肺炎支原体抗体金标法联合降钙素原、超敏C反应蛋白检测快速诊断支原体肺炎
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摘要
目的研究肺炎支原体金标法、被动凝集法、间接免疫荧光法、降钙素原(PCT)、白介素-6(IL-6)、白细胞计数(WBC)、超敏C反应蛋白(hs-CRP)、C反应蛋白(CRP)中部分指标联合检测在肺炎支原体肺炎中的诊断价值。方法选取2017年9-12月间来该院就诊的68例支原体肺炎的患儿和同期体检的63例健康儿童对照,运用logistic回归分析结合受试者工作特征曲线(ROC曲线)下面积(AUC)分析单独指标与联合检测的诊断效能。结果与其他两种方法相比,金标法灵敏度较低,为77.9%,但特异度较高,为88.9%;支原体肺炎组PCT、IL-6、hs-CRP、CRP水平均显著高于对照组,回归分析结果显示,金标法、PCT、hs-CRP三项指标被保留;金标法、金标法联合PCT、以及金标法联合PCT和hs-CRP的AUC分别为0.834、0.996和0.998,联合检测优于金标法单独检测。结论肺炎支原体抗体金标法联合PCT和hs-CRP检测对支原体肺炎的具有较好的诊断效果,有较大的临床意义。
Objective To study the diagnostic values of individual or combined tests of colloid gold basedimmunoassay,passive agglutination,indirect immune-fluorescence method,PCT,IL-6,WBC,hs-CRP and/or CRP in detection of the mycoplasma pneumoniae pneumonia(MPP).Methods 68 MPP child patients and 63 healthy controls from September to December 2017 were enrolled,the diagnostic values of individual and combined tests were evaluated using logistic regression together with area under curve(AUC)of ROC curves.Results Compared with the other two methods,the gold standard method has lower sensitivity(77.9%),but higher specificity(88.9%).The levels of PCT,IL-6,hs-CRP and CRP in mycoplasma pneumonia group were significantly higher than those in control group.Regression analysis showed that the three indexes of gold standard method,PCT and hs-CRP were retained.AUC of gold standard method,gold standard method combined with PCT,and gold standard method combined with PCT and hs-CRP were 0.834,0.996 and 0.998 respectively.Combined detection was superior to gold standard method alone.Conclusion Combined tests of antibody-coated colloid gold based-immunoassay,PCT and hs-CRP have relatively good diagnostic value in MPP detection,and they are of high clinical significance.
Objective To study the diagnostic values of individual or combined tests of colloid gold basedimmunoassay,passive agglutination,indirect immune-fluorescence method,PCT,IL-6,WBC,hs-CRP and/or CRP in detection of the mycoplasma pneumoniae pneumonia(MPP).Methods 68 MPP child patients and 63 healthy controls from September to December 2017 were enrolled,the diagnostic values of individual and combined tests were evaluated using logistic regression together with area under curve(AUC)of ROC curves.Results Compared with the other two methods,the gold standard method has lower sensitivity(77.9%),but higher specificity(88.9%).The levels of PCT,IL-6,hs-CRP and CRP in mycoplasma pneumonia group were significantly higher than those in control group.Regression analysis showed that the three indexes of gold standard method,PCT and hs-CRP were retained.AUC of gold standard method,gold standard method combined with PCT,and gold standard method combined with PCT and hs-CRP were 0.834,0.996 and 0.998 respectively.Combined detection was superior to gold standard method alone.Conclusion Combined tests of antibody-coated colloid gold based-immunoassay,PCT and hs-CRP have relatively good diagnostic value in MPP detection,and they are of high clinical significance.
引文
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[13]张昊.肺炎支原体快速液体培养法与被动凝集法的应用比较[J].辽宁医学杂志,2010,24(6):306-307.
[14]LIEBERMAN D,LIVNAT S,SCHLAEFFER F,et al.IL-1beta and IL-6in community-acquired pneumonia:bacteremic pneumococcal pneumonia versus Mycoplasma pneumoniae pneumonia[J].Infection,1997,25(2):90-94.
