肺炎支原体抗体分型检测和被动颗粒凝集检测结果比较

Comparison of passive particle agglutination test and ELISA determination of antibody isotype on Mycoplasma pneumonia infection

目的研究酶联免疫法（ELISA）抗体分型检测与被动颗粒凝集法（凝集法）检测结果间的一致性，并探讨两种检测对肺炎支原体感染的诊断价值。方法2010年11月至2011年5月间，从济宁医学院附属医院收集191例肺炎支原体感染疑似患者的血清。采用凝集法检测标本中肺炎支原体抗体的滴度水平，ELISA对肺炎支原体IgM、IgG、IgA抗体进行分型检测。Kappa检验评价两种检测结果的一致性，Kmskal—Wallis秩和检验分析各抗体亚型在凝集法滴度组间和患者年龄组间的分布差异。通过抗体分型分析各滴度组标本所处的病程，并结合临床诊断评价凝集法高滴度标本中两种方法检测结果的诊断价值。结果191例患者中，两种方法对肺炎支原体感染的检测总符合率为84．3％，Kappa=0．642，P〈0．01。凝集法不同滴度组问IgM及IgA的检出率存在统计学差异（P〈0．05）。另外，IgM在幼儿及青少年患者中检出率较高，而IgG及IgA在老年患者中检出率较高。抗体分型结果提示，凝集法阳性组中75例（58．1％）为现症感染，其中高滴度组中27例（96．4％）为现症感染，与该组的临床诊断相符。结论凝集法与ELISA法的一致性较好；ELISA法检测IgM、IgG、IgA亚型可提示现症感染和既往感染。

Objective To investigate the consistency between the results of passive panicle agglutination test （ PPA ） and ELISA on Mycoplasma pneumonia （ M. pneumonia ） infection. Study the diagnostic value of both assays. Methods From November 2010 to May 2011, the serum samples of ]191 patients with respiratol7 symptoms were collected from Affiliated Hospital of Jining Medical University. All samples were tested for antibody levels against M. pneumonia using PPA, and for IgM, IgG, IgA subclass using ELISA. The correlation between the results of two methods was evaluated by Kappa test and Spearman rank correlation analysis. The variances of the antibody subclasses among samples with different PPA titers and different age groups were analyzed by Kruskal-Wallis test. The infection status of patients was analyzed based on ELISA results and the clinical relevam＇e of both assays was evaluated in comparison with clinical diagnosis for samples with high PPA titer. Results The level of agreement between the results of PPA and ELISA was 84. 3%, with Kappa value of 0. 642 （ P 〈 0. 01 ）. The prevalence of IgM and IgA antibody against M. pneumonia was significantly different among samples with various PPA titers （ P 〈 0. 05 ）. The prevalence of IgM subclass was higher in child and teenager groups, while that of IgA and IgG were higher in elderly group. Antibody isotyping results suggested that 58. 1% of PPA positive samples （75 cases）, especially 96. 4% of samples with high PPA titer （27 cases）, were of current infection, which was in consistent with clinical diagnosis. Conclusion PPA showed good consistency with ELISA on diagnosis of Mycoplasma pneumonia infection. Antibody subclass determination by ELISA indicates disease progression, thus to differentiate current infection from past. （Chin J Lab Med,2012,35：639-642 ）