血清淀粉样蛋白A联合呼吸道病原体谱IgM荧光检测在社区老年人呼吸道感染性疾病中的临床相关性研究

Clinical relevance of serum amyloid A combined with IgM fluorescence detection of respiratory pathogens in community elderly patients with respiratory tract infectious diseases

目的探讨血清淀粉样蛋白A(SAA)联合呼吸道病原体谱IgM荧光检测在社区老年人呼吸道感染疾病中的相关性和临床应用价值。方法选取2020年1月~2020年12月接受治疗的100例社区获得性呼吸道感染老年患者作为研究对象,均应用间接免疫荧光法进行呼吸道病原体IgM抗体检测,应用量子点荧光免疫层析法进行血清SAA和C反应蛋白(CRP)检测,根据结果将其分为细菌组、病毒组、混合组和支原体组。选取同期100例老年体检者作为对照组。比较各组呼吸道病原体IgM和血清SAA、CRP检测结果,分析其在呼吸道感染中的诊断价值。结果100例患者呼吸道病原体IgM抗体检测总阳性率65.0%(65/100),根据结果将其分为细菌组10例、病毒组40例、混合组12例和支原体组3例。其中单一感染和混合感染分别占52.3%(34/65)和47.7%(31/65)。100例标本中血清SAA阳性率为61.0%(61/100),其中65例抗体阳性标本中SAA阳性率为80%(52/65)。混合组血清SAA、CRP水平要明显高于细菌组、病毒组、支原体组和对照组,细菌组血清SAA和CRP水平也明显高于病毒组、支原体组和对照组,病毒组血清SAA明显高于支原体组和对照组,支原体组与对照组比较差异也有统计学意义(P<0.05),而病毒组、支原体组、对照组血清CRP水平比较差异无统计学意义(P>0.05)。混合组和细菌组的血清SAA阳性率明显高于病毒组、支原体组和对照组,病毒组也明显高于支原体组和对照组,差异均有统计学意义(P<0.05)。受试者工作特征曲线(ROC)分析显示,血清SAA诊断鉴别细菌感染与非细菌感染的曲线下面积(AUC)为0.966,灵敏度为0.955,特异度为0.977,相比血清CRP的诊断价值更高(P<0.05)。结论作为一个敏感性很高的急性时相蛋白,SAA在社区老年患者感染呼吸道疾病不同病原体后的升高水平不同,其在监测病原体感染的灵敏度要高于CRP,血清SAA联合呼吸道病原体谱IgM荧光检测对社区老年患者呼吸道感染性疾病的病因学诊断有重要临床应用价值。

Objective To explore the clinical application value and correlation of serum amyloid A(SAA)combined with respiratory pathogen spectrum IgM fluorescence detection in community elderly patients with respiratory tract infection.Methods 100 cases of elderly patients with communityacquired respiratory tract infection who received treatment in our hospital from January 2020 to December 2020 were selected as the research objects.All the patients were tested for IgM antibody of respiratory pathogens by the method of indirect immunofluorescence,serum SAA,C-reactive protein(CRP)was detected by quantum dot fluorescence immunochromatography.According to the results,they were divided into bacterial group,virus group,mixed group and mycoplasma group.100 cases of physical examination in the same period were selected as the control group.The results of IgM、CRP and SAA in serum of each group were compared.Results The total positive rate of IgM antibody was 65.0%(65/100).According to the results,they were divided into bacterial group(n=10),virus group(n=40),mixed group(n=12)and Mycoplasma group(n=3).The single infection and mixed infection accounted for 52.3%(34/65)and 47.7%(31/65)respectively.The positive rate of SAA was 69.0%(69/100),and the positive rate of SAA in 65 antibody positive samples was 80%(52/65).The serum SAA and CRP levels in the mixed group were significantly higher than those in the bacterial group,virus group,mycoplasma group and the control group.The serum SAA and CRP levels in the bacterial group were also significantly higher than those in the virus group,mycoplasma group and the control group.The serum SAA in the virus group was significantly higher than that in the mycoplasma group and the control group,and the difference between the mycoplasma group and the control group was statistically significant(P<0.05).There was no significant difference in serum CRP level among virus group,mycoplasma group and control group(P>0.05).The positive rate of SAA in mixed group and bacterial group was significantly higher than that in virus group,mycoplasma group and control group,and that in virus group was significantly higher than that in mycoplasma group and control group,the differences were statistically significant(P<0.05).The area under the curve(AUC)of serum SAA in the diagnosis of bacterial infection and non bacterial infection was 0.966,the sensitivity was 0.955,and the specificity was 0.977,which was higher than that of CRP(P<0.05).Conclusion As an acute phase protein with high sensitivity,SAA has different levels in elderly patients with community respiratory tract infection after infection with different pathogens,and its sensitivity in monitoring pathogen infection is higher than that of CRP.Serum SAA combined with IgM fluorescence detection of respiratory pathogens spectrum has important clinical application value in etiology diagnosis of community elderly respiratory tract infectious diseases.