[15]WOLF J,WAETZIG G H,REINHEIMER T M,et al.Asoluble form of the interleukin-6family signal transducer gp130is dimerized via a C-terminal disulfide bridge resulting from alternative mRNA splicing[J].Biochem Biophys Res Commun,2016,470(4):870-876.
[16]JONES S A,SCHELLER J,ROSE-JOHN S.Therapeutic strategies for the clinical blockade of IL-6/gp130signaling[J].J Clin Invest,2011,121(9):3375-3383.
[17]TAMURA M,WATANABE M,NAKAJIMA A,et al.Serial quantification of procalcitonin(PCT)predicts clinical outcome and prognosis in patients with communityacquired pneumonia(CAP)[J].J Infect Chemother,2014,20(2):97-103.
[2]ZHOU Z,LI X,CHEN X,et al.Comparison of P1and16SrRNA genes for detection of Mycoplasma pneumoniae by nested PCR in adults in Zhejiang,China[J].J Infect Dev Ctries,2015,9(3):244-253.
[3]NARITA M.Pathogenesis of neurologic manifestations of Mycoplasma pneumoniae infection[J].Pediatr Neurol,2009,41(3):159-166.
[4]刘春灵,肺炎支原体肺炎的诊断[J].中国医刊,2009,44(11):16-17.
[5]降钙素原急诊临床应用专家共识组.降钙素原(PCT)急诊临床应用专家共识[J].中华急诊医学杂志,2012,21(9):944-951.
[6]TARTEY S,TAKEUCHI O.Pathogen recognition and Toll-like receptor targeted therapeutics in innate immune cells[J].Int Rev Immunol,2017,36(2):57-73.
[7]张晓慧,李光韬,张卓莉.C反应蛋白与超敏C反应蛋白的检测及其临床意义[J].中华临床免疫和变态反应杂志,2011,5(1):74-79.
[8]翁艳,许小花.C-反应蛋白定量检测在小儿急性呼吸道感染中的诊断价值[J].中国妇幼保健,2013,28(3):454-455.
[9]WAITES K B,TALKINGTON D F.Mycoplasma pneumoniae and its role as a human pathogen[J].Clin Microbiol Rev,2004,17(4):697-728.
[10]WAITES K B,BALISH M F,ATKINSON T P.New insights into the pathogenesis and dection of Mycoplasma pneumoniae infections[J].Future Microbiol,2008,3(6):635-648.
[11]FOY H M.Infections caused by Mycoplasma pneumoniae and possible carrier state in different populations of patients[J].Clin Infect Dis,1993,17(Suppl 1):S37-S46.
[12]TALKINGTON D F,WAITES K B,BESSER RE,et al.E-merging from obscurity:understanding pulmonary and exrrapulmonary syndromes,pathogenesis,and epidemiology of human Mycoplasma pneumoniae infections,in Emerging Infections5[M].ASM:Washington DC,2001:57-84.
[13]张昊.肺炎支原体快速液体培养法与被动凝集法的应用比较[J].辽宁医学杂志,2010,24(6):306-307.
[14]LIEBERMAN D,LIVNAT S,SCHLAEFFER F,et al.IL-1beta and IL-6in community-acquired pneumonia:bacteremic pneumococcal pneumonia versus Mycoplasma pneumoniae pneumonia[J].Infection,1997,25(2):90-94.
[15]WOLF J,WAETZIG G H,REINHEIMER T M,et al.Asoluble form of the interleukin-6family signal transducer gp130is dimerized via a C-terminal disulfide bridge resulting from alternative mRNA splicing[J].Biochem Biophys Res Commun,2016,470(4):870-876.
[16]JONES S A,SCHELLER J,ROSE-JOHN S.Therapeutic strategies for the clinical blockade of IL-6/gp130signaling[J].J Clin Invest,2011,121(9):3375-3383.
[17]TAMURA M,WATANABE M,NAKAJIMA A,et al.Serial quantification of procalcitonin(PCT)predicts clinical outcome and prognosis in patients with communityacquired pneumonia(CAP)[J].J Infect Chemother,2014,20(2):97-103.