تشخیص عفونت EBV
اپشتین بار ویروس ﻳﻜﻲ اﺯ ﮔﺴﺘﺮﺩﻩ ﺗﺮﻳﻦ ﻭﻳﺮﻭﺳﻬﺎﻱ ﺑﻴﻤﺎﺭﻳﺰاﻱ اﻧﺴﺎﻧﻲ اﺯ ﺩﺳﺘﻪ ﻫﺮﭘﺲ ﻫﺎ ﻣﻴﺒﺎﺷﺪ. ﻭﻳﺮﻭﺱ ﺑﻮﺳﻴﻠﻪ ﮔﺴﺘﺮﻩ ﻫﺎﻱ ﻋﻔﻮﻧﻲ , اﻧﺘﻘﺎﻝ ﺧﻮﻥ و ﭘﻴﻮﻧﺪ اﻋﻀﺎ ﻧﻴﺰ اﻧﺘﻘﺎﻝ می یابد.EBV ﻋﺎﻣﻞ ﺑﻴﻤﺎﺭﻱ ﻣﻮﻧﻮﻧﻜﻠﻴﻮﺯ ﻋﻔﻮﻧﻲ (ﺑﻴﻤﺎﺭﻱ ﻓﺎﻳﻔﺮ) اﺳت ﻛﻪ ﻳﻚ ﺑﻴﻤﺎﺭﻱ ﻫﻤﺮاه ﺑﺎ ﺗﺐ ﻛﻪ ﻣﻌﻤﻮﻻ ﺑﺎ ﻓﺎﺭﻧﮋﻳﺖ و ﺁﺩﻧﻮﭘﺎﺗﻲ ﻏﺪﺩ ﻟﻨﻔﺎﻭﻱ و ﮔﺎﻫﺎ ﺑﺎ ﺑﺰﺭﮒ ﺷﺪﻥ ﻃﺤﺎﻝ و ﻛﺒﺪ و ﺑﻨﺪﺭﺕ ﺑﺎ ﺑﺜﻮﺭاﺕ ﭘﻮﺳﺘﻲ ﻫﻤﺮاﻩ ﻣﻴﺒﺎﺷﺪ.
ﻫﻨﮕاﻣﻴﻜﻪ ﺑﺮاﻱ اﻭﻟﻴﻦ ﺑﺎﺭ ﺩﺭ ﺩﻭﺭاﻥ ﺑﭽﮕﻲ اﻳﻦ ﻋﻔﻮﻧﺖ اﻳﺠﺎﺩ میﺸﻮﺩ ﺑﺪﻭﻥ ﻋﻼﻣﺖ اﺳﺖ. ﺩﺭ ﻛﺸﻮﺭﻫﺎﻱ ﺻﻨﻌﺘﻲ اﻏﻠﺐ ﻧﻮﺟﻮاﻧﺎﻥ و ﺟﻮاﻧﺎﻥ ﺩﭼﺎﺭ ﻋﻔﻮﻧﺖ ﻣﻴﺸﻮﻧﺪ ﻛﻪ اﻏﻠﺐ ﺑﺎ ﻋﻼﻳﻢ ﺑﺎﺭﺯ ﻫﻤﺮاﻩ اﺳﺖ. ﻋﻔﻮﻧﺘﻬﺎﻱ EBV ﮔﺎﻫﻲ ﺩﺭ ﺣﻀﻮﺭ ﺑﻴﻤﺎﺭﻳﻬﺎﻳﻲ ﭼﻮﻥ ﻟﻨﻔﻮﻡ ﺑﺪﺧﻴﻢ ( ﻓﺮﻡ ﺁﻧﺪﻣﻴﻚ ﻟﻨﻔﻮﻡ ﺑﻮﺭﻛﻴﺖ ﺩﺭ ﺁﻓﺮﻳﻘﺎ) و ﻛﺎﺭﺳﻴﻨﻮﻣﺎﻱ ﻧﺎﺯﻭﻓﺎﺭﻧﮋ NPC، ( ﺑﺨﺼﻮﺹ ﺷﺎﻳﻊ ﺩﺭ ﺁﺳﻴﺎﻱ ﺟﻨﻮﺏ ﺷﺮﻗﻲ) . NPC ﺳﻮﻣﻴﻦ ﺳﺮﻃﺎﻥ ﺑﺪﺧﻴﻢ ﺷﺎﻳﻊ ﺩﺭ ﺟﻨﻮﺏ ﭼﻴﻦ میﺒﺎﺷﺪ. اﺯ ﺳﺎﻝ 2011 ﺷﻮاﻫﺪﻱ ﺩﺭ ﺣﺎﻝ اﻓﺰاﻳﺶ اﺳﺖ ﻣﺒﻨﻲ ﺑﺮاﻳﻨﻜﻪ ﻋﻔﻮﻧﺖ EBV ﻫﻤﺮاﻩ ﺑﺎ ﺑﺎﻻ ﺭﻓﺘﻦ ﺭﻳﺴﻚ ﺑﻴﻤﺎﺭﻱ ﻣﺎﻟﺘﻴﭙﻞ اﺳﻜﻠﺮﻭﺯﻳﺲ و ﻳﺎ ﺣﺎﻟﺖ ﺗﻬﺎﺟﻤﻲ MS اﺳﺖ.
