FilmArray检测在儿童重症肺炎中的应用研究
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摘要
目的探讨FilmArray检测系统在儿童重症肺炎诊治中的应用价值,了解儿童重症肺炎病原学特点。方法收集2017年5月至2018年3月本院儿童重症监护病房重症肺炎住院患儿鼻咽拭子标本158例,通过Film Array平台检测呼吸道病原菌,同时进行血常规、CRP、降钙素原(PCT)、呼吸道病毒抗原七项等检查。分析158例重症肺炎患儿病原菌特点,对Film Array检测与呼吸道病毒抗原七项检测阳性率进行比较分析。结果收集的158份标本中,FilmArray检测阳性标本114例(72. 15%),单一病原体感染检出91例(57. 59%),其中鼻病毒/肠病毒检出率最高,为26例(16. 46%);两种病原体混合感染检出23例(14. 56%),其中呼吸道合胞病毒、腺病毒混合感染检出阳性率最高(2. 53%)。分析不同年龄组呼吸道病原检出情况,在≤1岁组,呼吸道合胞病毒、人鼻病毒/肠病毒检出率最高(25%);在> 1～3岁组人鼻病毒/肠病毒检出率最高(25%);在> 3～5岁组流感病毒A、腺病毒检出率最高(27. 27%);≥5岁组人鼻病毒/肠病毒检出率最高(26. 08%)。158例患儿中有53例(33. 54%)合并细菌感染,最常见合并感染细菌为肺炎链球菌(7. 59%)。呼吸道病毒抗原七项检查阴性患儿中,FilmArray检测阴性组PCT高于Film Array检测阳性组(P=0. 03),Film Array检测阳性率(72. 15%)高于呼吸道病毒抗原七项检测(19. 62%),差异有统计学意义(P <0. 01)。百日咳组白细胞计数、咳嗽时间高于非百日咳组,差异有统计学意义(P <0. 05);非百日咳组降钙素原(PCT)高于百日咳组,差异有统计学意义(P <0. 01)。结论 Film Array检测能快速、准确地对20种呼吸道病原进行检测,检测阳性率高,提高病毒诊断率,临床医师结合感染指标及痰培养结果,可以更好指导临床诊疗。
Objective To explore the application value of the Film Array detection system in the diagnosis and treatment of severe pneumonia in children,and to understand the pathogenic characteristics of severe pneumonia in children. Methods A tolal of 158 nasopharyngeal swab specimens were collected from children with severe pneumonia in Hunan Children's Hospital from May 2017 to March 2018. Film Array were used to detect respiratory pathogen. Blood routine,C-reactive protein( CRP),procalcitonin( PCT) and seven kinds of respiratory virus antigen were also performed on all the samples. The pathogenic characteristics of 158 cases of severe pneumonia were analyzed,and the positive rate of seven kinds of respiratory virus antigen test method and Film Array were statistically analyzed. Results Among 158 patients with severe pneumonia,114( 72. 15%) were positive and 91( 57. 59%) single pathogen infection were detected by Film Array, with the highest detection rate of rhinoviruses/enteroviruses( 16. 46%). 23( 14. 56%) mixed infection were detected by Film Array,respiratory syncytial virus combined with adenovirus infection had the highest positive rate( 2. 53%). The detection of respiratory pathogens in different age groups was analyzed. The highest positivity rates of children aged < 1 years were human rhinovirus/enterovirus and respiratory syncytial virus( 25%),> 1-3 years was human rhinovirus/enterovirus( 25%),3-5 years were influenza virus A and adenovirus( 27. 27%), > 5 years was human rhinovirus/enterovirus( 26. 08%). Among 158 patients,53( 33. 54%) had bacterial infection,and the most common bacterial infection was Streptococcus pneumoniae( 7. 59%). In seven respiratory virus antigen test negetive children,PCT in Film Array negative group was higher than that in Film Array positive group( P = 0. 03). The positive rate of Film Array was higher than that of the seven respiratory virus antigen test method( 72. 15% vs 19. 62%,P < 0. 01). The level of white blood cell and cough days in pertussis group were higher than that in non-pertussis group,which was significantly different( P < 0. 01). The PCT level in non-pertussis group was higher than that in pertussis group,with significant difference( P < 0. 01). Conclusions Film Array detection can detect 20 kinds of respiratory tract pathogens rapidly and accurately. The positive rate of detection is high,and the diagnosis rate of virus is improved. The combination of infection indicators and sputum culture results by clinicians can better guide the clinical diagnosis and treatment.
