兒童肺炎支原體感染三種實(shí)驗(yàn)診斷方法評(píng)價(jià)

趙志偉　宋曼莉

【摘要】 目的：探討兒童肺炎支原體感染的快速、簡(jiǎn)便、有效的臨床實(shí)驗(yàn)室診斷方法。方法：對(duì)2016年12月收集的200例臨床呼吸道感染患兒的咽拭子和靜脈血樣本進(jìn)行肺炎支原體快速鑒定培養(yǎng)鏡檢、抗體檢測(cè)、抗原檢測(cè)及熒光定量PCR（Polymerase chain reaction）分析。以快速培養(yǎng)鑒定鏡檢法為診斷肺炎支原體感染金標(biāo)準(zhǔn)，比較抗體檢測(cè)、抗原檢測(cè)及熒光定量PCR三種診斷方法的靈敏度、特異度和Youden指數(shù)（正確診斷指數(shù)）。結(jié)果：抗體檢測(cè)的靈敏度、特異度和Youden指數(shù)分別為76.3%、77.9%、54.2%；抗原檢測(cè)為37.7%、89.5%、27.2%；熒光定量PCR為93.0%、96.5%、89.5%。熒光定量PCR法的靈敏度、特異度和Youden指數(shù)均高于抗體檢測(cè)和抗原檢測(cè)法（P<0.05），三者Youden指數(shù)兩兩比較，差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論：熒光定量PCR具有較高的靈敏度、特異度和Youden指數(shù)，可以在未來(lái)替代快速鑒定培養(yǎng)鏡檢、抗體檢測(cè)和抗原檢測(cè)法，作為臨床診斷兒童肺炎支原體感染的快速、簡(jiǎn)便而有效的實(shí)驗(yàn)室診斷方法。

【關(guān)鍵詞】 肺炎支原體； 抗體檢測(cè)； 抗原檢測(cè)； 熒光定量PCR

【Abstract】 Objective：To explore the fast，simple and effective method to clinical diagnosis of mycoplasma pneumonia infection of children.Method：Throat swabs and venous blood samples were obtained from 200 children with respiratory infection，these samples were tested by rapid identification culture and microscopy，antibody detection，antigen detection，fluorescence quantitative PCR in December 2016.Rapid identification culture and microscopy was set as the diagnostic “gold standard”，sensitivity，specificity and youden index of three methods were compared.Result：The sensitivity，specificity and youden index of antibody detection were respectively 76.3%，77.9% and 54.2%；antigen detection were respectively 37.7%，89.5% and 27.2%；fluorescence quantitative PCR were respectively 93.0%，96.5% and 89.5%.The sensitivity，specificity and youden index of fluorescence quantitative PCR were higher than those of antibody detection and antigen detection（P<0.05），compared youden index of three methods，the differences were statistically significant（P<0.05）.Conclusion：The sensitivity，specificity and Youden index of fluorescence quantitative PCR are higher，it can take the place of rapid identification culture and microscopy，antibody detection and antigen detection in the future，and it is a rapid，convenient and effective laboratory diagnosis method to clinical diagnosis Mycoplasma pneumoniae infection of children.

【Key words】 Mycoplasma pneumoniae； Antibody detection； Antigen detection； Fluorescence quantitative PCR

First-authors address：Haicang Hospital of Xiamen，Xiamen 361026，China

doi：10.3969/j.issn.1674-4985.2017.25.017

肺炎支原體（Mycoplasma pneumoniae，MP）是一種大小介于細(xì)菌和病毒之間，缺乏細(xì)胞壁，能利用人工培養(yǎng)基生長(zhǎng)繁殖的原核細(xì)胞型微生物，是人類支原體肺炎（M.pneumoniae pneumonia，MPP）的病原體。MP主要經(jīng)飛沫傳播，潛伏期2～3周，易感人群主要為兒童和青少年[1-3]。國(guó)內(nèi)外多項(xiàng)研究表明，MP的感染發(fā)病率從0.6%～47%不等，占兒童社區(qū)獲得性肺炎（Community-acquired pneumonia，CAP）病原體的70%左右。隨著大環(huán)內(nèi)酯類抗菌藥物的廣泛應(yīng)用，其耐藥性有所增加，甚至出現(xiàn)了耐藥株。有效而靈敏的實(shí)驗(yàn)室診斷方法是診斷MP感染的主要依據(jù)。目前，國(guó)內(nèi)大多醫(yī)院對(duì)MP感染的診斷，依舊停留在典型的臨床感染癥狀結(jié)合血常規(guī)及MP抗體檢測(cè)或MP培養(yǎng)進(jìn)行診斷的水平。近年來(lái)，熒光定量PCR（Fluorescencd quantitative PCR，F(xiàn)Q-PCR）和抗原檢測(cè)診斷MP感染雖已在臨床科研中少量使用，但大多醫(yī)院并未廣泛應(yīng)用[4-6]。在國(guó)外，PCR基因診斷已作為臨床診斷的一種常用手段，以FQ-PCR為主。……