ﻫﺪﻑ اﺻﻠﻲ ﺗﺸﺨﻴﺺ EBV ﺩﺭ اﺷﺨﺎﺻﻲ ﺑﺎ اﻳﻤﻨﻲ ﺳﺎﻟﻢ ﺗﻤﺎﻳﺰ ﺑﻴﻦ ﻋﻔﻮﻧﺖ ﺣﺎﺩ و ﻣﺰﻣﻦ اﺳﺖ. ﺭﻭﺷﻬﺎﻱ ﺳﺮﻭﻟﻮﮊﻳﻜﻲ ﮔﻮﻧﺎﮔﻮﻧﻲ ﺩﺭ اﻳﻦ ﺭاﺳﺘﺎ ﺑﻜﺎﺭ ﮔﺮﻓﺘﻪ ﺷﺪﻩ اﺳﺖ. ﺳﻴﺴﺘﻢ اﻳﻤﻨﻲ ﺩﺭ اﺷﺨﺎﺹ ﺳﺎﻟﻢ ﻣﻴﺘﻮاﻧﺪ ﺑﺴﻴﺎﺭ ﺳﺮﻳﻊ ﻋﻮﺩ ﻣﺠﺪﺩ ﻭﻳﺮﻭﺱ ﺭا ﺳﺮﻛﻮﺏ ﻧﻤﺎﻳﺪ. اﻣﺎ, ﺩﺭ اﻓﺮاﺩﻱ ﺑﺎ اﻳﻤﻨﻲ ﺗﻀﻌﻴﻒ ﺷﺪﻩ (ﺑﺮاﻱ ﻣﺜﺎﻝ ﺁﻧﻬﺎﻳﻴﻜﻪ ﺗﺤﺖ ﺩﺭﻣﺎﻧﻬﺎﻱ ﺿﻌﻴﻒ ﺳﺎﺯﻱ ﺳﻴﺴﺘﻢ اﻳﻤﻨﻲ ﺑﻌﺪ اﺯ ﻋﻤﻞ ﭘﻴﻮﻧﺪ ﻫﺴﺘﻨﺪ و ﻳﺎ ﺩﭼﺎﺭ ﺑﻴﻤﺎﺭﻱ اﻳﺪز ﻫﺴﺘﻨﺪ) ﻋﻔﻮﻧﺖ EBV ﻣﻴﺘﻮاﻧﺪ ﺑﺼﻮﺭﺕ ﻏﻴﺮ ﻗﺎﺑﻞ ﻛﻨﺘﺮﻟﻲ ﻣﻨﺘﺸﺮ ﺷﺪﻩ و ﺑﺎﻋﺚ ﺑﻴﻤﺎﺭﻳﻬﺎﻱ ﻟﻨﻔﻮﭘﺮﻭﻟﻴﻔﺮاﺗﻴﻮ ﺷﺪﻳﺪﻱ ﮔﺮﺩﺩ. ﺩﺭ ﭼﻨﻴﻦ ﻣﻮاﺭﺩﻱ ﺗﻌﻴﻴﻦ ﻣﻴﺰاﻥ ﻭﻳﺮﻭﺱ ﺑﺮاﻱ ﺗﺸﺨﻴﺺ ﺑﺴﻴﺎﺭ اﻫﻤﻴﺖ ﺩاﺭﺩ ﻛﻪ ﺩﺭ اﻳﻨﺼﻮﺭﺕ PCR ﺑﻜﺎﺭ ﻣﻴﺮﻭﺩ. ﻣﻮﻧﻮﻧﻜﻠﻴﻮﺯ ﻋﻔﻮﻧﻲ ﺑﺎﻳﺪ اﺯ ﺑﻴﻤﺎﺭﻳﻬﺎﻱ اﻧﻜﻠﻮﺯﻳﻮﻥ ﺳﻴﺘﻮﻣﮕﺎﻝ و ﺗﻮﻛﺴﻮﭘﻼﺳﻤﺎ و, ﺩﺭ ﻣﻮاﺭﺩ ﭘﻴﺸﺮﻓﺖ ﻏﻴﺮ ﻃﺒﻴﻌﻲ, اﺯ ﺑﻴﻤﺎﺭﻱ اﻳﺪﺯ و ﺳﺎﻳﺮ ﻋﻔﻮﻧﺘﻬﺎ ﺗﻤﺎﻳﺰ ﺩاﺩﻩ ﺷﻮﺩ.
