尿抗原检测联合痰革兰染色诊断儿童肺炎链球菌肺炎  

Urinary Antigen Detection Combined with Sputum Gram Staining in Diagnosis of Children with Pneumococcal Pneumonia

作　　者：张昭勇 杨宏伟 张吉才 ZHANG Zhao-yong;YANG Hong-wei;ZHANG Ji-cai(Department of Clinical Laboratory,Taihe Hospital of Shiyan City Affiliated Hospital of Hubei Medical College,Shiyan,Hubei 442000,Chin)

机构地区：[1]十堰市太和医院湖北医药学院附属医院检验部,湖北十堰442000

出　　处：《临床误诊误治》2017年第12期87-89,共3页Clinical Misdiagnosis & Mistherapy

基　　金：湖北省卫生厅优秀青年人才项目(WJ2015Q039);湖北省卫生计生指导性项目(WJ2015Z115)

摘　　要：目的探讨尿肺炎链球菌抗原检测联合痰革兰染色诊断儿童肺炎链球菌肺炎的临床价值。方法选择2016年9月—2016年12月在我院住院的儿童肺炎链球菌肺炎427例,采集患儿的尿液及痰液标本,以痰培养作为肺炎链球菌肺炎诊断的金标准,对尿肺炎链球菌抗原检测和痰革兰染色镜检进行诊断性功能评价。结果本研究痰培养检出肺炎链球菌119例(27.9%),痰革兰染色镜检阳性168例(39.3%),尿肺炎链球菌抗原阳性112例(26.2%),且痰革兰染色镜检检出率与痰培养肺炎链球菌检出率差异有统计学意义(P<0.001)。尿肺炎链球菌抗原检测与痰革兰染色镜检诊断儿童肺炎链球菌肺炎的敏感性分别为73.1%、86.5%,特异性分别为91.9%、78.9%,两种方法并联使用的敏感性与特异性分别为96.6%、72.4%,串联使用的敏感性与特异性分别为63.0%、98.1%。结论尿肺炎链球菌抗原检测与痰革兰染色镜检并联诊断的敏感性高,适合门诊患者的筛查,而上述检测方法串联特异性高,适合住院患者确诊。Objective To investigate clinical value of urinary antigen detection combined with sputum gram staining in diagnosis of children with pneumococcal pneumonia. Methods A total of 427 children with streptococcus pneumoniae pneumonia admitted during September 2016 and December 2016 were recruited in this study. Samples of urine and sputum were collected. The sputum culture was used as gold standard in diagnosis of children with streptococcus pneumoniae pneumo-nia, and then diagnostic functions of urinary antigen detection and sputum gram staining in diagnosis of pneumococcal pneumo-nia were evaluated. Results A total of 119 patients （27. 9%） were detected as having streptococcus pneumoniae by sputum culture, and 168 patients （39. 3%） were positive by sputum gram staining test, and 112 patients （26. 2%） were positive uri-nary antigen,and the differences in detection rates of sputum gram staining and sputum culture were statistically significant （P〈 0. 001）. Rates of diagnostic sensitivity of urinary antigen detection and sputum gram staining were 73. 1% and 86. 5%respectively, and specificity rates were 91. 9% and 78. 9% respectively. The sensitivity and specificity rates by multiple test of two method were 96. 6% and 72. 4% respectively;while sensitivity and specificity rates by tandem test of two methods were 63. 0% and 98. 1% respectively. Conclusion Multiple test of urinary antigen detection and sputum gram staining has higher sensitivity in screening of patients in clinic, while tandem test of two methods has higher specificity in confirmation of inpa-tients diagnosis.

关 键 词：肺炎 肺炎球菌性 儿童 诊断 

分 类 号：R446[医药卫生—诊断学] R725.6[医药卫生—临床医学]