肺炎支原体RNA检测在儿童肺炎支原体肺炎疗效监测中的应用价值  

Clinical value of Mycoplasma pneumoniae RNA detection in the monitoring of Mycoplasma pneumoniae pneumonia treatment in children

作　　者：郭丽[1,2] 孙琳[1] 郭琰[1] 李勤静[1] 吴喜蓉[1] 刘芳[1] 李颖佳[1] 王杏云[1] 王婷[1] 徐保平[1] 冯雪莉[1] 申阿东[1] 

机构地区：[1]首都医科大学附属北京儿童医院,北京市儿科研究所,儿科学国家重点学科,教育部儿科重大疾病研究重点实验室,儿童呼吸道感染性疾病研究北京市重点实验室,北京100045 [2]北京市平谷区妇幼保健院,北京101200

出　　处：《中国循证儿科杂志》2016年第2期109-112,共4页Chinese Journal of Evidence Based Pediatrics

基　　金：国家科技支撑计划:2013BAI09B11;首都卫生发展科研专项:2014-1-2094,2016-1-2092

摘　　要：目的探讨应用肺炎支原体RNA检测(RNA实时荧光恒温扩增技术,MP-SAT)作为儿童肺炎支原体肺炎(MPP)治疗效果监测指标的可行性和应用价值。方法纳入北京市平谷区妇幼保健院住院的社区获得性肺炎患儿,其中符合MPP诊断标准者为MPP组,余为非MPP组。1以血清肺炎支原体(MP)抗体(MP-Ab)检测为诊断MP感染的参照试验,考察MP-SAT诊断MP感染的敏感度和特异度。2对MP-SAT和血清MP-Ab均阳性MPP病例行动态观察,比较MP-SAT和血清MP-Ab在大环内酯类药物标准治疗不同时间的阳性率,MP-SAT转阴时间和临床痊愈时间。3比较不同MP-SAT转阴时间MPP病例发热时间、入院24 h内血常规(WBC、N、L),超敏C反应蛋白(hs-CRP)和血清乳酸脱氢酶(LDH)及胸部X线指标的差异。结果 MPP组73例,非MPP组150例。MP-SAT诊断MP感染的敏感度和特异度分别为83.6%(61/73)、97.3%(146/150)。MPP组MP-SAT和血清MP-Ab均阳性61例,随治疗时间的延长,MP-SAT阳性率显著降低(P<0.05),而血清MP-Ab的阳性率呈增高趋势(P<0.05)。61例临床痊愈时间平均为(3.0±0.9)周,MP-SAT转阴时间为(3.3±0.8)周,差异无统计学意义(P>0.05)。MP-SAT转阴时间越长的病例表现为发热持续时间越长,入院24 h内中性粒细胞百分比、CRP、LDH水平越高,X线胸片大片实变比例越高,淋巴细胞百分比越低(P<0.05)。结论 MP-SAT可作为评价MPP转归以及判断大环内酯类药物疗效的指标。Objective To evaluate the clinical utility of Mycoplasma pneumonia RNA detection（ real-time isothermal transcriptionmediated RNA amplification assay,MP-SAT） in the treatment of Mycoplasma pneumoniae pneumonia in children. Methods Children with community-acquired pneumonia in Beijing Pinggu District Maternal and Child Health Care Hospital, according to the Mycoplasma pneumoniae diagnostic criteria,were divided into the Mycoplasma pneumoniae pneumonia and non-Mycoplasma pneumoniae pneumonia groups.①When the results of serological tests were considered as the standard,the sensitivity and specificity of MP-SAT were evaluated.②MP- SAT and serum MP-Ab positive cases were observed dynamically,the detection rate of MP-SAT and MP-Ab in different treatment course and the times of MP-SAT turning to negative and clinical recovery were compared.③The differences of fever duration after macrolide administration,blood routine inspection（ WBC, N, L）,hypersensitive c-reactive protein（ hs-CRP）,serum lactate dehydrogenase（ LDH） and the imaging results admitted to hospital within 24 hours were compared. Results Mycoplasma pneumoniae pneumonia group included 73 cases,non-Mycoplasma pneumoniae pneumonia group included 150 cases. The sensitivity,specificity of MP-SAT were 83. 6%（ 61 /73） and 97. 3%（ 146 /150）,respectively. Children with both MP-SAT and MP-Ab positive results were followed to evaluate the treatment effect. After the treatment,the detection rate of SAT reduced significantly（ P 〈0. 05）,while detection rate of serum MP-Ab increased significantly（ P 〈0. 05）. The time of clinical recovery was（ 3. 0 ± 0. 9） weeks,similar to that of MP-SAT turning to negative（ 3. 3 ± 0. 8）weeks（ P 〉0. 05）. Those with longer time of turning to negative had a longer fever duration after macrolide administration,increasing neutrophil,decreasing lymphocyte,higher level CRP and LDH,and large field of consolidation were more frequently observed on X-ray film（ P 〈0. 05）. Conclusion MP-SAT

关 键 词：肺炎支原体 社区获得性肺炎 RNA检测 诊断 临床疗效 儿童 

分 类 号：R725.6[医药卫生—儿科]