呼吸道病原体IgM抗体检测及炎性指标的诊断价值分析  

Determination of pathogen IgM antibody and analysis on the value of inflammatory indexes in diagnosing of respiratory tract infectio

作　　者：褚福禄[1] 李琛 赵辉 刘义庆[1] 刘占锋 路超[1] 司元全[1] 刘志[1] 马婷婷 赵梦麒 贾伟[1] 邹建文[1] Chu Fulu;Li Chen;Zhao Hui;Liu Yiqing;Liu Zhanfeng;Lu Chao;Si Yuanquan;Liu Zhi;Ma Tingting;Zhao Mengqi;Jia Wei;Zou Jianwen(Department of Laboratory Medicine,Shandong Provincial Hospital Affiliated to Shandong University,Jinan 250021,China;Jinan Hospital,Jinan 250013,China;Maternal and Child Care Center in Chengyang District of Qingdao City,Qingdao 266109,China)

机构地区：[1]山东大学附属省立医院临床医学检验部,济南250021 [2]山东省济南医院,250013 [3]青岛市城阳区妇幼保健计划生育服务中心,266109

出　　处：《国际免疫学杂志》2018年第4期419-424,共6页International Journal of Immunology

基　　金：山东省医药卫生科技发展计划项目（2017WS095）

摘　　要：目的 探讨呼吸道感染（respiratory tract infection,RTI）者病原体IgM抗体（IgM antibody,IgM-Ab）及炎性指标的诊断价值.方法 2016年1至6月山东省立医院1316例RTI者中有577例同时检测呼吸道IgM-Ab和细菌培养,分成细菌组50例、病毒组172例、混合组56例和支原体组112例,对照组为180例体检者,分析IgM-Ab及各组炎性指标.结果 IgM-Ab总阳性率为71.12％（936/1316）.单一感染占47.22％（442/936）,混合感染占52.78％（494/936）,577例标本检出致病菌123株（21.32％）.混合组C反应蛋白（C-reactive protein,CRP）水平大于病毒组（Z=-3.070,P〈0.05）,细菌组、混合组降钙素原（procalcitonin,PCT）水平大于病毒组（Z=-5.512、-4.984,均P〈0.05）和支原体组（Z=-5.174、-5.654,均P〈0.05）,细菌组、混合组PCT阳性率大于病毒组（χ2=30.286、22.695,均P〈0.05）和支原体组（χ2=40.142、31.156,均P〈0.05）.PCT和CRP曲线下面积（AUC）分别为0.751和0.587,差异有统计学意义（P〈0.05）.结论 PCT是细菌性感染的理想标志物,联合IgM-Ab检测对RTI病因学诊断有重要价值. Objective To explore the application value of the pathogen IgM antibody （IgM-Ab）and inflammatory indicators in the diagnosis of patients with respiratory tract infection （RTI）. Methods We pro-spectively enrolled 1316 pateints with RTI from January to June 2016. Specimens from 557 patients were ana-lyzed and compared the outcome of bacterial cuture and pathogen IgM-Ab detection of patients with bacterial in-fection （n = 50）,to those with viral（n = 172）,mycoplasma（n = 112）,virus-bacterial mixed infections （n =56）,and with those of control group （n = 180）. Results Respiratory agents were detected in 936 （71. 12%） of 1316 patients with RTI. A single agent was identified in 442 patients （47. 22%）,and multiple agents in 494 （52. 78%）. Positive bacterial culture results were obtained in 123 specimens （21. 32%）. Patients with virus-bacterial mixed infections had a significantly higher level of CRP than those with virus infection （Z = - 3. 070, P 〈 0. 05）. We established that the mean level of PCT was statistically higher in patients with bacterial infection and those with virus-bacterial mixed infections than that in those with viral patients（Z = - 5. 512,- 4. 984, both P 〈 0. 05）and in those with mycoplasma infection（Z = - 5. 174,- 5. 654,both P 〈 0. 05）. In patients with bacterial infection and those with virus-bacterial mixed infections,the positive rate of PCT were higher than that in patients with viral（χ2 = 30. 286,22. 695,both P 〈 0. 05）and in those with mycoplasma infection （χ2 =40. 142,31. 156,both P 〈 0. 05）. The area under receiver operating characteristic （ROC）curve was 0. 751 for PCT,lager than that for CRP （P 〈 0. 05）. Conclusion PCT levels are superior predictors for the diagnosis of bacterial RTI. PCT values combined with IgM-Ab is a fair way to evaluate the etiologic agents at the time of sus-picion of RTI.

关 键 词：呼吸道感染 C反应蛋白质 白细胞计数 前白蛋白 降钙素 

分 类 号：R56[医药卫生—呼吸系统] R446.6[医药卫生—内科学]