液态芯片法在社区获得性肺炎病毒检测中的应用价值  

Clinical value of viral detection of liquid chip method in community-acquired pneumonia

作　　者：顾秀丽[1] 冯伟明[1] 朱敏[1] 王玫[1] 黄艳飞[1] 张明新[1] 田晓波[1] 郑春玉[1] 马安林[2] 刘淑娥[2] 徐蒙[2] 鲁辛辛[1] 

机构地区：[1]首都医科大学附属北京同仁医院检验科,100730 [2]卫生部中日友好医院感染科

出　　处：《中华医学杂志》2015年第4期264-268,共5页National Medical Journal of China

摘　　要：目的 评价液态芯片法在社区获得性肺炎（CAP）病毒检测中的应用价值.方法 采集2013年10月至2014年9月因CAP于首都医科大学附属北京同仁医院和卫生部中日友好医院171例就诊患者的342份鼻咽拭子和口咽拭子,分别采用液态芯片法（xTAG RVP）和普通多重呼吸道病毒核酸检测法（Seeplex RV15）对15种呼吸道病毒进行检测;使用传统方法（间接免疫荧光法和特异性抗原法）对9种呼吸道病原体进行检测;用实时荧光定量-PCR方法进行确认.对检测结果进行统计学分析,并进行临床应用评价.结果 171例CAP患者实时荧光定量-PCR方法的病毒检测阳性率为35.7％ （61/171）,其中甲型流感病毒（FluA）、乙型流感病毒（FluB）、呼吸道合胞病毒（RSV）、鼻病毒（HRV）、人偏肺病毒（hMPV）占所有检出病毒的90.5％,平均年龄为49.17岁.实时荧光定量-PCR方法对口咽拭子和鼻咽拭子呼吸道病毒检测的阳性率分别为31.6％和33.9％,两种标本类型差异无统计学意义（Kappa=0.714,P＜0.001;McNemar χ^2=0,P=1.000）.xTAG（R） RVP和Seeplex RV15两种多重呼吸道病毒核酸检测技术对342份标本病毒检测阳性率分别为32.5％与29.5％,两种方法的结果一致率为85.4％（292/342）（Kappa=0.66）.传统方法阳性率是14.0％.与Seeplex RV15及传统方法相比,xTAG RVP具有更高的敏感度（93.3％）、符合率（92.4％）和阴性预测值（96.9％）,与实时荧光定量-PCR一致率高（Kappa=0.83）.结论 液态芯片法优于传统方法和普通多重呼吸道病毒核酸检测法,可作为CAP病毒检测的常规方法.Objective To evaluate the clinical value of viral detection of liquid chip method in community-acquired pneumonia （CAP）.Methods A total of 342 swabs were collected from 171 patients of community-acquired pneumonia from October 2013 to September 2014.The methods of xTAG（R） RVP and Seeplex RV15 ACE were employed to detect respiratory viruses.And traditional methods of indirect immunofluorescence and specific antigen were used for comparison.All results were validated by realtimePCR and statistically analyzed.Results Of 171 CAP patients with an average age of 49.17 years,35.7% （61/171） were virus positive.Influenza A （FluA）,influenza B （FluB）,respiratory syncytial virus （RSV）,human rhinovirus （HRV） and human metapneumovirus （hMPV） accounted for 90.5% of all detected viruses.The detection rates of mouth swabs and nasopharyngeal swabs were 31.6% and 33.9% respectively.Two specimen types showed no significant differences （Kappa =0.714,P 〈 0.001 ; McNemar χ^2 =0,P =1.000）.The positive rates of viral detection by xTAG RVP and Seeplex RV15 were 32.5% and 29.5% respectively.And the consistence rate of results was up to 85.4% （292/342） （Kappa =0.66）.The positive rate of traditional methods was 14.0%.However,xTAG RVP had a higher sensitivity （93.3%）,higher consistence rate （92.4%） and negative predictive value （96.9%） compared with Seeplex RV15 and traditional methods.Also xTAG RVP had a high consistent rate of realtime-PCR （Kappa =0.83）.Conclusions Liquid chip is superior to other detection methods.And it may be used routinely for viral detection of CAP.

关 键 词：芯片分析技术 社区获得性感染 肺炎病毒感染 临床价值 

分 类 号：R563.1[医药卫生—呼吸系统]