缺口连接酶联反应对小婴儿沙眼衣原体肺炎的诊断价值  

Diagnostic Value of Gap-Ligase Chain Reaction Enzyme Linked Immunosorbent Assay for Chlamydia Trachomatis Pneumonia in Neonatal and Small Infants

作　　者：邓春[1] 李晓文[1] 余加林[1] 吴仕孝[1] 

机构地区：[1]重庆医科大学附属儿童医院新生儿科,重庆400014

出　　处：《实用儿科临床杂志》2009年第4期253-256,共4页Journal of Applied Clinical Pediatrics

基　　金：国家自然科学基金项目资助(39670766)

摘　　要：目的探讨缺口连接酶联反应(Gap-LCR)ELISA对小婴儿(<6个月)沙眼衣原体(CT)肺炎的诊断价值。方法收集本院新生儿科及门诊393例肺炎患儿鼻咽拭子标本进行CT组织培养检测,并参照Dille文献经计算机软件辅助设计4条质粒基因探针,地高辛和生物素标记,取鼻咽拭子标本应用以上引物进行Gap-LCR,产物进行聚丙烯酰胺凝胶电泳(PAGE)和ELISA检测;对Gap-LCR阳性而TC阴性的患者,应用主要外膜蛋白基因omp1引物进行PCR证实,并比较不同年龄、不同分娩方式间CT感染率。结果393例肺炎患儿CT检出率达12.5%(49例),其中14～28 d发病率为11.9%(10/84例),>28 d～3个月为16.9%(27/160例),>3～6个月为8.1%(12/149例)。发热25例(51.0%),阵发性单声咳嗽48例(98.0%),鼻塞45例(91.8%),口吐白沫45例(91.8%),呼吸急促49例(100%),口唇发绀28例(57.1%),肺部中细湿啰音26例(53.1%),干性啰音24例(49.0%),痰鸣音18例(36.7%),双肺呼吸音粗糙29例(59.2%),伴结膜炎13例(26.5%)。胸片均显示双侧广泛间质和(或)肺泡浸润,过度充气23例(46.9%),均无大叶实变或胸腔积液。所有患儿在未证实CT肺炎前采用头孢类或青霉素类抗生素治疗。11例于患病后证实为CT肺炎后改用阿奇霉素治疗9 d治愈;余患儿均未用大环内酯类药物,病程迁延(15～44 d),其中11例因反复咳嗽多次在本院门诊治疗。结论CT为小婴儿肺炎的重要病原体,临床若考虑到CT肺炎,应尽快行CT-LCR检测,尽早为临床提供CT肺炎诊断依据,以便早期诊断、早期应用敏感抗生素查行治疗。Objective To explore the diagnostic value of Gap - ligase chain reaction （LCR） - enzyme linked immunosorbent assay （ELISA） for Chlamydia trachomatis（CT） pneumonia in infants （ 〈 6 months）. Methods Acquisition 393 cases of in - patient and out - patient pneumonia were orgnized for infusion in neonatal department of hospital, and their nasopharyngeal swab specimens were collected and inoculated them into the monolayer McCoy cell. Iodine dyeing was used to detect CT. Four plasmid gene probes were designed by computer - aided design software according to reference reported by Dille. The probes labeled with biotin and digoxigninen were used to amplify CT plasmid DNA of nasopharyngeal swab specimens by Gap - LCR method and were examined by ELISA and polyacrylamide gel electrophoresis （PAGE）, and LCR was to amplify CT with plasmid DNA examined by ELISA. The cases with TC negative and Gap - LCR positive were analyzed by major outer membrane protein gene probe PCR, the cases with both TC and Gap - LCR negative were analyzed by major outer membrane CT major outer membrane protein gene probe and plasmid PCR,then the infectious rate of CT in ages and different modes of production were calculated. Results The positive rate of CT in 393 cases of pneumonia was 12.5% （49 cases）, the incidence in newborn infants aged 14 -28 days was 11.9% （10/84 cases） ,the incidence in 〉 28 days -3 months old baby was 16.9% （27/160 cases） ,and the incidence in 3 -6 months old baby was 8.1% （12/149 cases）. The clinical symptoms included that 25 cases（51.0% ） had fever,48 cases（98.0% ） with paroxysmal cough,45 cases （91.8%） with rhinocleisis, 45 cases （ 91.8% ） with spitting foam, 49 cases （ 100% ） with tachypnea, 28 cases （57.1%） with lips cyanosis,26 cases（53.1% ） with medium and moist rales,24 cases（49.0% ） with dry rales,18 cases（36.7% ） with phlegm whimper,29 cases（59.2% ） with rough breath sounds in both lungs and there were 13 cases（26.5% ） with conjunctivit

关 键 词：沙眼衣原体 连接酶联反应 鼻咽拭子 肺炎 婴儿 

分 类 号：R725.6[医药卫生—儿科]