儿童社区获得性肺炎肺炎支原体感染的快速诊断

Rapid diagnosis of mycoplasma pneumoniae in children with community-acquired pneumonia

目的:探讨儿童社区获得性肺炎(CAP)肺炎支原体(MP)感染的快速诊断方法,以帮助临床正确选择抗生素。方法:将159例经逆转录聚合酶链反应方法(RT-PCR)证实为MP感染的住院患儿随机分为A、B、C三组,分别进行血清特异性IgM、IgG及双份血清补体结合实验,同时设立健康对照组。结果:A组53例中MP特异性IgM阳性48例(90·57%);B组53例检出MP特异性IgG阳性35例(66·4%);C组53例患儿分别于入院第1d及至少10d后收集双份血清进行补体结合实验,共采集标本50人份,证实为MP阳性的46例(92·00%);MP-IgM检测结果还具有年龄差异,3岁以下组的阳性率低于3岁以上组(P<0·05);50例健康儿童MP-IgM阳性1例(2·00%),MP-IgG阳性7例(14·00%),双份血清实验检测未见阳性。结论:MP血清特异性IgM检测是早期快速诊断儿童MP感染的有效手段,但其结果具有年龄组的差异,婴幼儿MP感染的诊断还需结合PCR及双份血清实验。

Objective： To demonstrate the method of rapid diagnosis of mycoplasma pneumoniae （MP） in chihtren with community -acquired pneumonia （CAP） . Methods： 159 patients with CAP diagnozed positive by RT- PCR for MP in respiratory specimens were divided into 3 groups in random, group A： 53 cases were tested for MP specific IgM by EIA, group B： 53 cases were tested for MP specific IgG by EIA, group C： The paired samples were also tested with a complement fixation （CF） assay to 53 patients. The contrast group was established simultaneously. Results： In group A, the IgM specificity for EIA was 48 （90. 6% ）, and the positive rate between the 〈 3 year - old and ≥3 group showed significant difference. In group B, the 53 serum samples were positive for MP - IgG with 66%, and 92. 0% in the group C. In the contrast group, the positive rate was 2. 0% in lgM, 14. 0% in IgG, 0% in that paired sera. Conclusion： The IgM EIA serology test is a valuable tool for the early diagnosis of MP infection in children, as long as the EIA used in specific. In infant, the difficult interpretation for EIAs suggests that paired sera, combined with PCR detection on the respiratory tract specimens should be required for accurate diagnosis.