Diagnostic Value of Nasopharyngeal Aspirates in Children with Lower Respiratory Tract Infections.
Diagnostic Value of Nasopharyngeal Aspirates in Children with Lower Respiratory Tract Infections.
复制标题
鼻咽抽吸物对小儿下呼吸道感染的诊断价值
DOI：
10.4103/0366-6999.201595
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发表时间：
2017-03-20
影响因子：
6.1
通讯作者：
Zhang XB
中科院分区：
文献类型：
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作者：
Lu AZ;Shi P;Wang LB;Qian LL;Zhang XB
背景：鼻咽抽吸物（NPA）标本检测下呼吸道病原体的准确性仍存在争议。本研究的目的是评价抽吸物（NPA）标本在儿童下呼吸道感染（LRTI）诊断中的准确性。研究方法：前瞻性研究旨在收集2013年1月至2015年12月急性LRTI儿童的配对NPA和支气管肺泡灌洗液数据。对所有标本进行病原体检测：通过培养进行细菌检测，通过聚合酶链反应试验进行肺炎支原体（Mp）检测，通过免疫荧光试验进行病毒（甲型和B型流感病毒、1型和3型副流感病毒[PIV]、呼吸道合胞病毒和腺病毒）检测。NPA的诊断准确性分析按年龄<3岁（n = 194）和>3岁（n = 294）分层。结果：共收集488例患儿的配对标本。病原菌阳性率为61.6%。NPA培养对肺炎链球菌的诊断特异性为89.9%，阴性预测值为100%，对肺炎链球菌的诊断特异性为97.2%，阴性预测值为98.9%。NPA阳性预测值在<3岁儿童中为77.4%，在>3岁儿童中为89.1%。NPA标本对PIV Ⅲ诊断的特异性为99.8%，阴性预测值为96.5%。NPA对腺病毒的特异性为97.8%，阴性预测值为98.4%，对>3岁的腺病毒特异性为98.9%，阴性预测值为99.3%。结论：NPA是侵入性较小的诊断呼吸道标本，阴性NPA结果有助于“排除”下呼吸道感染;然而，阳性结果并不能可靠地“排除”病原体的存在。
Background: The accuracy of nasopharyngeal aspirate (NPA) specimens in detecting lower respiratory pathogens remains controversial. The objective of this study was to evaluate the diagnostic accuracy of aspirates (NPAs) specimen in lower respiratory tract infections (LRTIs) in children. Methods: The prospective study was designed to collect the data of paired NPAs and bronchoalveolar lavage fluids from children with acute LRTIs from January 2013 to December 2015. All specimens were subjected to pathogen detection: bacterial detection by culture, Mycoplasma pneumoniae (Mp) detection by polymerase chain reaction assay and virus (influenza A and B viruses, parainfluenza virus [PIV] Types 1 and 3, respiratory syncytial virus, and adenovirus) detection by immunofluorescence assay. The diagnostic accuracy analysis of NPAs was stratified by age ⩽3 years (n = 194) and >3 years (n = 294). Results: We collected paired specimens from 488 children. The positive rate of pathogen was 61.6%. For Streptococcus pneumoniae, NPA culture had the specificity of 89.9% and negative predictive value of 100% in age ⩽3 years, the specificity of 97.2% and negative predictive value of 98.9% in age >3 years. For Mp, the positive predictive values of NPA was 77.4% in children ⩽3 years, and 89.1% in children >3 years. For PIV III, NPA specimen had the specificity of 99.8% and negative predictive value of 96.5% in children ⩽3 years. For adenovirus, NPA had the specificity of 97.8% and negative predictive value of 98.4% in age ⩽3 years, the specificity of 98.9% and negative predictive value of 99.3% in age >3 years. Conclusions: NPAs are less invasive diagnostic respiratory specimens, a negative NPA result is helpful in “rule out” lower airway infection; however, a positive result does not reliably “rule in” the presence of pathogens.