2020 年第 11 期 第 15 卷

基于临床资料的两种肺炎支原体检测方法对比分析

Comparative analysis of two Methods  for detection of Mycoplasma pneumoniae in children based on clinical data

作者：代雷阳1王英萍2宋顺琪1樊茂1冯星星1骆琪丽1张红芳1杜廷义1

英文作者：Dai Leiyang1 Wang Yingping2 Song Shunqi1 Fan Mao1 Feng Xingxing1 Luo Qili1 Zhang Hongfang1 Du Tingyi1

单位：1昆明市儿童医院昆明医科大学附属儿童医院检验科云南省儿童重大疾病研究重点实验室650000；2昆明市儿童医院昆明医科大学附属儿童医院急诊科650000

英文单位：1Department of Clinical Laboratory Kunming Children′s Hospital Children′s Hospital Affiliated to Kunming Medical University， Yunnan Key Laboratory of Children′s Major Disease Research Kunming 650000 China; 2Department of Emergency Kunming Children′s Hospital Children′s Hospital Affiliated to Kunming Medical University， Kunming 650000 China

关键词：肺炎支原体抗体检测；儿童；被动凝集法；免疫胶体金技术；临床资料

英文关键词：Detectionofmycoplasmapneumoniaeantibody;Children;Passiveagglutinationmethod;

• 摘要：

• 目的 结合临床资料及阳性率，比较被动凝集法（PA法）与免疫胶体金技术(GICT)检测儿童肺炎支原体(MP)感染的结果，探讨2种方法在快速诊断MP感染中的价值。方法 选取2019年3—4月昆明市儿童医院急诊就诊的疑似MP感染的357例患儿为观察对象，采其血清，分别使用PA法与GICT法（A、B 2种试剂）进行MP抗体的检测，同时收集患儿就诊体征、相关检查数据、临床诊断、治疗措施和转归情况等信息。结果 临床样本中不同方法的阳性率依次为：PA法（抗体滴度≥1∶160）：21.4%（63/295）；GICT-A试剂MP-免疫球蛋白（Ig）M：10.2%（30/295）；GICT-B试剂MP-IgM：23.1%（68/295）。以PA法（抗体滴度≥1∶160）为阳性预判值，GICT-A试剂MP-IgM的敏感度33.3%，特异度96.1%，阳性预测值70.0%，阴性预测值84.2%，阳性似然比8.54，阴性似然比0.69；GICT-B试剂MP-IgM的敏感度74.6%，特异度93.1%，阳性预测值69.1%，阴性预测值93.0%，阳性似然比10.66，阴性似然比0.27。2种方法的敏感度差距主要来自于低滴度阳性标本。作为非特异性的检测指标，临床常用的白细胞计数和C反应蛋白对于区分是否MP感染，不具备协助作用。结论 在MP感染血清学检测中，GICT快速检测方法的实际可行性，应该建立在对拟引进检测系统的性能评价和持续改进基础之上。半定量全滴度的PA试验是目前此类方法评价的重要参考。不同GICT法检测试剂之间检测效能的差距集中表现在PA法的低滴度样本上。

• Objective Combined with clinical basic conditions and positive rate, the Results  of passive agglutination(PA) and immune colloidal gold technique(GICT) in detecting children with Mycoplasma pneumonia(MP) infection were compared to investigate the value of two Methods  in rapid diagnosis of MP infection. Methods Totally 357 patients with suspected MP infection admitted to Kunming Children′s Hospital from March to April 2019 were selected. The serum was collected and the MP antibody was detected by PA method and GICT method (A and B two reagents). The information of physical signs, relevant examination data, clinical diagnosis, treatment measures and prognosis were collected. Results The positive rates of the three Methods  in the clinical samples were: PA method(antibody titer≥1∶160) 21.4%（63/295）; GICT-A reagent MP-immunoglobulin (Ig)M: 10.2%（30/295）; GICT-B reagent MP-IgM: 23.1%（68/295）. The PA method(antibody titer≥1∶160) was used as the positive predictive value in this test. The sensitivity of the GICT-A reagent MP-IgM was 33.3%, the specificity was 96.1%, the positive predictive value was 70.0%, and the negative predictive value was 84.2%. The positive likelihood ratio was 8.54, the negative likelihood ratio was 0.69.The sensitivity of GICT-B reagent MP-IgM was 74.6%, specificity was 93.1%, positive predictive value was 69.1%, negative predictive value was 93.0%, positive likelihood ratio was 10.66, and negative likelihood ratio was 0.27. The difference of sensitivity between the two Methods  was mainly from the positive samples with low titer. As a non-specific detection index, white blood cell count and C-reactive protein commonly used in clinic are not helpful in distinguishing MP infection.Conclusions In the serological detection of MP infection, the practical feasibility of the rapid detection method of GICT should be based on the performance evaluation and continuous improvement of the proposed detection system. The semi-quantitative full titer PA test is an important reference for the evaluation of such Methods . The difference of detection efficiency between different GICT detection reagents is mainly reflected in PA.