鼻咽抽吸物MP-DNA拷贝数与肺炎支原体肺炎临床表现的关系
|
摘要
目的探讨鼻咽抽吸物肺炎支原体基因MP-DNA拷贝数与肺炎支原体肺炎(MPP)临床表现的关系。方法回顾分析294例MPP住院患儿的临床资料,根据其MP-DNA拷贝数分为低拷贝组(MP-DNA拷贝数≤10~3/mL)21例、中拷贝组(10~4～10~6/mL)156例、高拷贝组(> 10~6/mL)117例。对三组患儿的临床表现、实验室检查结果、胸部X线变化进行比较分析;并用ROC曲线分析鼻咽抽吸物MP-DNA拷贝数对难治性肺炎支原体肺炎(RMPP)的诊断价值。结果与低、中拷贝组相比,高拷贝组的热程延长,热峰、C反应蛋白、乳酸脱氢酶增高,大片肺实变或肺不张、胸腔积液、肺外多器官受累以及RMPP发生率也增高,差异均有统计学意义(P<0.05)。MP-DNA拷贝数判断RMPP的ROC曲线下面积(AUC)为0. 701;当临界值为4. 83×10~6时,灵敏度和特异度分别为80.8%和55.4%。结论鼻咽抽吸物MP-DNA拷贝数与MPP炎症反应及肺内外损害可能相关,高MP-DNA拷贝数对早期诊断RMPP有一定参考意义。
Objective To explore relationship between nasopharyngeal Mycoplasma pneumoniae(MP)-DNA copies and clinical characteristics in Mycoplasma pneumoniae pneumonia(MPP) children. Method A total of 294 hospitalized MPP children were enrolled retrospectively and grouped according to the levels of nasopharyngeal MP-DNA copies tested: low copy level group( ≤ 10~3/mL, n= 21), moderate copy level group( 10~4-10~6/mL, n= 156) and high copy level group(> 10~6/mL, n= 117).Clinical manifestations, laboratory results and image features of the three groups were compared. ROC curve was used to analyze the predictive value of MP-DNA copies in refractory Mycoplasma pneumoniae pneumonia(RMPP). Results Compared with low and moderate MP-DNA copies groups, high MP-DNA copies group had longer duration of fever, higher peak temperature and CRP level. The incidence of consolidation or atelectasis, pleural effusion, multiple extrapulmonary complications and RMPP were significantly higher in high MP-DNA copies group than those in low/moderate groups. ROC curve analysis showed AUC of the MP-DNA copies for the diagnosis of RMPP was 0.701. The best threshold value estimated was 4.83×10~6/mL, the diagnostic sensitivity and specificity was 80. 8 % and 55. 4 %, respectively. Conclusions There may be positive correlation between nasopharyngeal MP-DNA copies and inflammation, pulmonary and extrapulmonary damage in MPP children. High MP-DNA copies may serve as a clinical indicator for early diagnosis of RMPP.
Objective To explore relationship between nasopharyngeal Mycoplasma pneumoniae(MP)-DNA copies and clinical characteristics in Mycoplasma pneumoniae pneumonia(MPP) children. Method A total of 294 hospitalized MPP children were enrolled retrospectively and grouped according to the levels of nasopharyngeal MP-DNA copies tested: low copy level group( ≤ 10~3/mL, n= 21), moderate copy level group( 10~4-10~6/mL, n= 156) and high copy level group(> 10~6/mL, n= 117).Clinical manifestations, laboratory results and image features of the three groups were compared. ROC curve was used to analyze the predictive value of MP-DNA copies in refractory Mycoplasma pneumoniae pneumonia(RMPP). Results Compared with low and moderate MP-DNA copies groups, high MP-DNA copies group had longer duration of fever, higher peak temperature and CRP level. The incidence of consolidation or atelectasis, pleural effusion, multiple extrapulmonary complications and RMPP were significantly higher in high MP-DNA copies group than those in low/moderate groups. ROC curve analysis showed AUC of the MP-DNA copies for the diagnosis of RMPP was 0.701. The best threshold value estimated was 4.83×10~6/mL, the diagnostic sensitivity and specificity was 80. 8 % and 55. 4 %, respectively. Conclusions There may be positive correlation between nasopharyngeal MP-DNA copies and inflammation, pulmonary and extrapulmonary damage in MPP children. High MP-DNA copies may serve as a clinical indicator for early diagnosis of RMPP.
引文
[1]Jain S,Williams DJ,Arnold SR,et al.Community-acquired pneumonia requiring hospitalization among U.S.children[J].N Engl J Med,2015,372(9):835-845.