ﺩﺭ ﺑﺎﺭﺩاﺭﻱ ، EBV ﺑﺎﻋﺚ ﻋﻔﻮﻧﺖ ﺟﻔﺖ و ﺁﺳﻴﺐ ﺯﺩﻥ ﺑﻪ ﻗﻠﺐ, ﭼﺸﻢ و ﻛﺒﺪ ﺟﻨﻴﻦ میﮕﺮﺩﺩ. ﺩﺭ ﺑﭽﻪ ﻫﺎ, ﻫﻤﺮاﻩ ﺷﺪﻥ ﻋﻔﻮﻧﺘﻬﺎﻱ ﻛﻠﻴﻮﻱ ﺑﺎ ﻋﻼﻳﻤﻲ ﺷﺎﻣﻞ ﻫﻤﺎﭼﻮﺭﻱ ﻣﻴﻜﺮﻭﺳﻜﻮﭘﻲ ﺗﺎ اﺯ ﻛﺎﺭ اﻓﺘﺎﺩﮔﻲ ﺣﺎﺩ ﻛﻠﻴﻪ ﻣﺸﺎﻫﺪﻩ ﻣﻴﺸﻮﺩ. ﭘﺎﺳﺦ اﻳﻤﻨﻲ ﺑﻪ ﻳﻚ ﻋﻔﻮﻧﺖ EBV ﺑﻭﺳﻴﻠﻪ ﺗﺸﻜﻴﻞ ﺁﻧﺘﻲ ﺑﺎﺩﻳﻬﺎ ﻋﻠﻴﻪ ﻛﭙﺴﻴﺪ EBV, ﻫﺴﺘﻪ EBV و ﺁﻧﺘﻲ ﮊﻧﻬﺎﻱ اﻭﻟﻴﻪ اﻧﺠﺎﻡ ﻣﻴﺸﻮﺩ.
