实时荧光核酸恒温扩增检测技术在肺炎支原体肺炎早期诊断中的价值及影响因素分析

Value of simultaneous amplification and testing in early diagnosis of Mycoplasma pneumoniae pneumonia and related influencing factors

目的评估实时荧光核酸恒温扩增检测技术(SAT)在儿童肺炎支原体肺炎(MPP)早期诊断中的应用价值及影响因素分析。方法选取2016年12月至2017年12月住院治疗的社区获得性肺炎患儿526例,采用颗粒凝集法检测MP血清学抗体(MP-Ab),并以此结果为参照,评价SAT用于诊断MPP的价值。结果以血清MP-Ab检测结果确诊MPP患儿165例,MP-SAT诊断MPP的敏感度为90.9%(150/165)、特异度为97.9%(368/376),准确性高(约登指数为0.89),两者的一致性好(Kappa=0.90)。MP-SAT在短病程患儿中的诊断敏感度明显高于长病程患儿(P=0.031);MP-SAT诊断敏感度明显高于单次血清MP-Ab(P=0.018),两者的一致性差(Kappa=0.039);MP-SAT与双份血清MP-Ab一致性好(Kappa=0.91)。多因素logistic回归分析结果显示:病程(≥7 d)、院外应用大环内酯类药物治疗是影响MP-SAT检出结果的主要因素(P<0.05)。结论 MP-SAT在MPP的早期诊断中应用价值高,可以有效弥补急性期单份血清MP-Ab检测的不足,辅助临床进行早期诊断;尽可能在病程早期(<7 d)和大环内酯类药物应用前进行MP-SAT检测。

Objective To investigate the value of simultaneous amplification and testing（SAT） in the early diagnosis of Mycoplasma pneumoniae pneumonia（MPP） in children and related influencing factors. Methods A total of 526 children with community-acquired pneumonia who were hospitalized between December 2016 and December 2017 were enrolled. Particle agglutination was used to measure serum Mycoplasma pneumoniae（MP） antibody（MPAb）. The value of SAT in the diagnosis of MPP was evaluated based on these results. Results Based on the results of serum MP-Ab measurement, 165 children were diagnosed with MPP. MP-SAT had a sensitivity of 90.9%（150/165）, a specificity of 97.9%（368/376）, and high accuracy（Youden index=0.89） in the diagnosis of MPP, suggesting that there was good consistency between these two methods（Kappa=0.90）. The diagnostic sensitivity of MP-SAT in children with a short course of disease was significantly higher than that in children with a long course of disease（P=0.031）. The diagnostic sensitivity of MP-SAT was significantly higher than that of single serum MP-Ab measurement（P=0.018）, with poor consistency between these two methods（Kappa=0.039）. MP-SAT had good consistency with double serum MP-Ab measurement（Kappa=0.91）. The multivariate logistic regression analysis showed that course of disease（≥7 days） and outof-hospital macrolide treatment were the main factors influencing the results of MP-SAT（P〈0.05）. Conclusions MPSAT has high value in the early diagnosis of MPP and can effectively cover the shortage of single serum MP-Ab test in the acute stage and thus provide help for early clinical diagnosis. MP-SAT test should be performed in the early stage of the disease（〈7 days） and before the application of macrolide treatment.