Objective To explore the application value of the Film Array detection system in the diagnosis and treatment of severe pneumonia in children,and to understand the pathogenic characteristics of severe pneumonia in children. Methods A tolal of 158 nasopharyngeal swab specimens were collected from children with severe pneumonia in Hunan Children's Hospital from May 2017 to March 2018. Film Array were used to detect respiratory pathogen. Blood routine,C-reactive protein( CRP),procalcitonin( PCT) and seven kinds of respiratory virus antigen were also performed on all the samples. The pathogenic characteristics of 158 cases of severe pneumonia were analyzed,and the positive rate of seven kinds of respiratory virus antigen test method and Film Array were statistically analyzed. Results Among 158 patients with severe pneumonia,114( 72. 15%) were positive and 91( 57. 59%) single pathogen infection were detected by Film Array, with the highest detection rate of rhinoviruses/enteroviruses( 16. 46%). 23( 14. 56%) mixed infection were detected by Film Array,respiratory syncytial virus combined with adenovirus infection had the highest positive rate( 2. 53%). The detection of respiratory pathogens in different age groups was analyzed. The highest positivity rates of children aged < 1 years were human rhinovirus/enterovirus and respiratory syncytial virus( 25%),> 1-3 years was human rhinovirus/enterovirus( 25%),3-5 years were influenza virus A and adenovirus( 27. 27%), > 5 years was human rhinovirus/enterovirus( 26. 08%). Among 158 patients,53( 33. 54%) had bacterial infection,and the most common bacterial infection was Streptococcus pneumoniae( 7. 59%). In seven respiratory virus antigen test negetive children,PCT in Film Array negative group was higher than that in Film Array positive group( P = 0. 03). The positive rate of Film Array was higher than that of the seven respiratory virus antigen test method( 72. 15% vs 19. 62%,P < 0. 01). The level of white blood cell and cough days in pertussis group were higher than that in non-pertussis group,which was significantly different( P < 0. 01). The PCT level in non-pertussis group was higher than that in pertussis group,with significant difference( P < 0. 01). Conclusions Film Array detection can detect 20 kinds of respiratory tract pathogens rapidly and accurately. The positive rate of detection is high,and the diagnosis rate of virus is improved. The combination of infection indicators and sputum culture results by clinicians can better guide the clinical diagnosis and treatment.
引文
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[12] Brealey JC,Chappell KJ,Galbraith S,et al. Streptococcus pneumoniae colonization of the nasopharynx is associated with increased severity during respiratory syncytial virus infection in young children[J]. Respirology,2018,23(2):220-227. DOI:10. 1111/resp. 13179.
[13] Chorazy ML,Lebeck MG,Mc Carthy TA,et al. Polymicrobial acute respiratory infections in a hospital-based pediatric population[J]. Pediatr Infect Dis J,2013,32(5):460-466. DOI:10.1097/INF. 0b013e31828683ce.
[14]王传清,朱启镕.百日咳与非百日咳迁延性慢性咳嗽儿童及青少年临床特征分析[J].临床儿科杂志,2010,28(6):542-544. DOI:10. 3969/j. issn. 1000-3606. 2010. 06. 010.
[15]中华医学会儿科学分会感染学组,《中华儿科杂志》编辑委员会.中国儿童百日咳诊断及治疗建议[J].中华儿科杂志,2017,55(8):568-572. DOI:10. 3760/cma. j. issn. 0578-1310.2017. 08. 004.
