vs 36.0(27.0，44.0) d vs 41.0(29.0，48.0) d，P＞0.05。
      结论  抗体检测可以补充核酸检测用于诊断，且抗体在普通、重症与危重患者中的差异性表达与患者的免疫状态密切相关，核酸转阴时间与病情严重程度的关系需要进一步研究。

     

    Abstract:
      Background  With the deepen understanding of COVID-19 's diagnosis and disease classification, more attention has been paid to the clinical value of serum antibodies.
      Objective  To analyze the dynamic changes of specific antibodies in COVID-19 patients and its relationship with the prognosis of critical patients, and explore the immune mechanism of critical patients, so as to provide reference for the diagnosis, early classification and improvement of prognosis of COVID-19 patients.
      Methods   A retrospective survey was conducted on 1 921 COVID-19 patients (including 952 males and 969 females) admitted to Huoshenshan Hospital in Wuhan City from February 2, 2020 to April 15, 2020. According to the clinical classification criteria in Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia, the patients were divided into common group (n=1 280), severe group (n=591) and critical group (n=50), and their baseline characteristics and laboratory results were compared. The dynamic changes of antibody positive rate and titer with the course of disease were observed. Furthermore, the relationship between 2019-nCoV antibody expression and laboratory results as well as nucleic acid test results were analyzed.
      Results  The positive rate of IgM reached a peak of 80.9% at the 6th week after onset, and then showed a downward trend. The positive rate of IgG reached 90.69% at the 4th week, 100% at the 9th week, and remained at a high level. The IgM of common and severe patients increased at first and then decreased while the IgM in critical patients was delayed but strongly reacted, and decreased continuously. The average titer of IgM was severe group > common group > critical group 53.18(27.44, 105.13) > 46.48(23.39, 91.08) > 38.54 (19.6, 64.23), P < 0.05. The IgG of critical patients appeared the latest, and the average titer was significantly lower than the other two groups 102.59(66.48,172.34) vs 154.08 (86.25, 184.87), 153.1 (87.88, 184.6) (P < 0.05). The IgG of the three groups showed a continuous increase. With the aggravation of the severity of the disease, neutrophil count, white blood cell count and procalcitonin increased significantly, but there was no significant difference in nucleic acid negative conversion time among the three groups 36.0 (27.0, 45.0) vs 36.0 (27.0, 44.0) vs 41.0 (29.0, 48.0)(P＞0.05).
      Conclusion   Antibody detection can supplement nucleic acid detection for diagnosis, and the differential expression of antibodies in common, severe and critical patients is closely related to the immune status of patients. The relationship between nucleic acid negative time and the severity of the disease needs to be further studied.

     

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