实时荧光定量PCR在儿童肺部真菌感染诊断中的价值探讨

Value of real time fluorescent quantitative PCR in the diagnosis of pulmonary fungal infection in children

目的探讨实时荧光定量PCR在儿童肺部真菌感染中的诊断价值。方法收集本院儿科收住院的临床拟诊侵袭性肺部真菌感染的34例患儿做研究组;另收集同期入院,临床不考虑真菌感染的肺炎患儿19例做对照组。全部患者取气管内分泌物或咽部吸出物做真菌培养、涂片找真菌、白色念珠菌PCR检测、曲霉菌PCR检测,并取全血做G试验、GM试验。2组间比较,研究检测结果。结果研究组34例样本中,G试验阳性17例,GM试验阳性0例,白色念珠菌PCR检测阳性12例,曲霉菌PCR检测阳性1例,对照组19例样本中G试验、GM试验均阴性,白色念珠菌PCR检测阳性1例,曲霉菌PCR检测阳性0例。白色念珠菌PCR与G试验一致性检验,提示2组间一致性中等(Kappa=0.538),白色念珠菌PCR研究组与对照组差异有统计学意义(χ2=4.426,P<0.05)。结论 PCR检测可用于儿童侵袭性肺部真菌感染的早期诊断,与传统检测方法联合使用,可提高诊断敏感性。

Objective To explore the diagnostic value of real time fluorescent quantitative PCR in the diagnosis of pulmonary fungal infection in children. Methods 34 patients with invasive pulmonary fungal infection in our hospital were admitted to the research group,and 19 patients were admitted to the control group. The control group was not considered in the same period.Tracheal secretions or pharyngeal aspiration were sampled from all patients for the fungal culture,smear for Fungi and Candida albicans PCR,Song fungal PCR detection,and whole blood G test,GM test. Comparison between the two groups was conducted,and the results were studied. Results In the research group（ n = 34）,G test was positive in 17 cases,GM test was positive in 0 patient,Candida albicans PCR was positive in 12 cases,Aspergillus PCR was positive in 1 case; while,in the control group,19 cases were negative in G test and GM test,PCR detection of Candida albicans was positive in 1 case,Aspergillus PCR was positive in 0 case. Consistency test of Candida albicans PCR and G were performed,the two groups showed that the consistency was medium（ Kappa = 0. 538）; the difference between Candida albicans PCR study group and control group was statistically significant（ χ2= 4. 426,P 0. 05）. Conclusion PCR detection can be used in early diagnosis of invasive pulmonary fungal infection in children,which can be used in the combination with the traditional detection methods,and can improve the diagnostic sensitivity.