533例肺炎儿童鼻咽抽吸物和支气管肺泡灌洗液的病原检出一致性分析

Consistency between nasopharyngeal aspirates and bronchoalveolar lavage fluid in pathogen detection in children with pneumonia:an analysis of 533 cases

目的探究肺炎儿童鼻咽抽吸物(nasopharyngeal aspiration,NPA)和支气管肺泡灌洗液(bronchoalveolar lavagefluid,BALF)的病原检出一致性。方法回顾性分析2017年2月至2020年3月间533例肺炎患儿的NPA与BALF检出病原结果,用配对卡方McNemar检验比较NPA与BALF之间病原检出差异,用Kappa检验对两种样本检出的病原进行一致性分析。结果NPA检出细菌的灵敏度为28%,特异度为74%,阳性预测值为14%,阴性预测值为91%,Kappa值为0.013,与BALF检测结果一致性较差;NPA检出病毒的灵敏度为52%,特异度为81%,阳性预测值为24%,阴性预测值为94%,Kappa值为0.213,与BALF检测结果一致性较差;NPA检测肺炎支原体的灵敏度为78%,特异度为71%,阳性预测值为49%,阴性预测值为90%,Kappa值为0.407,与BALF检测结果一致性中等。结论NPA与BALF检出细菌与病毒的一致性较差,临床医生根据NPA检出细菌或病毒来诊断下呼吸道感染时需谨慎;NPA与BALF检出肺炎支原体的一致性中等,临床医生根据NPA检出肺炎支原体来诊断下呼吸道感染可靠性较高,但仍需结合临床综合判断。

Objective To study the consistency between nasopharyngeal aspirates(NPA)and bronchoalveolar lavage fluid(BALF)in pathogen detection in children with pneumonia.Methods A retrospective analysis was performed on the data of pathogens detected in 533 children with pneumonia from February 2017 to March 2020.The paired McNemar's test was used to compare the difference in pathogen detection between NPA and BALF groups.The Kappa coefficient was used to analyze the consistency in pathogen detection between the two groups.Results NPA had a sensitivity of 28%,a specificity of 74%,a positive predictive value of 14%,and a negative predictive value of 91%in detecting bacteria,and a Kappa coefficient of 0.013 suggested poor consistency between NPA and BALF.NPA had a sensitivity of 52%,a specificity of 81%,a positive predictive value of 24%,and a negative predictive value of 94%in detecting viruses,and a Kappa coefficient of 0.213 suggested poor consistency between NPA and BALF.NPA had a sensitivity of 78%,a specificity of 71%,a positive predictive value of 49%,and a negative predictive value of 90%in detecting Mycoplasma pneumoniae,and a Kappa coefficient of 0.407 suggested moderate consistency between NPA and BALF.Conclusions There is poor consistency between NPA and BALF in the detection of bacteria and viruses,and clinicians should be cautious in diagnosing lower respiratory tract infection based on bacteria or viruses detected in NPA.There is moderate consistency between NPA and BALF in the detection of Mycoplasma pneumoniae,suggesting that it may be reliable to diagnose lower respiratory tract infection based on Mycoplasma pneumoniae detected in NPA,while comprehensive judgment in combination with clinical conditions is needed.