呼吸道感染患儿非细菌病原体IgM抗体检测的临床价值

目的 了解合肥市第一人民医院14岁以下急性呼吸道感染儿科住院患儿非细菌病原体感染情况。 方法 收集合肥市第一人民医院2018年1—12月呼吸道感染儿科住院患儿724例的血清标本;其中婴儿组(0~1岁)339例,幼儿组(>1~3岁)188例,学龄前组(>3~6岁)131例,学龄期组(>6~14岁)66例。应用间接免疫荧光法(indirect immunofluorescence assay,IFA)对嗜肺军团菌(legionella pneumophila,LP)、肺炎支原体(mycoplasma pneumonise,MP)、Q热立克次体(coxiella burnetii,COX)、肺炎衣原体(chlamydia pneumoniae,CP)、腺病毒(adenovirus,ADV)、呼吸道合胞病毒(respiratory syncytial virus,RSV)、甲型流感病毒(influenza A virus,INFA)、乙型流感病毒(influenza B virus,INFB)和副流感病毒1、2和3型(parainfluenza virus,PIVs)共9种呼吸道病原体血清IgM抗体联合检测,对阳性病例进行回顾性临床分析。 结果 724例患儿检出呼吸道病原体血清IgM抗体阳性病例273例,总阳性率为37.71%,共检出MP(29.70%)、INFB(5.80%)、RSV(4.56%)、ADV(0.55%)和PIVs(0.14%)5种病原体。混合感染阳性22例,占阳性病例的8.06%(22/273)。男患儿与女患儿血清IgM抗体总检出率比较差异无统计学意义(P=0.059),但2组MP检出率比较差异有统计学意义(P=0.001)。婴儿组、幼儿组、学龄前组和学龄期组患儿血清IgM抗体总阳性率分别为27.14%、53.19%、54.20%、48.48%,其中MP、RSV及INFB 3种病原体在4个年龄组中的检出率比较差异均有统计学意义(均P<0.05)。冬季总阳性率最高(50.00%,102/204),INFB则在春季流行。 结论 合肥市第一人民医院患儿呼吸道疾病感染的非细菌性病原体主要为肺炎支原体,且MP、RSV和INFB 3种病原体感染具有年龄和季节分布特点。 

Clinical values of non-bacterial pathogen IgM antibodies detection in children with respiratory tract infections

Objective To investigate the infection of non-bacterial pathogens in children with acute respiratory tract infections below 14 years old in the author's hospital. Methods In the First People's Hospital of Hefei, a total of 724 serum samples of respiratory tract infections were enrolled during the period from January to December in 2018. The 724 cases were divided into baby group(339 cases, 0-1 years old), infant group(188 cases,1-3 years old), preschool group(131 cases,3-6 years old) and school group(66 cases, 6-14 years old).The IgM antibodies of legionella pneumophila(LP), mycoplasma pneumonise(MP), coxiella burnetii(COX), chlamydia pneumoniae(CP), adenovirus(ADV), respiratory syncytial virus(RSV), influenza a virus(INFA), influenza b virus(INFB) and parainfluenza virus(PIVs) in the serum were detected by using indirect immunofluorescence assay(IFA) and a retrospective clinical analysis was performed with those positive cases. Results The results showed that the total positive rate was 37.71%(273/724) and the five detected pathogens were MP(29.70%), INFB(5.80%), RSV(4.56%), ADV(0.55%) and PIVs(0.14%), respectively. Mixed-infections of pathogens were detected in 22 cases, accounting for 8.06%(22/273) of positive cases. The total positive rates of IgM were no significant different between male and female groups(P=0.059). However, the positive rate of MP IgM antibodies were statistically significant between the two gender groups(P=0.001). The total positive rates of babies, infants, preschool and school groups were 27.14%, 53.19%, 54.20% and 48.48%, respectively. Among the four age groups, there were significant differences in the detection rates of MP,RSV and INFB(all P<0.05). MP occurred frequently in winter(50.00%, 102/204), while the prevalence of INFB was in spring. Conclusion MP is the primary non-bacterial respiratory infection occurred in hospitalized children in the First People's Hospital of Hefei. Besides, the pathogen infections of MP, RSV and INFB have characteristics of age and seasonal distribution.