呼吸道病原体多重核酸检测方法在社区获得性肺炎患儿诊断中的应用  

The Application of Multiple Nucleic Acid Detection for RespiratoryPathogens in the Diagnosis of Children with CAP

作　　者：赵延如 李洁琼[1] 刘芳[2] 吴喜蓉[3] 赵志鹏[3] 尹青琴[3] 王咏红[1] 马琦 全舒婷 王亚翠 孙琳[1] 申阿东[1] ZHAO Yanru;LI Jieqiong;LIU Fang;WU Xirong;ZHAO Zhipeng;YIN Qingqin;WANG Yonghong;MA Qi;QUAN Shuting;WANG Yacui;SUN Lin;SHEN Adong(Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics(Capital Medical University),Ministry of Education,Beijing Key Laboratory of Pediatric Respiratory Infection Diseases,Beijing Pediatric Research Institute,Beijing Children’s Hospital,Capital Medical University,Beijing 100045,China;Interventional Pulmonology Department,Beijing Children’s Hospital,Beijing 100045,China;Department of Respiratory,Beijing Children’s Hospital,Beijing 100045,China;Tianjin Emergency Center,Tianjin 300011,China)

机构地区：[1]首都医科大学附属北京儿童医院呼吸感染疾病研究室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]首都医科大学附属北京儿童医院介入肺科,北京100045 [3]首都医科大学附属北京儿童医院呼吸科,北京100045 [4]天津市急救中心,天津300011

出　　处：《标记免疫分析与临床》2020年第12期2030-2034,共5页Labeled Immunoassays and Clinical Medicine

基　　金：十三五重大专项课题(编号:2018ZX10103001-003)。

摘　　要：目的评价呼吸道病原体多重核酸检测方法在社区儿童获得性肺炎(community acquired pneumonia,CAP)诊断中的价值。方法纳入2018年5月至12月于首都医科大学附属北京儿童医院住院的CAP患儿354例,采集痰液等标本,采用呼吸道病原体多重核酸检测方法,并分别评价其在肺炎支原体肺炎(mycoplasma pneumoniae pneumonia,MPP)和病毒性肺炎中诊断的灵敏度和特异性,以及分析其与七项呼吸道病原检测方法的一致性。结果155例MPP组患儿,152例病原体核酸检测MP阳性,即灵敏度为98.1%;以病毒性肺炎和细菌性肺炎患儿为非MPP对照组,病原体核酸检测结果显示MP阳性4例,特异性为98.0%(195/199)。158例病毒性肺炎患儿,病原体核酸检测出病毒141例,灵敏度为89.2%。以MPP和细菌性肺炎患儿为非病毒性肺炎对照组,196例患儿病原体核酸检测检出病毒39例(19.9%),特异性为80.1%。158例病毒性肺炎患儿中99份标本其病原体核酸检测结果与病毒抗原检测结果完全一致。59例不一致结果以病毒抗原检测为单一感染而病毒核酸检测为混合感染为主(30例),且主要来源于病毒抗原检测方法所不涵盖的其他病毒感染。结论呼吸道病原体多重核酸检测在MPP诊断中具有较高的灵敏度和特异性;与传统的病毒抗原检测相比,虽存在一定的假阴性,但具有高通量检测的优势,可同时完成更多种病毒类型的检出;具有快速、灵敏度高等特点,可以为儿童呼吸道病原体的诊断以及鉴别诊断提供很好的证据。Objective To evaluate the value of multiple nucleic acid detection for respiratory pathogens in the diagnosis of community-acquired pneumonia(CAP)in children.Methods From May,2018 to December,2018,a total of 354 children with CAP admitted to Beijing Children’s Hospital were enrolled for the study.Sputum and other respiratory specimens were collected and detected by respiratory tract pathogen multiple nucleic acid detection method.The sensitivity and specificity of the test were evaluated in children with mycoplasma pneumoniae pneumonia(MPP)and viral pneumonia,respectively.The consistency of results was analyzed between the multiple nucleic acid detection method and virus antigen detection method.Results Among 155 children with MPP,152 cases were positive for MP using nucleic acid detection method,resulting in a sensitivity of 98.1%.When classified children with viral pneumonia and bacterial pneumonia as the non-MPP control group,four cases were detected as MP positive using nucleic acid detection method,resulting in a specificity of 98.0%(195/199).In 158 children with viral pneumonia,141 cases were detected with virus infected with a sensitivity of 89.2%.When classified children with MPP and bacterial pneumonia as the non-viral-pneumonia control group,39 cases(19.9%)were detected as positive,resulting in a specificity of 80.1%.Among the 158 children with viral pneumonia,the completely consistent results of nucleic acid test and virus antigen detection method were found in 99 children.Of the 59 cases with inconsistent results,30 cases were detected with a single virus antigen but multiple virus nucleic acid.Conclusion The multiple nucleic acid detection kit has a high sensitivity and specificity in MPP diagnosis.When compared with the traditional virus antigen detection method,it has the advantages including high-throughput detection and is able to detect more virus types simultaneously,despite the false negative results.It can provide a strong evidence for the diagnosis of CAP in children.

关 键 词：社区获得性肺炎 儿童 多重核酸检测 诊断 病原体 

分 类 号：R372[医药卫生—病原生物学] R725.6[医药卫生—基础医学]