[2] Archimbaud C,Chambon M,Bailly JL,et al. Impact of rapid enterovirus molecular diagnosis on the management of infants,children,and adults with aseptic meningitis[J]. J Med Virol,2009,81(1):42-48. DOI:10. 1002/jmv. 21330.
[3] Harper SA,Bradley JS,Englund JA,et al. Seasonal influenza in adults and children--diagnosis,treatment,chemoprophylaxis,and institutional outbreak management:clinical practice guidelines of the Infectious Diseases Society of America[J]. Clin Infect Dis,2009,48(8):1003-1032. DOI:10. 1086/598513.
[4] Poritz MA,Blaschke AJ,Byington CL,et al. Film Array,an automated nested multiplex PCR system for multi-pathogen detection:development and application to respiratory tract infection[J].PLo S One,2011,6(10):e26047. DOI:10. 1371/journal. pone.0026047.
[5] Jain S,Self WH,Wunderink RG,et al. Community-Acquired Pneumonia Requiring Hospitalization among U. S. Adults[J]. N Engl J Med,2015,373(5):415-427. DOI:10. 1056/NEJMoa1500245.
[6] Rhedin S,Lindstrand A,Hjelmgren A,et al. Respiratory viruses associated with community-acquired pneumonia in children:matched case-control study[J]. Thorax,2015,70(9):847-853.DOI:10. 1136/thoraxjnl-2015-206933.
[7] Chiu SC,Lin YC,Wang HC,et al. Surveillance of upper respiratory infections using a new multiplex PCR assay compared to conventional methods during the influenza season in Taiwan[J]. Int J Infect Dis,2017,61:97-102. DOI:10. 1016/j. ijid. 2017. 06.011.
[8] Peltola V,Waris M,Osterback R,et al. Rhinovirus transmission within families with children:incidence of symptomatic and asymptomatic infections[J]. J Infect Dis,2008,197(3):382-389. DOI:10. 1086/525542.
[9] Murdoch DR,Jennings LC. Association of respiratory virus activity and environmental factors with the incidence of invasive pneumococcal disease[J]. J Infect,2009,58(1):37-46. DOI:10.1016/j. jinf. 2008. 10. 011.
[10] Madhi SA,Klugman KP. A role for Streptococcus pneumoniae in virus-associated pneumonia[J]. Nat Med,2004,10(8):811-813. DOI:10. 1038/nm1077.
[11] Fathima P,Blyth CC,Lehmann D,et al. The Impact of Pneumococcal Vaccination on Bacterial and Viral Pneumonia in Western Australian Children:Record Linkage Cohort Study of 469589Births,1996-2012[J]. Clin Infect Dis,2018,66(7):1075-1085. DOI:10. 1093/cid/cix923.
[12] Brealey JC,Chappell KJ,Galbraith S,et al. Streptococcus pneumoniae colonization of the nasopharynx is associated with increased severity during respiratory syncytial virus infection in young children[J]. Respirology,2018,23(2):220-227. DOI:10. 1111/resp. 13179.
[13] Chorazy ML,Lebeck MG,Mc Carthy TA,et al. Polymicrobial acute respiratory infections in a hospital-based pediatric population[J]. Pediatr Infect Dis J,2013,32(5):460-466. DOI:10.1097/INF. 0b013e31828683ce.
[14]王传清,朱启镕.百日咳与非百日咳迁延性慢性咳嗽儿童及青少年临床特征分析[J].临床儿科杂志,2010,28(6):542-544. DOI:10. 3969/j. issn. 1000-3606. 2010. 06. 010.
[15]中华医学会儿科学分会感染学组,《中华儿科杂志》编辑委员会.中国儿童百日咳诊断及治疗建议[J].中华儿科杂志,2017,55(8):568-572. DOI:10. 3760/cma. j. issn. 0578-1310.2017. 08. 004.