ﺩﺭ ﻣﺮﺣﻠﻪ اﻭﻝ ﺑﻴﻤﺎﺭﻱ ﺁﻧﺘﻲ ﺑﺎﺩﻳﻬﺎﻱ IgM و IgG ﻋﻠﻴﻪ ﺁﻧﺘﻲ ﮊﻥ ﻛﭙﺴﻴﺪ ﻭﻳﺮﻭﺱ ﻗﺎﺑﻞ ﺗﺸﺨﻴﺺ ﻣﻴﺒﺎﺷﺪ. ﻳﻚ ﻧﺘﻴﺠﻪ Anti-EBV-CA ﻣﺜﺒﺖ ﻳﻚ ﻣﺎﺭﻛﺮﻣﺸﺨﺺ ﻋﻔﻮﻧﺖ ﺣﺎﺩ اﺳﺖ. ﺁﻧﺘﻲ ﺑﺎﺩﻳﻬﺎﻱ IgG ﻋﻠﻴﻪ ﺁﻧﺘﻲ ﮊﻧﻬﺎﻱ اﻭﻟﻴﻪ ﺩﻳﺮﺗﺮ ﺩﺭ ﻣﺮﺣﻠﻪ ﺣﺎﺩ ﺗﻮﻟﻴﺪ ﺷﺪﻩ و ﺑﻌﺪ اﺯ 6-3 ﻣﺎﻩ ﺑﻪ ﺳﻂﺢ ﻏﻴﺮ ﻗﺎﺑﻞ ﺗﺸﺨﻴﺼﻲ ﻛﺎﻫﺶ ﻣﻴﺎﺑﻨﺪ. ﺳﻂﺢ ﺁﻧﺘﻲ ﺑﺎﺩﻱ Anti-CA IgG ﺑﻂﻮﺭ ﻣﺎﺩاﻡ اﻟﻌﻤﺮ ﺑﺎﻗﻲ ﻣﻴﻤﺎﻧﺪ . ﺣﺪﻭﺩ 8-6 ﻫﻔﺘﻪ ﺑﻌﺪ اﺯ ﻋﻔﻮﻧﺖ, ﺁﻧﺘﻲ ﺑﺎﺩﻳﻬﺎﻱ ﻋﻠﻴﻪ EBNA ﺗﻮﻟﻴﺪ می ﺸﻮﻧﺪ. ﻭﺟﻮﺩ اﻳﻦ ﺁﻧﺘﻲ ﺑﺎﺩﻱ ﻫﺎ ﻭﺟﻮﺩ ﻳﻚ ﻋﻔﻮﻧﺖ کهنه ﺭا ﻣﺸﺨﺺ میﻜﻨﻨﺪ.
اﺳﺎﺱ ﺗﺴﺖ:
ﻳﻮﺭﻭﻻﻳﻦ ﻳﻚ ﺭﻭﺵ اﻳﻤﻮﻧﻮاﺳﻲ ﻛﻴﻔﻲ ﺁﺯﻣﺎﻳﺸﮕﺎﻫﻲ ﻣﻴﺒﺎﺷﺪ ﺑﻂﻮﺭﻳﻜﻪ ﻧﻮاﺭﻫﺎﻱ ﻏﺸﺎﻳﻲ ﺑﺼﻮﺭﺕ ﺧﻂﻮﻁ ﺧﺎﻟﺼﻲ اﺯ ﺁﻧﺘﻲ ﮊﻧﻬﺎﻱ ﺳﻨﺘﺰ ﺷﺪﻩ ﺑﻴﻮﺷﻴﻤﻴﺎﻳﻲ ﺑﻌﻨﻮاﻥ ﻓﺎﺯ ﺟﺎﻣﺪ ﺣﻚ ﺷﺪﻩ اﻧﺪ. ﻫﺮ ﺁﻧﺘﻲ ﮊﻥ ﺭﻭﻱ ﻳﻚ ﻗﻂﻌﻪ ﻏﺸﺎﻳﻲ ﻣﺠﺰا ﭘﻮﺷﺎﻧﺪﻩ ﺷﺪﻩ اﺳﺖ و ﺑﻨﺎﺑﺮاﻳﻦ ﺑﺎﺯﺩﻩ ﺗﻌﻴﻴﻦ ﺁﻧﺘﻲ ﺑﺎﺩﻳﻬﺎ ﺑﺮاﻱ ﻫﺮ ﭘﺮﻭﺗﻴﻨﻲ ﺭا ﺑﻪ ﺣﺪاﻛﺜﺮﻣﻴﺮﺳﺎﻧﺪ. اﺯ ﺁﻧﺠﺎﻳﻴﻜﻪ ﺑﺎﻧﺪﻫﺎﻱ ﺁﻧﺘﻲ ﮊﻧﻲ ﺩﺭ ﻣﻜﺎﻧﻬﺎﻱ ﻣﺸﺨﺺ ﻗﺮاﺭ ﺩاﺭﻧﺪ ﻧﺘﺎﻳﺞ ﻣﻴﺘﻮاﻧﻨﺪ ﺑﺼﻮﺭﺕ ﭼﺸﻤﻲ و ﺑﺪﻭﻥ ﻧﻴﺎﺯ ﺑﻪ ﺗﺠﻬﻴﺰاﺕ اﺿﺎﻓﻪ ﻣﻮﺭﺩ اﺭﺯﺷﻴﺎﺑﻲ ﻗﺮاﺭ ﮔﻴﺮﻧﺪ. اﻧﺠﺎﻡ ﮔﺮﻓﺘﻦ ﺻﺤﻴﺢ ﺗﻤﺎﻡ ﻣﺮاﺣﻞ ﺗﺴﺖ ﺗﻮﺳﻄ ﻧﻤﺎﻳﺎﻥ ﺷﺪﻥ ﺑﺎﻧﺪ ﻛﻨﺘﺮﻝ ﻗﺎﺑﻞ ﺗﺎﻳﻴﺪ ﻣﻴﺒﺎﺷﺪ.
