【摘要】：流行性腮腺炎由腮腺炎病毒引起,為影響兒童及青少年的急性傳染病。除侵犯腮腺外,可引起腦膜炎、腦膜腦炎、睪丸炎、卵巢炎、胰腺炎、乳腺炎等,可與腮腺炎同時發(fā)生,也可發(fā)生于腮腺炎之前或之后,或者單獨出現(xiàn)[11]。 腮腺炎病毒屬副粘病毒,系單股核糖核酸型。人是本病毒的唯一儲存宿主。腮腺炎病毒可在雞胚及組織培養(yǎng)如猴腎、人羊膜、HeLa細(xì)胞中繁殖。含有病毒顆粒抗原(V抗原)及可溶性抗原(S抗原)2種抗原成分。腮腺炎病毒很少變異,一般僅存在一種抗原型別。病毒顆粒具有血凝素,可與雞等紅細(xì)胞發(fā)生凝集反應(yīng),并可用以測定病人血凝抑制抗體。S抗原多用以進行補體結(jié)合試驗。病毒在56℃經(jīng)20分鐘,稀乙醚經(jīng)30分鐘,1%來蘇、乙醇、甲醇經(jīng)2-5分鐘皆可滅活。 本病僅發(fā)生于人類,人群對本病普遍易感。傳染源為早期患者和隱性感染者。發(fā)病前7天病毒已在唾液中出現(xiàn),并持續(xù)至發(fā)病后9天。表現(xiàn)為睪丸炎或腦膜炎而無腮腺炎的患者,也有病毒自唾液排出。[2]根據(jù)血清學(xué)及流行病學(xué)調(diào)查,大流行中隱性感染占30-40%,并有病毒自唾液中排出,成為重要的傳染源。本病借唾液飛沫傳播,全年皆有病例發(fā)生,多數(shù)發(fā)生于晚冬及初春。15歲以下兒童及青少年約占發(fā)病人數(shù)90%。成人80%可測出抗體。一次感染后可有持久免疫力,很少再次感染。 腮腺炎病毒進入人體后的發(fā)病過程,存在二種假說。一種認(rèn)為病毒由口經(jīng)腮腺導(dǎo)管如睪丸、腦、胰腺等中致病。另一種認(rèn)為病毒最初在呼吸道表層上皮中復(fù)制,以后進入血中隨循環(huán)播散至腮腺及其他器官并在其中增殖,再自這些器官第二次進入血中,侵犯第一次病毒血癥未侵及的器官。有些病例僅有其他器官受侵而無腮腺受累,或其他器官先于腮腺受累的事實,似更支持第二種假說。腮腺的非化膿性炎癥是本病的主要病理改變。腮腺中有漿液纖維性滲出,腮腺導(dǎo)管周圍及腺體壁有淋巴細(xì)胞浸潤。導(dǎo)管可阻塞或擴張。睪丸受累時輕者僅有間質(zhì)水腫及漿液纖維性滲出,重者可有淋巴細(xì)胞浸潤、曲精小管上皮破壞及堵塞。腮腺炎腦膜炎病變輕微,尸檢材料很少。腦炎病變主要為急性血管周圍脫髓鞘改變,與感染后腦炎無大差別。潛伏期14-21天。前驅(qū)期癥狀有乏力、食欲不振等,繼之腮腺腫大作痛,進酸性食物后痛尤明顯。腮腺腫大可限于一側(cè),但多數(shù)病人一側(cè)腫大后1-4天又累及對側(cè)。一般以耳垂為中心,向前、后、下發(fā)展,狀如梨形,具堅韌感,邊緣不清。局部皮膚緊張發(fā)亮,表面灼熱,但多不紅,有輕觸痛。頷下腺或舌下腺可同時或少數(shù)情況下單獨受累。腮腺腫大于2-3日達(dá)高峰,持續(xù)4-5日后消退。病人發(fā)熱38℃左右,持續(xù)約一周。一般成人患者癥狀較兒童為重。睪丸炎多見于成人,多發(fā)生于腫大的腮腺開始消退之時。病 人又發(fā)高熱,睪丸腫痛。睪丸多數(shù)為單側(cè),全病程10日左右。雖然1/3病人有不同程度的睪丸萎縮,但即或雙側(cè)受累,也很少引起不育。腮腺炎病毒極易侵犯中樞神經(jīng)系統(tǒng),可引起腦膜炎、腦膜腦炎。腦脊液檢查至少一半以上的腮腺炎病人有改變。臨床有頭痛、頸強直表現(xiàn)者,約占腮腺炎病例的10%。全病程約10日,大多恢復(fù)而無后遺癥。腮腺炎病毒尚可引起乳腺炎、卵巢炎、胰腺炎、心肌炎、甲狀腺炎、腎炎、多關(guān)節(jié)炎以及單側(cè)神經(jīng)性耳聾等。血白細(xì)胞計數(shù)正常或減低。有睪丸炎者白細(xì)胞總數(shù)可增多。腮腺炎患者血淀粉酶增高。有些腦膜炎病例,臨床上雖無腮腺炎,但血淀粉酶增高,可能為亞臨床型腮腺炎。有胰腺炎的病例除血淀粉酶增高外,血脂肪酶亦高。腦膜炎病例腦脊液細(xì)胞數(shù)增加,以淋巴細(xì)胞為主,蛋白正常或升高。腦膜炎病例腦脊液細(xì)胞數(shù)增加,以淋巴細(xì)胞為主,蛋白正常或升高,糖量正常,但10-20%病例亦可減低。典型腮腺炎病例不難診斷。本病應(yīng)與化膿性腮腺炎、腮腺腫瘤、藥物及其他病毒(如副流感病毒、柯薩奇甲組病毒)引起的腮腺腫大鑒別。確診(包括無臨床腮腺炎的腦膜炎或睪丸炎病人)有賴病毒分離及血清學(xué)檢查。病毒分離可取血、咽漱液、腮腺導(dǎo)管分泌物、腦脊液及尿,接種組織培養(yǎng)細(xì)胞或雞胚羊膜腔。血清學(xué)檢查常用的方法為補體結(jié)合試驗。S抗體出現(xiàn)早,下降較快,6-12月后一般已不能測出。V抗體出現(xiàn)晚,遲于S抗體1-2周,效價 常較S抗體為高,且持續(xù)多年。急性期及恢復(fù)期雙份血清S及V抗體效價4倍增加時可以確定診斷。S抗體高而無V抗體者可初步認(rèn)為是新病例的早期感染;有V抗體而無S抗體者可認(rèn)為過去曾受感染。還可測定中和抗體及血凝抑制抗體。本病無特異治療,主要對癥及支持治療。重型睪丸炎及腦膜炎患者可用腎上腺皮質(zhì)激素,可減輕癥狀,但不能防止睪丸萎縮。腮腺炎、腦膜炎、睪丸炎預(yù)后好很少復(fù)發(fā)或死亡。腮腺炎病人應(yīng)隔離至臨床癥狀消失為止。丙種球蛋白一般無被動免疫效果。對1歲以上兒童及青少年未患過腮腺炎者,可用腮腺炎減毒活疫苗免疫注射。也有將腮腺炎病毒與麻疹及風(fēng)疹病毒聯(lián)合制備疫苗。接種95%血中抗體陽性、腮腺炎發(fā)病率降低,抗體持續(xù)最少5年。現(xiàn)在做為預(yù)防腮腺炎病毒的最好方法就是注射腮腺炎減毒活疫苗,而現(xiàn)有的生產(chǎn)工藝為以SPF雞胚細(xì)胞做為腮腺炎病毒感染的基礎(chǔ)細(xì)胞,然后在適宜溫度下培養(yǎng),最后收獲病毒液[3]。因此,在此生產(chǎn)工藝中毒種的感劑量及小牛血清濃度將是兩個非常重要的因素,找出最佳的毒種劑量及合適的血清濃度會對腮腺炎減毒活疫苗的產(chǎn)量及質(zhì)量有明顯的提高。
[Abstract]:Epidemic mumps are caused by mumps virus and are acute infectious diseases affecting children and adolescents. In addition to invading the mumps, it can cause meningitis, meningoencephalitis, orchitis, ovaritis, pancreatitis, mastitis, etc. It can occur simultaneously with mumps, before or after mumps, or alone [11].
