呼吸道病原菌基因检测法诊断儿童肺炎链球菌感染的临床价值

The clinical value of respiratory tract pathogenic gene detection in the diagnosis of Streptococcus pneumoniae infection in children

目的探讨呼吸道病原菌基因检测法对诊断儿童肺炎链球菌感染的应用价值。方法收集2016年6月—2017年6月在首都儿科研究所附属儿童医院呼吸科住院的初诊细菌性肺炎患儿224例,每位病例采集深部痰或支气管肺泡灌洗液标本,按传统病原菌培养是否分离到肺炎链球菌分为非肺炎链球菌组136例和肺炎链球菌组88例。用呼吸道病原菌核酸检测试剂盒(恒温扩增芯片法)检测2组病例中的病原菌,应用SPSS 17.0统计软件及Kappa检验来对比2种检测方法的检出效能。结果非肺炎链球菌组应用呼吸道病原菌基因检测法检出肺炎链球菌40例,其中深部痰标本检出32例,支气管肺泡灌洗液标本检出8例;肺炎链球菌组应用呼吸道病原菌基因检测法检出肺炎链球菌80例,其中深部痰标本检出52例,支气管肺泡灌洗液标本检出28例。与传统病原学培养对比,呼吸道病原菌基因检测肺炎链球菌的灵敏度、特异度、总符合率、阳性预测值、阴性预测值分别为90.9%、74.4%、80.3%、66.7%、92.3%。2种检测方法对肺炎链球菌的检出率具有较好的一致性(Kappa>0.4)。结论呼吸道病原菌基因检测具有快速、特异、灵敏的优势,与传统的病原学分离培养检验有较高的一致性及总符合率,能为临床医生提供可靠的诊疗依据。

Objective To explore the application value of the detection of respiratory tract pathogenic gene for the diag- nosis of Streptococcus pneumoniae infection in children. Methods From June, 2016 to June, 2017, 224 cases who were newly diagnosed with bacterial pneumonia hospitalized in the Department of respiration, Capital Institute of Pediatrics were collected. Each case was collected deep sputum or bronchoalveolar lavage specimens, according to the traditional bacterial culture was divided into non Streptococcus pneumoniae group 136 cases and 88 cases of Streptococcus pneumoniae group. The pathogens in the two groups were detected by respiratory tract gene detection kit （loop mediated isothermal amplification）. The detection efficiency of the two detection methods was compared by SPSS 17.0 software and Kappa test. Results The detection of respiratory pathogens were detected in Streptococcus pneumoniae gene of Streptococcus pneumoniae in 40 cases, including deep sputum samples were detected in 32 cases, bronchoalveolar lavage fluid were de- tected in 8 cases. Streptococcus pneumoniae was detected in the detection of respiratory pathogens gene of Streptococcus pneumoltiae in 80 cases, including deep sputum samples were detected in 52 cases, bronchoalveolar lavage fluid were de- tected in 28 cases. Compared with traditional pathogen culture, the sensitivity, specificity, total coincidence rate, posi- tive predictive value and negative predictive value of respiratory tract pathogen gene detection for Streptococcus pneumoniae were 90.9% , 74.4% , 80.3% , 66.7% and 92.3% , respectively. The two detection methods were consistent with the detection rate of Streptococcus pneumoniae （ Kappa 〉 0.4）. Conclusion Respiratory tract pathogen gene detection has the advantage of fast, specific and sensitive. It has high consistency with traditional pathogen isolation and culture test, and it can provide reliable diagnosis and treatment basis for clinicians.