被动凝集法诊断肺炎支原体感染最佳抗体滴度的探讨及临床价值评估  

Selection of optimal antibody titer and clinical value of passive agglutination for the diagnosis of Mycoplasma pneumoniae infection

作　　者：王良玉 蔚然 朱宏斌[1] 史大伟[3] 韩晓华[4] 宁立华 辛德莉[6] Wang Liangyu;Wei Ran;Zhu Hongbin;Shi Dawei;Han Xiaohua;Ning Lihua;Xin Deli(Department of Pediatrics,Beijing Chao-Yang Hospital,Capital Medical University(Shijingshan Branch),Beijing 100043,China;Department of Respiratory,Women and Children′s Hospital,Qingdao University,Qingdao 266071,China;Department of Pediatrics,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Pediatrics,Shengjing Hospital of China Medical University,Shenyang 117004,China;Department of Pediatrics,Children′s Hospital of Baotou,Baotou 014030,China;Department of Infectious Disease,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京朝阳医院(石景山院区)儿科,北京100043 [2]青岛大学附属妇女儿童医院呼吸科,青岛266071 [3]首都医科大学附属北京友谊医院儿科,北京100050 [4]中国医科大学附属盛京医院儿科,沈阳117004 [5]包头市儿童医院儿科,包头014030 [6]首都医科大学附属北京友谊医院感染科,北京100050

出　　处：《中华实用儿科临床杂志》2024年第12期927-930,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨被动凝集法检测急性期单份血清诊断肺炎支原体(MP)感染的最佳抗体滴度,评估采用不同抗体滴度作为诊断标准时其临床应用价值。方法横断面研究。收集2016年12月至2017年2月中国医科大学附属盛京医院儿科及2019年11月包头市儿童医院儿科诊断为MP感染的住院患儿的临床血清样本88对。以双份血清特异性抗体滴度的4倍变化作为金标准,绘制受试者工作特征曲线(ROC),评估检测急性期单份血清时,采用不同抗体滴度作为阳性判定标准时,其诊断MP感染的临床应用价值,从而找到最合适的血清抗体滴度作为诊断界值。结果1.采用血清特异性抗体滴度≥1∶40作为阳性判定标准时,其敏感度72.9%,ROC曲线下面积0.817,特异度87.5%,易造成过度诊断。采用1∶160作为阳性判定标准时,其特异度较高(97.5%),ROC曲线下面积0.775,敏感度较低(52.1%),易漏诊。采用≥1∶80作为阳性判定标准,敏感度60.4%,特异度较高(97.5%),ROC曲线下面积0.823,综合情况较上述两标准更合适。2.病程≥5 d采血,72.5%的患儿已产生抗体,且60.0%的患儿抗体滴度≥1∶80。结论1.采用被动凝集法检测MP感染时,推荐抗体滴度≥1∶80作为诊断标准。但临床工作中,确诊或排除MP感染仍需结合临床及其他实验室检测结果。2.病程5~7 d是较为合适的采血时间。如临床怀疑MP感染,抗体滴度1∶40也有提示意义,可结合分子生物学实验室诊断协诊或间隔较短时间复测。ObjectiveTo investigate the optimal serum antibody titer in acute stage for the diagnosis of Mycoplasma pneumoniae(MP)infection by passive agglutination,and to evaluate the clinical diagnostic value of different antibody titers.MethodsA cross-sectional study.Eighty-eight pairs of clinical serum samples were collected from children with MP infection treated at the Department of Pediatrics in Shengjing Hospital of China Medical University from December 2016 to February 2017 and Children′s Hospital of Baotou in November 2019.The four-fold change of the double serum specific antibody titer was used as the gold standard,and the receiver operating characteristic(ROC)curve was plotted.When detecting the single serum in acute stage,different antibody titers were used as positive criteria to evaluate their clinical application value in the diagnosis of MP infection and find the most appropriate serum antibody titer as the diagnostic cut-off value.Results(1)When the serum specific antibody titer≥1∶40 was used as the positive criterion,the sensitivity was 72.9%,the area under the ROC curve was 0.817,and the specificity was 87.5%,which might cause overdiagnosis.When the serum specific antibody titer≥1∶160 was used as the positive criterion,the specificity was 97.5%,the area under the ROC curve was 0.775,and the sensitivity was 52.1%,which might cause missed diagnosis.When the serum specific antibody titer≥1∶80 was used as the positive criterion,the sensitivity was 60.4%,the specificity was 97.5%,and the area under the ROC curve was 0.823,overall performing better compared with the said two criteria.(2)After the disease lasted at least 5 days,blood samples were collected.About 72.5%of the children had antibodies,and 60.0%of the children had antibody titers≥1∶80.Conclusions(1)When the passive agglutination method is used to detect MP infection,antibody titer≥1∶80 is recommended as the diagnostic standard.However,in clinical practice,the diagnosis of MP infection depends on clinical and other laboratory te

关 键 词：肺炎支原体 被动凝集法 最佳诊断界值 

分 类 号：R725.6[医药卫生—儿科]