[2]Liu WK,Liu Q,Chen DH,et a1.Epidemiology of acute respiratory infections in children in Guangzhou:a three-year study[J].PLoS One,2014,9(5):e96674.
[3]Gao J,Yue B,Li H,et al.Epidemiology and clinical features of segmental/lobar pattern Mycoplasma pneumoniae pneumonia:a ten-year retrospective clinical study[J].Exp Ther Med,2015,10(6):2337-2344.
[4]Yin Y,Lu Q,Yan X.Epidemiology of Mycoplasma pneumoniae infections[J].Zhonghua Er Ke Za Zhi,2016,54(2):91-93.
[5]翟佳羽,林烈桔,麦朗君,等.难治性肺炎支原体肺炎患儿临床特点及危险因素分析[J].临床儿科杂志,2017,35(8):569-574.
[6]朱春梅,曹玲.重症支原体肺炎并发症的诊治[J].中国实用儿科杂志,2015,30(3):161-165.
[7]成云改,李淑娴,李雪静,等.肺炎支原体肺炎患儿肺泡灌洗液病菌量与临床特征相关性研究[J].中华儿科杂志,2013,51(10):736-740.
[8]胡亚美,江载芳.诸福棠实用儿科学[M].8版.北京:人民卫生出版社,2015.
[9]中华医学会儿科学分会呼吸学组,中华儿科杂志编辑委员会.儿童社区获得性肺炎管理指南(试行)(上)[J].中华儿科杂志,2013,10(51):745-752.
[10]梅玉霞,丁立人,庄承,等.儿童难治性支原体肺炎诊治进展[J].上海交通大学学报,2015,35(2):286-290.
[11]刘金荣,赵顺英.难治性肺炎支原体肺炎的发病机制[J].临床儿科杂志,2013,31(12):1186-1188.
[12]成智,崔振泽,黄燕.儿童重症肺炎支原体肺炎研究进展[J].国际儿科学杂志,2012,39(1):92-95.
[13]Nilsson AC,Bj?rkman P,Welinder-Olsson C,et a1.Clinical severity of Mycoplasma pneumoniae(MP)infection is associated with bacterial load in oropharyngeal secretions but not with MP genotype[J].BMC Infect Dis,2010,10:39-46.
[14]中华医学会儿科学分会呼吸学组,中华实用儿科临床杂志编辑委员会.儿童肺炎支原体肺炎诊治专家共识(2015年版)[J].中华实用儿科临床杂志,2015,30(17):1304-1308.
[15]Stelmach I,Podsiadlowicz-Borzecka M,Grzelewski T,et al.Humoral and cellular immunity in children with Mycoplasma pneumoniae infection:a 1-year prospective study[J].Clin Diagn Lab Immunol,2005,12(10):1246-1250.
[16]Miyashita N,Kawai Y,Inamura N,et al.Setting a standard for the initiation of steroid therapy in refractory or severe Mycoplasma pneumoniae pneumonia in adolescents and adults[J].J Infect Chemother,2015,21(3):153-160.
[17]Gong L,Zhang CL,Zhen Q.Analysis of clinical value of CT in the diagnosis of pediatric pneumonia and mycoplasma pneumonia[J].Exp Ther Med,2016,11(4):1271-1274.
[18]张晗,尚云晓.重症肺炎支原体肺炎早期识别[J].中国实用儿科杂志,2015,30(3):176-179.
[19]王进雅,诸留珍,陆璐,等.肺炎支原体DNA拷贝数在儿童肺炎支原体肺炎中价值的研究[J].内蒙古医学杂志,2016,48(2):129-132.
[20]吴良霞.肺炎支原体肺炎肺外并发症[J].中华实用儿科临床杂志,2013,28(16):1210-1211.
[21]Smith LG.Myeoplasma pneumonia and its complications[J].Infect Dis Clin North Am,2010,24(1):57-60.
[22]Narita M.Pathogenesis of extrapulmonary manifestations of Mycoplasma pneumoniae infection with special reference to pneumonia[J].J Infect Chemother,2010,16(3):162-169.
[23]Yang HJ,Song DJ,Shim JY.Mechanism of resistance acquisition and treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia in children[J].Korean J Pediatr,2017,60(6):167-174.
[24]Wang M,Wang Y,Yan Y,et al.Clinical and laboratory profiles of refractory Mycoplasma pneumoniae pneumonia in children[J].Int J Infect Dis,2014,29:18-23.
[25]Bao YX,Li J,Tian Y,et al.Atopy:a risk factor of refractory Mycoplasma pneumoniae pneumonia?[J].Clin Respir J,2017,11(6):931-934.
