15784例未成年人呼吸道感染患者病原体IgM抗体检测及流行病学分析

Pathogen IgM antibody detection and epidemiological analysis of 15 784 minorpatients with respiratory tract infection

目的 检测黄石地区未成年人呼吸道感染患者病原体IgM抗体并分析流行病学特征,同时比较呼吸道感染病原抗体检测和核酸检测的诊断效能。方法 回顾性分析2020年1月1日至2022年12月31日在黄石市妇幼保健院及黄石爱康医院就诊的15 784例非新型冠状病毒感染的急性呼吸道感染未成年人患者呼吸道病原体IgM抗体检测结果,分析呼吸道病原体感染与年份、季节、性别、年龄段的关系。采集384例未成年人非新型冠状病毒感染的急性呼吸道感染患者的血清和咽拭子,分别采用血清学方法检测IgM抗体和多重核酸扩增法检测核酸,比较两种方法检测结果的差异。结果 15 784例非新型冠状病毒感染的急性呼吸道感染未成年人患者中呼吸道病原体IgM抗体阳性率为24.50%,2020、2021、2022年IgM抗体检出率分别为17.62%、28.70%、25.89%,差异有统计学意义(χ^(2)=167.699,P<0.001);呼吸道病原体IgM抗体检出率最高的是肺炎支原体(15.25%),其次是乙型流感病毒(3.76%),第三位是军团菌(2.15%);春季呼吸道病原体IgM抗体检出率为21.66%,夏季为26.33%,秋季为29.86%,冬季为20.49%,不同季节呼吸道病原体IgM抗体检出率比较,差异有统计学意义(χ^(2)=123.351,P<0.001);女性患者IgM抗体检出率(26.11%)高于男性(23.09%),差异有统计学意义(χ^(2)=19.341,P<0.001);新生儿组IgM抗体检出率为3.46%,婴儿组为14.67%,幼儿组为19.45%,儿童组为33.87%,青少年组为13.81%,不同年龄组的IgM抗体检出率比较,差异有统计学意义(χ^(2)=949.188,P<0.001)。在比对的384例标本中,血清IgM抗体阳性率为29.95%,呼吸道咽拭子核酸检测阳性率为34.11%,二者诊断一致性较好(Kappa=0.809,P<0.001)。结论 未成年人呼吸道感染病原体IgM抗体检出率与年份、季节、性别、年龄段有关,每年流行的呼吸道感染病原体不尽相同,春、冬季是未成年人呼吸道感染的高发季节;在未成年人呼吸道感染检测中多重呼吸道病原体核酸检测法阳性率比血清IgM抗体检测阳性率更高,因此推荐为临床首选的检测方法。

Objective To detect the IgM antibodies of respiratory infection pathogens among the minor patients with respiratory tract infection in the Huangshi area,and to analyze their epidemiological characteristics,meanwhile to compare the diagnostic efficiency between the pathogenic antibody detection and nucleic acid detection of respiratory tract infection pathogens.Methods A retrospective analysis was conducted on the IgM antibody detection results of respiratory tract pathogens in 15784 minor patients of non-COVID-19 acute respiratory infections visited in the Huangshi Municipal Maternal and Child Health Care Hospital and Huangshi Aikang Hospital from January 1,2020 to December 31,2022.The relationship between the respiratory pathogen infections with the year,season,gender and age group was analyzed.The serum and throat swab samples from 384 minor patients with non-COVID-19 acute respiratory infections were collected and the IgM antibody and nucleic acid were detected by the serological method and multiplex nucleic acid amplification method.The difference was compared between the two testing methods.Results Among the 15784 minor patients with non-COVID-19 acute respiratory infections,the positive rate of respiratory pathogens IgM antibody was 24.50%.The IgM antibody detection rates for each year during 2020-2022 were 17.62%,28.70%and 25.89%,respectively,and the differences were statistically significant(χ^(2)=167.699,P<0.001).The IgM antibody highest detection rate of respiratory tract pathogens was Mycoplasma pneumoniae(15.25%),followed by Influenza virus type B(3.76%)and the third was Legionella pneumophila(2.15%).The IgM antibody detection rate was 21.66%in spring,26.33%in summer,29.86%in autumn and 20.49%in winter,the respiratory tract pathogens detection rate had statistical difference among different seasons(χ^(2)=123.351,P<0.001).The IgM antibody detection rate in females was higher than that in males(26.11%vs.23.09%),and the difference was statistically significant(χ^(2)=19.341,P<0.001).The IgM antibody detection rate was 3.46%in the neonates group,14.67%in the infants group,19.45%in the young children group,33.87%in the children group and 13.81%in the adolescents group,and the difference was statistically significant(χ^(2)=949.188,P<0.001).Among the 384 samples in the comparison,the serum IgM antibody positive rate was 29.95%,and the respiratory throat swab nucleic acid positive rate was 34.11%,indicating the good consistency between the two diagnostic methods(Kappa=0.809,P<0.001).Conclusion The detection rate of pathogen antibodies in the minor patients with respiratory infection is associated with year,season,gender and age.The epidemic pathogens of respiratory tract infection are not the same every year,and spring and winter are the high incidence seasons of respiratory tract infection in minors.In the detection of respiratory tract infection in minors,the positive rate of multiple respiratory tract pathogen nucleic acid detection is higher than that of serum IgM antibody detection,so it is recommended as the first choice clinical detection method.