南京地区1122例肺炎患者肺炎支原体感染流行特点及IL-6、PCT检测的诊断价值

Epidemiological characteristics of Mycoplasma pneumoniae infection and diagnostic value of IL-6 and PCT detection in 1122 pneumonia patients in Nanjing,China

目的分析肺炎支原体(MP)感染的特点及流行趋势,探讨白细胞介素-6(IL-6)和降钙素原(PCT)检测对MP感染的应用价值。方法回顾性分析本院2022年9月1日至2023年8月31日期间1122例肺炎患者的MP核酸检测结果及患者年龄、性别、采样日期和就诊类别等临床资料,分析MP核酸阳性检出率在不同性别、年龄、就诊类别和季节的差异。绘制受试者工作特征(ROC)曲线,分析IL-6、PCT水平及二者比值在肺炎支原体肺炎(MPP)中的诊断价值。结果1122例肺炎患者中,MP总阳性检出率为24.96%。男性和女性患者的MP核酸阳性检出率分别为23.28%和27.29%,差异无统计学意义(P>0.05)。MP核酸阴性患者的中位年龄为37岁,阳性患者的中位年龄为7岁,差异有统计学意义(P<0.01)。MP核酸阳性患者主要集中于1~2岁(20.37%)、3~5岁(25.60%)和6~8岁(67.40%)。913例住院患者和209例门诊患者的MP核酸阳性检出率分别为22.45%和35.89%,差异有统计学意义(P<0.01)。秋季的MP核酸阳性检出率最高(42.47%)。MP可与其他5种呼吸道病原体发生混合感染,其中与人鼻病毒混合感染的患者数最多(17例)。ROC曲线分析显示,对全年龄段患者而言,IL-6/PCT比值诊断MP感染的ROC曲线下面积(AUCROC)为0.746,优于IL-6和PCT单独检测;对6~8岁的MP易感患者而言,IL-6诊断MP感染的AUCROC为0.767,预测价值最高。结论MPP易在秋季流行,6~8岁儿童是主要的MP易感群体。IL-6/PCT比值有望成为MPP的辅助诊断和预后评估指标,IL-6水平对MP易感人群感染MP的预测价值最高。

Objective To analyze the characteristics and epidemic trends of Mycoplasma pneumoniae(MP)infection among the patients in our hospital,and explore the diagnostic values of interleukin-6(IL-6)and procalcitonin(PCT)detection for MP infection.Methods A retrospective analysis was conducted on the test results of MP nucleic acid and clinical data,including age,gender,sampling date,and treatment category of the 1122 pneumonia patients in our hospital from September 1,2022,to August 31,2023.The positive detection rate of MP nucleic acid was analyzed in different genders,ages,visit categories,and seasons.Receiver operating characteristic(ROC)curves were plotted to analyze the diagnostic value of IL-6 and PCT levels,and their ratio values in Mycoplasma pneumoniae pneumonia(MPP).Results Among the 1122 pneumonia patients,the overall positive detection rate of MP was 24.96%.The positive detection rates of MP nucleic acid in male and female patients were 23.28%and 27.29%,respectively,with no statistically significant difference(P>0.05).The median age of MP nucleic acid-negative patients was 37 years,while that of MP nucleic acid-positive patients was 7 years,showing a statistically significant difference(P<0.01).MP nucleic acid-positive patients were mainly concentrated in the age groups of 1 to 2 years(20.37%),3 to 5 years(25.60%),and 6 to 8 years(67.40%).The positive detection rates of MP nucleic acid among 913 inpatients and 209 outpatients were 22.45%and 35.89%,respectively,with statistically significant difference(P<0.01).The highest MP nucleic acid positive detection rate was observed in autumn(42.47%).MP could be co-infected with five other respiratory pathogens in which human rhinovirus(HRV)was the most common(17 cases).ROC curve analysis showed that the IL-6/PCT ratio had the best diagnostic performance for MP infection in the patients with all ages,with an area under the curve(AUC~(ROC))of 0.746,superior to IL-6 and PCT alone.For MP-susceptible patients aged 6 to 8 years,IL-6 had the highest predictive value for MP infection,with an AUC~(ROC)of 0.767.Conclusions MPP tends to be epidemic in autumn,with children aged 6 to 8 years being the main susceptible population.The IL-6/PCT ratio is expected to become an auxiliary diagnostic and prognostic evaluation indicator for MPP.IL-6 levels have the highest predictive value for MP infection in the susceptible population.