[2]Liu WK,Liu Q,Chen DH,et a1.Epidemiology of acute respiratory infections in children in Guangzhou:a three-year study[J].PLoS One,2014,9(5):e96674.
[3]Gao J,Yue B,Li H,et al.Epidemiology and clinical features of segmental/lobar pattern Mycoplasma pneumoniae pneumonia:a ten-year retrospective clinical study[J].Exp Ther Med,2015,10(6):2337-2344.
[4]Yin Y,Lu Q,Yan X.Epidemiology of Mycoplasma pneumoniae infections[J].Zhonghua Er Ke Za Zhi,2016,54(2):91-93.
[5]翟佳羽,林烈桔,麦朗君,等.难治性肺炎支原体肺炎患儿临床特点及危险因素分析[J].临床儿科杂志,2017,35(8):569-574.
[6]朱春梅,曹玲.重症支原体肺炎并发症的诊治[J].中国实用儿科杂志,2015,30(3):161-165.
[7]成云改,李淑娴,李雪静,等.肺炎支原体肺炎患儿肺泡灌洗液病菌量与临床特征相关性研究[J].中华儿科杂志,2013,51(10):736-740.
[8]胡亚美,江载芳.诸福棠实用儿科学[M].8版.北京:人民卫生出版社,2015.
[9]中华医学会儿科学分会呼吸学组,中华儿科杂志编辑委员会.儿童社区获得性肺炎管理指南(试行)(上)[J].中华儿科杂志,2013,10(51):745-752.
[10]梅玉霞,丁立人,庄承,等.儿童难治性支原体肺炎诊治进展[J].上海交通大学学报,2015,35(2):286-290.
[11]刘金荣,赵顺英.难治性肺炎支原体肺炎的发病机制[J].临床儿科杂志,2013,31(12):1186-1188.
[12]成智,崔振泽,黄燕.儿童重症肺炎支原体肺炎研究进展[J].国际儿科学杂志,2012,39(1):92-95.
[13]Nilsson AC,Bj?rkman P,Welinder-Olsson C,et a1.Clinical severity of Mycoplasma pneumoniae(MP)infection is associated with bacterial load in oropharyngeal secretions but not with MP genotype[J].BMC Infect Dis,2010,10:39-46.
[14]中华医学会儿科学分会呼吸学组,中华实用儿科临床杂志编辑委员会.儿童肺炎支原体肺炎诊治专家共识(2015年版)[J].中华实用儿科临床杂志,2015,30(17):1304-1308.
[15]Stelmach I,Podsiadlowicz-Borzecka M,Grzelewski T,et al.Humoral and cellular immunity in children with Mycoplasma pneumoniae infection:a 1-year prospective study[J].Clin Diagn Lab Immunol,2005,12(10):1246-1250.
[16]Miyashita N,Kawai Y,Inamura N,et al.Setting a standard for the initiation of steroid therapy in refractory or severe Mycoplasma pneumoniae pneumonia in adolescents and adults[J].J Infect Chemother,2015,21(3):153-160.
[17]Gong L,Zhang CL,Zhen Q.Analysis of clinical value of CT in the diagnosis of pediatric pneumonia and mycoplasma pneumonia[J].Exp Ther Med,2016,11(4):1271-1274.
[18]张晗,尚云晓.重症肺炎支原体肺炎早期识别[J].中国实用儿科杂志,2015,30(3):176-179.
[19]王进雅,诸留珍,陆璐,等.肺炎支原体DNA拷贝数在儿童肺炎支原体肺炎中价值的研究[J].内蒙古医学杂志,2016,48(2):129-132.
[20]吴良霞.肺炎支原体肺炎肺外并发症[J].中华实用儿科临床杂志,2013,28(16):1210-1211.
[21]Smith LG.Myeoplasma pneumonia and its complications[J].Infect Dis Clin North Am,2010,24(1):57-60.
[22]Narita M.Pathogenesis of extrapulmonary manifestations of Mycoplasma pneumoniae infection with special reference to pneumonia[J].J Infect Chemother,2010,16(3):162-169.
[23]Yang HJ,Song DJ,Shim JY.Mechanism of resistance acquisition and treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia in children[J].Korean J Pediatr,2017,60(6):167-174.
[24]Wang M,Wang Y,Yan Y,et al.Clinical and laboratory profiles of refractory Mycoplasma pneumoniae pneumonia in children[J].Int J Infect Dis,2014,29:18-23.
[25]Bao YX,Li J,Tian Y,et al.Atopy:a risk factor of refractory Mycoplasma pneumoniae pneumonia?[J].Clin Respir J,2017,11(6):931-934.