荧光定量PCR诊断肺炎支原体感染的临床价值评估  

Clinical Value Assessmentof Fluorescence Quantitative PCR in Diagnosis of Mycoplasma Pneumoniae Infection

作　　者：王良玉[1,2] 蔚然[1,2] 郭东星[1,2] 韩丽娜[3] 韩晓华[3] 窦海伟[1,2] 李静宜[1,2] 吴赵勇 李丹[1,2] 田秀君[1,2] 栗绍刚[1,2] 辛德莉[1,2] 

机构地区：[1]首都医科大学附属北京友谊医院,北京热带医学研究所,北京100050 [2]热带病防治研究北京市重点实验室,北京100050 [3]中国医科大学附属盛京医院小儿呼吸科,辽宁沈阳117004

出　　处：《继续医学教育》2017年第5期166-168,共3页Continuing Medical Education

基　　金：国家自然科学基金资助项目(81271890);北京市科技计划委员会基金资助项目(Z161100000116088)

摘　　要：目的通过采集临床诊断肺炎支原体感染患儿咽拭子及血清样本,以血清学诊断方法为对照,评估以社区获得性肺炎呼吸窘迫综合征毒素(Community-acquired respiratory distress syndrome toxin gene,CARDS)编码基因为目的基因的荧光定量PCR诊断肺炎支原体感染的临床诊断价值。方法采集临床诊断肺炎支原体感染患儿的咽拭子及急性期、恢复期血清样本,及健康儿童的咽拭子样本,以单次检测血清特异性抗体滴度≥1∶160或双份血清抗体滴度4倍及以上升高或降低为对照,评估以CARDS编码基因为目的基因的荧光定量PCR诊断肺炎支原体感染的临床诊断价值。结果采用以CARDS编码基因为目的基因的荧光定量PCR检测临床诊断为肺炎支原体感染患儿及健康儿童咽拭子样本各94例,肺炎支原体检出率分别为71.20%和15.96%。采用被动凝集法,以单次检测血清特异性抗体滴度≥1∶160或双份血清抗体滴度的4倍及以上升高或降低为确诊依据,血清学检测肺炎支原体阳性率为77.6%。以CARDS编码基因为目的基因的荧光定量PCR诊断肺炎支原体感染与对照标准符合率为80.85%,敏感度为83.56%,有较高的敏感度和符合率,特异度为71.43%,相对低。约登指数为0.55,ROC曲线下面积为0.696,提示对肺炎支原体感染的诊断有一定准确性。结论以CARDS的编码基因为目的基因的荧光定量PCR诊断肺炎支原体感染,有一定的准确性,快速、敏感,对肺炎支原体的早期诊断有参考价值,由于肺炎支原体有健康携带,特异度受到影响,诊断肺炎支原体感染需结合血清学及临床。Objective This research is intended to assess the clinical value of Real-time Fluorescence Quantitative PCR target Community- acquired respiratory distress syndrome toxin gene （CARDS） diagnosis of Mycoplasma pneumonia （MP） by the comparison of serology methods using by the throad swabs and acute-recovery paired serums from the children who are diagnosed with MP infection and throad swabs of health children. Methods Based on the collected throad swabs and acute-recovery paired serums from the children who were diagnosed with MP infection and the collected throad swabs of the healthy children, the clinical value of Real-time Fluorescence Quantitative PCR target CARDS diagnosis of MP was assessed with the compared standards which the single serum antibody titres are no less than 1：160 or there is a 4-fold change for the paired serum antibody titers. Results By detecting the throad swabs from the clinical and the healthy children who were diagnosed with MP infection by the real-time Fluorescence Quantitative PCR target CARDS, the positive rate was 71.20%, and the detection rate of MP was 15.96%. Regarding the single serum antibody titres are no less than 1 ： 160 or a 4-fold change of paired serum antibody titers as the compared standard, the positive rate was 77.6% by the passive agglutination method. By the comparison between the real-time Fluorescence Quantitative PCR target CARDS and the compared standards, there were a high coincidence rate and the sensitivity, whose value were 80.85% and 83.56%, respectively, and a relatively low specificity, whose value was 71.43%. That the Youden index is 0.55 and AUC is 0.696 suggested that it has a certain accuracy to diagnose MP infection. Conclusion Although the specific is low because of the asymptomatic carriage situation of MP in healthy children, the Real-time Fluorescence Quantitative PCR target CARDS has a certain accuracy to diagnose the MP infection, which can provide reference when the serology result is negative. It is suggested that the diagnosis of

关 键 词：肺炎支原体 CARDS基因 临床价值评估 临床价值评估 

分 类 号：R375[医药卫生—病原生物学]