细菌培养、聚合酶链反应与血清抗体检测在儿童百日咳诊断中的应用  

Application of bacterial culture, polymerase chain reaction and serum antibody detection in the diagnosis of pertussis in children

作　　者：汪丙松 潘嘉严 李振 崔凡 张旭 李磊 莫珍珍 武晓敏 徐济宝 王佐 Wang Bingsong;Pan Jiayan;Li Zhen;Cui Fan;Zhang Xu;Li Lei;Mo Zhenzhen;Wu Xiaomin;Xu Jibao;Wang Zuo(Department of Pediatric Respiratory Medicine,Wuhu No.1 People′s Hospital/Wuhu Children′s Medical Center,Wuhu 241000,Anhui Province,China;Laboratory Microbiology,Wuhu No.1 People′s Hospital/Wuhu Children′s Medical Center,Wuhu 241000,Anhui Province,China)

机构地区：[1]芜湖市第一人民医院/芜湖市儿童医学中心小儿呼吸内科,安徽芜湖241000 [2]芜湖市第一人民医院/芜湖市儿童医学中心检验科微生物室,安徽芜湖241000

出　　处：《中华实用儿科临床杂志》2021年第16期1249-1252,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：安徽省"十三五"医疗卫生重点专科建设项目(皖卫科教(2017)30号);芜湖市科技局资助项目(2020ms-318);芜湖市第一人民医院院内科研项目(2018WYY001I)。

摘　　要：目的评估细菌培养、聚合酶链反应(PCR)和血清抗百日咳毒素免疫球蛋白G(AntiPT-IgG)水平检测对疑诊百日咳的辅助诊断价值。方法将2018年6月至2019年5月芜湖市第一人民医院儿科收治的110例百日咳疑似病例作为研究对象,采集鼻咽拭子进行百日咳鲍特菌培养及其特异核酸PCR检测,其中78例留取血清标本,以酶联免疫吸附试验检测AntiPT-IgG水平。结果细菌培养与PCR组阳性率分别为21.8%和30.0%,2组比较差异无统计学意义(χ^(2)=1.198,P>0.05)。咳嗽病程<2周病例细菌培养阳性率为32.1%,明显高于2~4周(14.3%)与>4周(9.1%)病例(χ^(2)=6.522,P<0.05)。<2周病例PCR阳性率(39.6%)也明显高于咳嗽2~4周(25.7%)、>4周病例(13.6%)(χ^(2)=6.126,P<0.05)。78例患儿血清AntiPT-IgG水平为(75.727±78.454)IU/mL,其中<2周和2~4周AntiPT-IgG水平的中位数分别为5.909 IU/mL和20.948 IU/mL,阳性率分别为14.7%和38.1%。>4周和恢复期AntiPT-IgG水平分别为(79.281±68.254)IU/mL、(107.242±75.750)IU/mL,阳性率分别为39.1%、57.1%。结论疫苗时代,应综合病原学和血清学检测结果辅助临床诊断百日咳。咳嗽病程<2周可疑患儿细菌培养和特异核酸的病原检测阳性率高,咳嗽病程4周后血清学检测辅助诊断更为有效。Objective To evaluate the auxiliary diagnosis value of bacterial culture,polymerase chain reaction(PCR)and serum anti-pertussis toxin immunoglobulin G(AntiPT-IgG)level detection in suspected pertussis.Methods A total of 110 suspected cases of pertussis treated in the Department of Pediatrics of Wuhu No.1 People′s Hospital from June 2018 to May 2019 were recruited for the study.The nasopharyngeal swabs of all cases were collected for Bordetella pertussis culture and specific nucleic acid PCR detection.Serum samples of 78 cases were collected for the detection of AntiPT-IgG level by enzyme linked immunosorbent assays.Results The positive rates of bacterial culture group and PCR group were 21.8%and 30.0%,respectively,with no statistically significant difference(χ^(2)=1.198,P>0.05).The culture positive rate of cases with the duration of cough<2 weeks was 32.1%,which was signi-ficantly higher than that of cases with the duration of cough about 2-4 weeks(14.3%)or>4 weeks(9.1%)(χ^(2)=6.522,P<0.05).The PCR positive rate of cases with the duration of cough<2 weeks was 39.6%,which was also significantly higher than that of cases with the duration of cough about 2-4 weeks(25.7%)or>4 weeks(13.6%)(χ^(2)=6.126,P<0.05).The mean value for serum AntiPT-IgG level of 78 cases was(75.727±78.454)IU/mL,the median AntiPT-IgG levels of cases with the duration of cough<2 weeks and about 2-4 weeks were 5.909 IU/mL and 20.948 IU/mL,respectively,and the positive rates were 14.7%and 38.1%,respectively.The AntiPT-IgG level of cases with the duration of cough>4 weeks and that at convalescent stage were(79.281±68.254)IU/mL and(107.242±75.750)IU/mL,and the positive rates were 39.1%and 57.1%,respectively.Conclusions In the vaccine era,the results of pathogenic and serological tests should be combined to assist the clinical diagnosis of pertussis.The positive rate of bacterial culture and specific nucleic acid pathogen detection in children with cough duration less than 2 weeks is high,and the serological diagnosis is more effective after

关 键 词：百日咳 细菌培养 聚合酶链反应 血清抗体 诊断 

分 类 号：R725.1[医药卫生—儿科]