Mumps virus is a paramyxovirus, a single stranded ribonucleic acid type. It is the only storage host of the virus. Mumps virus can reproduce in chicken embryos and tissue cultures such as monkey kidney, human amniotic membrane, and HeLa cells. It contains two antigenic components: virus granule antigen (V antigen) and soluble antigen (S antigen). Mumps virus is rarely mutated and generally only exists. Virus particles have hemagglutinin, can agglutinate with chicken and other red blood cells, and can be used to detect hemagglutination inhibitory antibodies in patients. S antigen is often used for complement binding tests. Viruses can be inactivated by dilute ether for 30 minutes, 1% Lesu, ethanol and methanol for 2-5 minutes at 56 C for 20 minutes.
The disease occurs only in humans and is generally susceptible to the disease in the population. Infectious sources are early patients and latent infections. Viruses appear in saliva seven days before onset and persist until nine days after onset. The disease is transmitted by salivary droplets throughout the year. Most cases occur in late winter and early spring. Children and adolescents under 15 years old account for about 90% of the cases. 80% of adults can detect antibodies. Once infected, the disease has a lasting immunity and rarely re-infection.
There are two hypotheses about the pathogenesis of mumps virus when it enters the human body. One hypothesis is that the virus is caused by oral passage through parotid ducts such as testis, brain, pancreas, etc. The other hypothesis is that the virus first replicates in the surface epithelium of the respiratory tract, then enters the blood and circulates to the parotid gland and other organs and multiplies therein, and then from these organs to the second. Non-suppurative inflammation of the parotid gland is the main pathological change of the disease. Serous fibrillary exudation occurs in the parotid gland and the periductal area of the parotid gland. Lymphocyte infiltration and lymphocyte infiltration were found in the wall of the gland. The duct could be obstructed or dilated. Leydig edema and serous fibrillary exudation were found only in the mild cases. Lymphocyte infiltration was found in the severe cases. The epithelium of seminiferous tubules was destroyed and blocked. The incubation period is 14-21 days. The prodromal symptoms are fatigue and loss of appetite, followed by swelling and pain of the parotid gland, especially after eating acidic food. The parotid gland swelling reaches its peak in 2-3 days and subsides after 4-5 days. The patient has a fever of about 38 degrees centigrade, lasting about a week. The symptoms of adult patients are more serious than those of children. Orchitis is more common in adults and more common in adults. When the swollen parotid gland begins to subside.
Most of the testicles are unilateral, and the course of the disease is about 10 days. Although one third of the patients have varying degrees of testicular atrophy, or bilateral involvement, but also rarely cause infertility. Mumps virus is very easy to invade the central nervous system, can cause meningitis, meningoencephalitis. Cerebrospinal fluid examination at least half of the patients with mumps have changed. Mumps virus can also cause mastitis, ovaritis, pancreatitis, myocarditis, thyroiditis, glomerulonephritis, polyarthritis