病原体特异性IgM抗体检测在儿童呼吸道急性感染病原快速诊断中的价值研究

Value of pathogen specific IgM antibody detection in rapid diagnosis of pathogens in the children with acute respiratory tract infection

目的:研究病原体特异性IgM抗体检测在儿童呼吸道急性感染病原快速诊断中的价值。方法:本研究为前瞻性研究。选取朝阳市第二医院2018年10月至2018年12月住院的急性呼吸道感染患儿482例作为研究对象,采用间接免疫荧光法检测呼吸道合胞病毒(RSV)、流感病毒A(INFA)、流感病毒B(INFB)等11种病原体特异性IgM。以直接免疫荧光法结果为金标准,评价特异性IgM检测在不同年龄、不同病程呼吸道急性感染病原快速诊断中的价值。结果:482例急性呼吸道感染患儿共检出RSV、腺病毒、INFA、INFB、副流感病毒、噬肺军团菌、肺炎衣原体、肺炎支原体、柯萨奇病毒A 9种病原体254例,阳性的符合率分别为67.11%、85.71%、83.33%、78.57%、72.73%、0.00%、75.00%、91.57%、50.00%,腺病毒、INFA、INFB、肺炎支原体的阳性符合率明显高于RSV( P值均<0.05)。1~2岁、3~4岁、≥5岁组患儿特异性IgM抗体检测结果符合率分别为88.04%、79.12%、81.05%,均高于<1岁组(47.06%),差异有统计学意义( P值均<0.05)。发病时间7~14 d、15~21 d、>21 d组患儿特异性IgM抗体检测结果符合率分别为88.81%、92.41%、87.10%,均高于<7 d组(35.53%),差异有统计学意义( P值均<0.05)。特异性IgM抗体检测咽峡炎、支气管炎、扁桃体炎、支气管肺炎的符合率分别为90.57%、89.25%、82.22%、78.57%,高于毛细支气管炎和肺炎组(分别为60.78%、48.89%),差异有统计学意义( P值均<0.05)。 结论:检测血清IgM抗体可快速检测儿童大部分呼吸道感染病原体,但检测结果受年龄、发病时间、疾病类型的影响,对儿童急性呼吸道感染的快速诊断有一定的临床价值。

Objective To study the value of the pathogen specific IgM antibody detection in rapid diagnosis of pathogens in children with acute respiratory tract infection.Methods In a prospective study,482 children with acute respiratory tract infection in the Second Hospital of Chaoyang from October 2018 to December 2018 were selected as the research objects.Serum specific IgM of eleven pathogens was detected by indirect immunofluorescence assay,including respiratory syncytial virus(RSV),influenza virus A(INFA),influenza virus B(INFB)and so on.Using the results of direct immunofluorescence as the gold standard,the value of specific IgM detection in the rapid diagnosis of pathogens of acute respiratory infection in different ages and different courses was evaluated.Results RSV,adenovirus,INFA,INFB,Parainfluenza virus,Legionella pneumoniae,Chlamydia pneumoniae,Mycoplasma pneumoniae and coxsackievirus A were detected in 482 children with acute respiratory tract infection.The positive coincidence rates of nine pathogens were 67.11%,85.71%,83.33%,78.57%,72.73%,0.00%,75.00%,91.57%and 50.00%,respectively.The positive coincidence rates of adenovirus,INFA,INFB and Mycoplasma pneumonia were significantly higher than that of RSV(all P<0.05).The coincidence rates of specific IgM antibody detection results in 1-2-year old,3-4-year old and≥5-year old groups were 88.04%,79.12%and 81.05%,respectively,which were higher than that in<one-year old group(47.06%,all P<0.05).The coincidence rates of specific IgM antibody detection results in the 7-14-day,15-21-day and>21-day groups were 88.81%,92.41%and 87.10%,respectively,which were higher than that in<7-day group(35.53%,all P<0.05).The coincidence rates of specific IgM antibody in the detection of angina,bronchitis,tonsillitis and bronchopneumonia were 90.57%,89.25%,82.22%and 78.57%,respectively,which were higher than those in bronchiolitis and pneumonia(60.78%and 48.89%,respectively),and the difference was statistically significant(all P<0.05).Conclusions The detection of serum IgM antibody can rapidly detect most pathogens of respiratory tract infection in children,but the detection results are affected by age,onset time and disease type,which has certain clinical value for rapid diagnosis of children with acute respiratory tract infection.