ﺻﺤﺖ و ﺩﻗﺖ ﺗﺴﺖ:
127 ﺳﺮﻡ اﺯ ﺑﻴﻤﺎﺭاﻥ ﺩﺭ ﻣﺮاﺣﻞ ﻣﺨﺘﻠﻒ ﻋﻔﻮﻧﺖ EBV (ﻣﺸﺨﺺ ﺷﺪﻩ ﺑﺼﻮﺭﺕ ﺑﺎﻟﻴﻨﻲ و ﺳﺮﻭﻟﻮﮊﻳﻜﻲ ﺗﻮﺳﻄ ﺩﻛﺘﺮ ﮔﺎﺭﺗﻨﺮ, ﺩاﻧﺸﮕﺎﻩ ﻛﻠﻴﻨﻴﻜﻲ ﺳﺎﺭﻟﻨﺪ, ﺁﻟﻤﺎﻥ, ﻳﻮﺭﻭاﻳﻤﻴﻮﻥ) ﺑﺮاﻱ ﺁﻧﺘﻲ ﺑﺎﺩﻳﻬﺎﻱ ﻛﻼﺱ IgG و IgM ﻋﻠﻴﻪ VCA gp125, VCA p19, EBNA-1, p22 و EA-D ﺑﻮﺳﻴﻠﻪ ﻳﻮﺭﻭﻻﻳﻦ EBV ﭘﺮﻭﻓﺎﻳﻞ 2 ﻣﻮﺭﺩ ﺑﺮﺭﺳﻲ ﻗﺮاﺭ ﮔﺮﻓﺘﻨﺪ.
ﻋﻔﻮﻧﺖ ﺗﺎﺯﻩ ﺑﻮﺳﻴﻠﻪ ﺁﻧﺘﻲ ﺑﺎﺩﻳﻬﺎﻱ ﻛﻼﺱ IgG و IgM ﻋﻠﻴﻪ ﺁﻧﺘﻲ ﮊﻧﻬﺎﻱ VCAgp125 , VCA , ﻭﻳﺎ p19 ﻣﺸﺨﺺ ﺷﺪﻩ اﻧﺪ. ﺁﻧﺘﻲ ﺑﺎﺩﻳﻬﺎﻱ ﻛﻼﺱ IgG ﻋﻠﻴﻪ EA-D ﻧﻴﺰ ﻣﻴﺘﻮاﻧﻨﺪ ﺑﻮﺟﻮﺩ ﺁﻳﻨﺪ. ﻓﺎﺯ ﺑﻌﺪﻱ ﻋﻔﻮﻧﺖ ﺑﻮﺳﻴﻠﻪ ﺁﻧﺘﻲ ﺑﺎﺩﻳﻬﺎﻱ ﻛﻼﺱ IgG ﻋﻠﻴﻪ VCA gp125 ﻭﻳﺎ p19 و ﻋﻠﻴﻪ EBNA-1 ﻣﺸﺨﺺ ﺷﺪﻩ اﻧﺪ. ﺑﺎ ﻧﺎﭘﺪﻳﺪﺷﺪﻥ ﺛﺎﻧﻮﻳﻪ ﺁﻧﺘﻲ ﺑﺎﺩﻳﻬﺎ ﻋﻠﻴﻪ EBNA-1 ﺣﻀﻮﺭ ﺁﻧﺘﻲ ﺑﺎﺩﻳﻬﺎﻱ ﻛﻼﺱ IgG ﻋﻠﻴﻪ p22 ﻣﺸﺨﺺ ﻛﻨﻨﺪﻩ ﻓﺎﺯ ﺁﺧﺮ ﻋﻔﻮﻧﺖ ﻣﻴﺒﺎﺷﺪ
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