RNA恒温扩增检测技术在儿童肺炎支原体肺炎中的诊断价值评估  

Evaluation of RNA simultaneous amplification and testing for detection of Mycoplasma pneumoniae pneumonia in children

作　　者：冯雪莉[1] 李勤静[2] 徐保平[1] 孙琳[2] 焦伟伟[2] 殷菊[1] 李洁琼[2] 徐放[2] 綦辉[2] 肖婧[2] 申晨[2] 申阿东[2] 

机构地区：[1]首都医科大学附属北京儿童医院呼吸科,100045 [2]首都医科大学附属北京儿童医院北京市儿科研究所呼吸感染疾病研究室、国家呼吸疾病临床医学研究中心、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,100045

出　　处：《中华实用儿科临床杂志》2016年第16期1222-1226,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家科技支撑计划（2013BA109811）;首都卫生发展科研专项（2014-1-2094）;首都卫生发展科研专项（2016-1-2092）

摘　　要：目的评价RNA恒温扩增检测技术（SAT）在儿童肺炎支原体（MP）肺炎中的诊断价值。方法选取2014年2月至11月北京儿童医院呼吸科因肺炎收住院的患儿266例，利用MP-SAT技术和血清抗体（MP—Ab）颗粒凝集法分别检测MP感染。结果1．以血清学MP—Ab检测结果为标准，MP-SAT检测的敏感度和特异度分别为75．0％和89．7％。且MP—SAT在短病程组的诊断敏感度显著高于长病程组（88．2％比67．4％，P=0．006），提示MP—SAT在疾病早期的诊断价值较好。2．MP-SAT与入院时MP-Ab检测结果一致性较差，在MPP组和非MPP组分别有45．8％（64／140例）和10．3％（13／126例）的患儿2种检测方法结果不一致；但MP—SAT与双份血清MP-Ab检测结果一致性较好（Kappa值为0．89，P〈0．001），提示MP—SAT可有效辅助临床的早期快速确诊。3．MP-SAT在≥5岁患儿中检出率高，OR为7．99（95％CI4．25～15．02），P〈0．001，主要是由于MP感染以5岁以上儿童为主；而MP-SAT在病程≤7d的患儿中检出率高，OR为0．40（95％C10．22—0．73），P=0．003，则提示MP—SAT在疾病早期阳性率高，进行该检测时应注意采集样本的时间。结论MP—SAT在儿童MP肺炎的早期诊断中的价值较高，可有效弥补血清MP-Ab存在窗口期的不足；同时MP-SAT与急性期／恢复期双份血清检测结果的一致性较好，可有效辅助临床的早期快速确诊；且临床采用MP-SAT进行MP感染检测时应尽可能在疾病的早期采集样本。Objective To evaluate a method for detection of Mycoplasma pneumoniae pneumonia （MPP） by the RNA simultaneous amplification and testing （SAT） in children. Methods During February to November 2014, a total of 266 children with pneumonia treated in Department of Respiratory, Beijing Children＇s Hospital were enrolled in this study. RNA was tested by SAT （MP -SAT） and antibody was tested by particle agglutination assay （MP -Ab）, respectively. Results （ 1 ） With the result of MP - Ab as the reference, the sensitivity and specificity of the assay was 75.0% and 89.7% ,respectively. The sensitivity in the short course group （ ≤7 d） was significantly higher than that in the long course group （ 〉 7 d）（ 88.2% vs 67.4%, P = 0. 006）. It prompted that MP -SAT had better diagnostic value in the early stages of the disease. （2） Compared with the results of MP - SAT and MP - Ab on admission, there were 45.8% （64/140 cases） and 10.3% （ 13/126 cases） of cases with 2 inconsistent test results in MPP group and un - MPP group. But MP - SAT had good consistency with double serum MP - Ab testing result （ Kappa value was 0.89, P 〈 0.001 ）, suggesting MP - SAT could effectively assist clinical early diagnosis quickly. （ 3 ） The detection rate of MP - SAT was higher in ≥5 years old than that in 〈 5 years old group,and the OR value was 7.99 （95% CI 4.25 to 15.02 ,P 〈 0. 001 ）, which was because MP infection was given priority to those ≥5 years old children. And the detection rate of MP - SAT was higher in 〈 7 days than that in 〉17 days group, and OR value was 0.40 （95% CI 0. 22 to 0. 73,P = 0. 003）, which indicated that MP -SAT had high positive rate in the early stage of disease, and the doctors should pay attention to the time for getting the test samples. Conclusions MP - SAT is sensitive in the early stage of MPP, which can effectively make up for the inadequacy of MP - Ab. MP - SAT has good consistency with double serum detection results and can effectively

关 键 词：肺炎支原体 核酸扩增技术 诊断 儿童 

分 类 号：R725.6[医药卫生—儿科]