某部急性上呼吸道感染暴发疫情的病原学检测  

Pathogen detection of an epidemic of acute upper respiratory infection in a unit of PLA

作　　者：刘爱霞[1] 郭桐生[1] 徐军[1] 郭静霞[1] 马洪滨[1] 赵敏[2] 阎亮[3] 郝健 李伯安[1] 毛远丽[1] 

机构地区：[1]解放军302医院临检中心,北京100039 [2]解放军302医院感染1科,北京100039 [3]解放军302医院医务科,北京100039 [4]解放军105中心医院呼吸科,合肥230031

出　　处：《解放军医学杂志》2010年第3期249-251,共3页Medical Journal of Chinese People's Liberation Army

基　　金：军队“十一五”科技攻关项目(06G143)

摘　　要：目的通过实验室病原学筛查,结合流行病学史及临床表现,初步筛查某部急性上呼吸道感染暴发疫情的致病病原体。方法采集51例患者血液和咽拭子标本,分别采用免疫荧光、酶联免疫吸附试验(ELISA)、聚合酶链反应(PCR)、病毒分离及微生物学细菌培养等实验室诊断方法筛查、确定致病病原体,并对15例恢复期患者(发病后15～28d)血清进行IgG滴度检测,比较急性期与恢复期抗体滴度的变化。结果所有咽拭子的细菌培养及7例咽拭子的病毒分离试验结果均为阴性。对24例患者血清进行的免疫荧光法呼吸道常见20种病原体IgM抗体筛查结果显示:流感A型阳性率为20.8%(5/24),流感B型阳性率为12.5%(3/24),肺炎衣原体阳性率为20.8%(5/24),肺炎支原体阳性率为50.0%(12/24),其余病原体检测均为阴性。ELISA检测IgM抗体结果显示:总流感病毒IgM抗体阳性2例(3.92%),肺炎衣原体抗体阳性7例(13.7%),肺炎支原体抗体阳性20例(39.2%),呼吸道合胞病毒抗体阳性2例(3.92%),EB病毒抗体阳性1例(1.96%)。免疫荧光法肺炎支原体IgG抗体滴度检测结果显示1∶100稀释后阳性反应37例(72.5%),其中的31例(60.8%)在1∶1000稀释后仍呈阳性反应,对照组仅2例(6.45%)IgG抗体1∶100时呈阳性,在1∶1000稀释后均为阴性。PCR实验未见特异扩增反应。恢复期与急性期血清抗体效价检测发现15例中有7例肺炎支原体抗体效价有4倍以上变化。结论初步推断此次某部群体急性上呼吸道感染事件系肺炎支原体感染引起;该疫情的实验室快速诊断为今后疫情的早期诊断提供了思路。Objective To screen the pathogens of the epidemic of acute upper respiratory tract infection in a unit of PLA based on the laboratory screening for etiological agents, epidemiological history and clinical manifestations. Methods Immunofluorescence assay （IFA）, enzyme-linked immunosorbent assay （ELISA）, polymerase chain reaction （PCR）, virus isolation, microbiological culture, and other laboratory diagnostic methods were performed for the blood and throat swab samples collected from 51 patients to screen and determine the the pathogens. Meanwhile, the serum IgG titers of 15 convalescent cases （15-28 days after onset） were determined and compared with those of the acute cases. Results The results of bacterial culture of all throat swabs and virus isolation tests of 7 throat swabs were negative. IgM antibody screening of 20 kinds of common respiratory tract pathogens in the 24 serum samples by IFA indicated that 20.8% （5/24） of them were positive for influenza A virus, 12.5% （3/24） for influenza B virus, 20.8% （5/24） for Chlamydia pneumoniae, 50.0% （12/24） for Mycoplasma pneumoniae,and the rest were negative. The detection of IgM antibodies by ELISA indicated that 2 cases （3.92%） were positive for the total influenza virus, 7 cases （13.7%） for Chlamydia pneumoniae, 20 cases （39.2%） for Mycoplasma pneumoniae, 2 cases （3.92%） for respiratory syncytial virus, and 1 case （1.96%） for EB virus. The determination of Mycoplasma pneumoniae IgG antibody titers by IFA indicated that 37 cases （72.5%） showed positive reaction with 1∶100 dilution, of which 31 （60.8%） continued to show positive reaction with 1∶1000 dilution. In the control group, only 2 cases （6.45%） were positive for IgG antibody with 1∶100 dilution, and all were negative with 1∶1000 dilution. No specific amplification was found in the PCR experiment. The detection of serum antibody titers of the convalescents and acute patients showed that out of 15 cases, 7 had a change in Mycoplasma pneumo

关 键 词：呼吸道感染 疾病暴发流行 支原体 肺炎 

分 类 号：R446.5[医药卫生—诊断学]