IFA法对病原体IgM联合检测在成人呼吸道感染中的诊断价值

Application of IFA pathogen IgM in the diagnosis of adult respiratory tract infection

目的探讨间接免疫荧光法(IFA)对病原体IgM联合检测在成人呼吸道感染诊断中的应用价值。方法选择2014年7月至2017年8月行呼吸道感染全套检查的成年患者594例。所有患者均采用IFA法进行患者腺病毒(ADV)IgM抗体、肺炎衣原体(CPn)IgM抗体、甲型流感病毒(IFVA)IgM抗体、乙型流感病毒(IFVB)IgM抗体、嗜肺军团菌(LP1)IgM抗体、肺炎支原体(MP)IgM抗体、副流感病毒(PIVs)IgM抗体、Q热立克次体(QFR)IgM抗体及呼吸道合胞病毒(RSV)IgM抗体的联合检测。统计所有患者呼吸道病原体检测结果,分析两种及3种病原体合并感染的情况,并归纳最常见的易感染呼吸道病原体在不同年龄段患者中的感染情况。结果MP、IFVB、PIVs和IFVA的阳性率明显较高,分别为16.16%(96/594)、13.13%(78/594)、9.60%(57/594)、7.07%(42/594);594例检查对象中共有208例检测有呼吸道病原体阳性表达,总阳性率为35.02%。合并两种呼吸道病原体感染共53例,阳性率为8.92%,在所有阳性患者中占比25.48%;"IFA+IFB""IFB+PIV""IFB+MP"及"MP+PIV"阳性率明显高于合并其他两种呼吸道病原体的阳性率,差异均有统计学意义(P<0.05)。合并3种呼吸道病原体感染共25例,阳性率为4.21%,在所有阳性患者中占比12.02%;其中"IFA+IFB+MP""IFA+IFB+PIV"及"IFB+MP+PIV"阳性率明显高于合并其他3种呼吸道病原体感染的阳性率,差异均有统计学意义(P<0.05)。随着年龄的增加,IFVA、IFVB、MP及PIVs 4种病原体的感染率增加,且>18～30、>30～40岁年龄组的患者IFVB、MP及PIVs的感染率明显更高,>18～30岁年龄组患者IFVA感染率高于其他各组,差异均有统计学意义(P<0.05)。结论 IFA法对病原体IgM进行联合检测能有效诊断成人呼吸道感染类型,有利于临床对成人呼吸道感染病原体的分析,值得在临床推广应用。

Objective To investigate the value of indirect immunofluorescence assay （IFA） combined with IgM in the diagnosis of adult respiratory tract infection. Methods A total of 594 adult patients were enrolled in a comprehensive study of respiratory tract infection from July 2014 to August 2017 in our hospital.All patients underwent IFA combined detection of adenovirus （ADV） IgM antibodies,Chlamydia pneumoniae （CPn） IgM antibodies,influenza A virus （IFVA） IgM antibodies,influenza B virus （IFVB） IgM antibodies,Legionella pneumophila （LP1） IgM antibodies,Mycoplasma pneumoniae （MP） IgM antibodies,parainfluenza virus （PIVs） IgM antibodies,Q rickettsia （QFR） IgM antibodies,and respiratory syncytial virus （RSV） IgM antibodies.Patients with respiratory virus were tested,concurrent infection of two and three kinds of pathogen infection was analyzed,and the most common susceptible respiratory virus in patients of different age groups in the infection was summarized. Results The positive rates of MP,IFVA,IFVB and PIVs were significantly higher than those of other pathogens （ P 〈0.05）.Among the 594 patients,208 cases were positive for respiratory virus,the positive rate was 35.02%.There were 53 cases with infection of two respiratory pathogens,which accounted for 8.92% in all the patients and 25.48% in the total positive patients.Among them,positive rates of infection pattern,IFVA＋IFB,IFVB＋PIV,IFVB＋MP and MP＋PIV,were significantly higher than that of the other two kinds of pathogens （ P 〈0.05）.There were 25 cases with infection of three respiratory pathogens,which accounted for 4.21% in all the patients and 12.02% in the total positive patients.Among them,positive rates of infection pattern,IFVA＋IFVB＋MP,IFVA＋IFVB＋PIV and IFVB＋MP＋PIV,were significantly higher than the other three types of respiratory virus infection,the differences were statistically significant （P〈0.05）.The prevalence of IFVB,MP and PIVs increased with the increase of age,and the infection rates of IFVB,MP and PIVs were significantly higher in patients aged 18-30 and 30-40 （ P 〈0.05）.The infection rate of IFVA in patients aged 18-30 was higher than that of other groups （ P 〈0.05）. Conclusion IgM combined detection of IFA pathogens could effectively diagnose the type of adult respiratory tract infection,which is beneficial to the clinical analysis of adult respiratory tract infection virus.It is worthy to be popularized in clinical application.