317例儿童肺炎支原体感染检验结果分析

Analysis on the test result of children with mycoplasma pneumonia in 317 cases

目的探讨荧光聚合酶链反应（PCR）、被动凝集法、C反应蛋白（CRP）检测在儿童呼吸道肺炎支原体（MP）感染的临床应用价值及意义,寻求合理的检测方法以提高病原体的检出率,综合各种检测方法的优势,合理的指导临床用药。方法选择本院诊治的呼吸道感染患儿317例,荧光PCR检测咽拭子及深部痰液,被动凝集法检测患儿血清,免疫比浊法检测血浆CRP。结果荧光PCR阳性率15.1%（48/317）,单份血清被动凝集法30.6%（97/317）,双份血清被动凝集法35.6%（113/317）,荧光PCR联合被动凝集法41.6%（132/317）。荧光PCR与被动凝集法的结果一致性比较差,荧光PCR阳性患者检测平均病程8.2 d,被动凝集法阳性患者检测平均病程12.6 d,t=11.67,P〈0.001,两者检出时间差异有统计学意义,荧光PCR更适用于早期诊断。联合血浆CRP检测,以CRP〉6 mg/L为阳性,各种方法检测阳性患儿中CRP阳性率为荧光PCR阳性率的52.1%（25/48）;被动凝集法阳性滴度（1∶40）组71.6%（53/74）;被动凝集法阳性滴度大于（1∶40）组79.5%（31/39）;荧光PCR与CRP的阳性符合率低于被动凝集法。在不同年龄段3种方法的检测,0~3岁组62例呼吸道感染患儿单份及双份血清被动凝集法阳性率分别为3.2%（2/62）和4.8%（3/62）,与荧光PCR阳性率14.5%（9/62）比较,χ^2=6.64,P〈0.05,差异有统计学意义,荧光PCR更适用于婴幼儿的MP感染检测。结论荧光PCR更适用于早期诊断及婴幼儿的MP感染检测。被动凝集法与CRP对荧光PCR的检测结果,尤其对带菌人群的临床假阳性结果可提供辅助诊断,合理的指导临床用药。

Objective To investigate the fluorescence PCR,passive agglutination,C-reactive protein（CRP） detection of children with mycoplasma pneumonia（MP）,and its clinical value and significance.Methods 317 children with respiratory tract infection in our hospital were collected,fluorescence PCR was used to detect the throat swab and deep sputum,serum was detected by passive hemagglutination method,plasma CRP was tested by immune turbidimetry.Results The positive rates of the result tested by fluorescent PCR,monovalent serum passive hemagglutination method,paired serum passive hemagglutination method were 15.1%（48/317）,30.5%（97/317）,35.6%（113/317）;and the positive rate of the result tested by fluorescence PCR method combined with passive hemagglutination method was 41.6%（132/317）;The result of fluorescent PCR was not agree with the result of passive hemagglutination method.The average duration of positive patient tested by fluorescent PCR was 8.2 days,and that of positive patient tested by passive hemagglutination method was 12.6 days（t=11.67,P〈0.001）,which showed an significant difference between the two positive test times,and the fluorescent PCR was more suitable for early diagnosis.CRP 6 mg/L was positive,the positive rates of CRP tested by fluorescence PCR was 52.1%（25/48）;the positive rates of passive hemagglutination method positive titer（1∶40） group,passive hemagglutination method positive titer（1∶40） group were 71.6%（53/74）,79.5%（31/39）.The positive coincidence rate of fluorescence PCR and CRP was less than that of passive hemagglutination method.The positive rates of 62 children with respiratory tract infection in 0-3-year-old group tested by monovalent and paired serum passive hemagglutination method were 3.2%（2/62） and 4.8%（3/62）,and fluorescent PCR positive rate was 14.5%（9/62）,χ^2=6.64,P〈0.05,which showed an significant difference,and fluorescent PCR was more suitable for testing MP infections of infants and young children.Conclusion Fluorescent PCR is more suitable for early diagnosis and detection of MP in infants,passive hemagglutination method and CRP could help the diagnosis of positive result,particularly for the false positive results of carrier groups,and provide a reasonable guide for clinical medication.