The diagnostic value of serological tests and real-time polymerase chain reaction in children with acute Mycoplasma pneumoniae infection
The diagnostic value of serological tests and real-time polymerase chain reaction in children with acute Mycoplasma pneumoniae infection
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DOI：
10.21037/atm.2020.03.121
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发表时间：
2020-03-01
影响因子：
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通讯作者：
Chen, Zheng-Rong
中科院分区：
文献类型：
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作者：
Li, Qing-Ling;Dong, He-Ting;Chen, Zheng-Rong
背景资料：本研究旨在评价血清学检测和实时荧光定量聚合酶链反应（RT-PCR）在不同年龄组和不同病程儿童肺炎支原体（MP）感染中的临床意义和诊断效果。对经聚合酶链反应（PCR）确诊的下呼吸道感染（LRTI）患儿进行支气管肺泡灌洗液PCR检测（BALF-PCR）检测MP感染。结果：以BALF PCR为金标准，IgM和NPA PCR联合检测3-5岁儿童MP的阳性率为78.85%。5岁以上儿童IgM阳性率为71.21%，NPA PCR阳性率为72.72%，IgM + NPA PCR阳性率为84.85%。IgM和NPA联合PCR与BALF PCR的检出率一致（Kappa =0.727）。IgM和NPA联合PCR检测1-2周MP阳性率高达91.11%，与BALF PCR检测结果一致（Kappa =0.756）。2-3周IgM和NPA PCR阳性率均为63.16%，两者比较有一致性（Kappa =0.771）。IgM和NPA联合PCR是确诊3-5岁儿童MP感染的最佳检测方法，对于病程2-3周的5岁以上儿童，推荐使用NPA PCR或IgM。
Background: This study set out to evaluate the clinical significance and diagnostic effectiveness of serological tests and real-time polymerase chain reactions (RT-PCR) in children of different age groups and disease durations infected with Mycoplasma pneumoniae (MP).Methods: Pediatric patients with lower respiratory tract infection (LRTI) confirmed by polymerase chain reaction (PCR) were enrolled and subjected to bronchoalveolar lavage fluid PCR (BALF-PCR) for MP infection. The diagnostic values of the serum immunoglobulin M (IgM) test, paired sera immunoglobulin G (IgG) test, RT PCR applied to nasopharyngeal aspirates (NPA-PCR), and combined IgM and NPA-PCR test were evaluated.Results: When BALF PCR was used as the gold standard, the MP positivity rate of combined IgM and NPA PCR was 78.85%in children aged 3-5 years. The positivity rates of IgM, NPA PCR, and combined IgM and NPA PCR in children older than 5 years were 71.21%, 72.72%, and 84.85%, respectively. The detection rate of combined IgM and NPA PCR was consistent with BALF PCR (Kappa =0.727). The MP positivity rates of combined IgM and NPA PCR at 1-2 weeks was as high as 91.11%, and was consistent with the BALF PCR (Kappa =0.756). Moreover, the positivity rates of IgM or NPA PCR at 2-3 weeks were 63.16%, and were consistent with each other (Kappa =0.771).Conclusions: Combined IgM and NPA PCR is the optimal test to confirm MP infection among children aged 3-5 years in cases with a disease duration of less than2 weeks, and either NPA PCR or IgM is recommended for children older than 5 years with a disease duration of 2-3 weeks.