and unilateral nervous deafness. Blood white blood cell count is normal or reduced. People with orchitis are white and thin. In some cases of meningitis, although there is no mumps, the serum amylase may be increased, which may be subclinical type of mumps. In some cases of pancreatitis, besides the increase of serum amylase, the serum lipase is also high. In meningitis, the number of cerebrospinal fluid cells is increased, mainly lymphocytes, and the protein is normal or rising. The number of cerebrospinal fluid cells in meningitis patients increased, mainly lymphocytes, normal or elevated protein, normal sugar content, but 10-20% of cases can also be reduced. Typical cases of mumps are not difficult to diagnose. This disease should be differentiated from parotid gland enlargement caused by suppurative mumps, parotid tumors, drugs and other viruses (such as parainfluenza virus, Coxsackie A virus). Confirmed diagnosis (including meningitis or orchitis without clinical mumps) depends on virus isolation and serological examination. Virus isolation can take blood, pharyngeal gargle, parotid duct secretion, cerebrospinal fluid and urine, inoculate tissue-cultured cells or chicken embryo amniotic cavity. Serological tests commonly used are complement-binding tests. S antibodies appear early, decline faster, 6-12 After the month,.V antibody was not detected late, but later than S antibody for 1-2 weeks.
It is usually higher than S antibody and lasts for many years. Diagnosis can be made when the titers of S and V antibodies in both sera are increased four times in acute and convalescent stages. Severe orchitis and meningitis patients can use adrenocorticosteroids, can alleviate symptoms, but can not prevent testicular atrophy. Mumps, meningitis, orchitis prognosis is good rarely recurrence or death. Mumps should be isolated until the clinical symptoms disappear. Gamma globulin generally has no passive immune effect. For children and adolescents over one year old who have not suffered from mumps, live attenuated mumps vaccine can be used to immunize. There are also mumps virus and measles and rubella virus vaccine preparation. 95% of the blood antibody positive, mumps incidence decreased, antibody lasted for at least 5 years. Now the best way to prevent mumps virus is injection. Mumps live attenuated vaccine, and the existing production process for SPF chicken embryo cells as the basis of mumps virus infection cells, and then cultured at appropriate temperatures, and finally harvested the virus solution [3]. And the appropriate serum concentration will significantly improve the production and quality of live attenuated mumps vaccine.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2006
【分類號】：R392

【參考文獻】

相關(guān)期刊論文 前4條

1 徐冰;呼吸道合胞病毒疫苗研究進展[J];國外醫(yī)學(xué).預(yù)防.診斷.治療用生物制品分冊;1995年05期

2 JamesE,劉建;呼吸道合胞病毒和副流感病毒疫苗研制現(xiàn)狀WHO疫苗開發(fā)規(guī)劃會議報告[J];國外醫(yī)學(xué).預(yù)防.診斷.治療用生物制品分冊;1996年01期

3 周祖木;麻疹、腮腺炎和風(fēng)疹疫苗接種后發(fā)生橫 貫性脊髓炎[J];國外醫(yī)學(xué).預(yù)防.診斷.治療用生物制品分冊;1996年03期

4 周生華，董繼華，，田慕貞;呼吸道合胞病毒自然溫度敏感株的研究Ⅰ．呼吸道合胞病毒自然溫度敏感株的篩選及其特[J];中國病毒學(xué);1995年01期

本文編號：2196704