呼吸道九联检IgM检测对儿童急性下呼吸道感染的早期诊断价值

目的 探讨昆明地区小儿急性下呼吸道感染（ALRI）主要病原体及其流行特点,分析本地区小儿ALRI病原体与年龄的相关性,同时,评价呼吸道九联检IgM检测对ALRI的早期诊断价值.方法 ALRI患儿625例,按年龄将患儿分为3组：～1岁（婴儿组）,～3岁（幼儿组）,＞3岁,～ 10岁（儿童组）.同时,健康儿童100例作为对照组.应用间接免疫荧光法（IFA）检测九项主要病原体的IgM抗体,包括嗜肺军团菌（LP）、肺炎支原体（MP）、Q热立克次体（COX）、肺炎衣原体（CP）、腺病毒（ADV）、呼吸道合胞病毒（RSV）、甲型流感病毒（IFA）、乙型流感病毒（IFB）及副流感病毒1、2和3型（PIVS）.结果 625例ALRI患儿中,检出病原体感染345例,总检出率为55.2％.单一病原体感染132例,占阳性病例数的38.26％,以MP最多,其次为IFV、RSV和ADV,检出率依次为62.88％、27.27％、5.30％及4.55％;2种病原体混合感染148例,阳性检出率为69.48％;3种及以上混合感染65例,阳性检出率为30.52％.单一呼吸道病原体感染中,随着年龄增长,MP和IFB感染率呈上升趋势,而RSV和ADV感染率呈下降趋势,但3个年龄组间仅RSV差异有统计学意义（x^2=8.143,P=0.017）;而在2种/≥3种病原体混合感染中,随着年龄增长,感染率呈上升趋势,3个年龄组间差异有统计学意义（x^2=26.899,P＜ 0.001）/（x^2=6.138,P＜0.046）;而且,随着年龄增长,总的混合感染（2种及≥3种）趋势更明显,各组间差异统计学意义（x^2=30.930,P＜0.001）.结论 九项呼吸道病原体IgM抗体联合检测对明确昆明地区ALRI的病原体种类、流行病学特点、早期诊断和治疗很有帮助,具有经济、高效、便于操作和易于判读结果等优点。

Value of Nine Respiratory Pathogens Detection in Early Diagnosis of Children with Acute Lower Respiratory Tract Infections

Objective This study was aimed to investigate the major pathogens and popular features of acute lower respiratory infections（ALRI） in children in Kunming area,analyze the correlation between the age of the children and ALRI pathogens in this region,and evaluate the diagnostic value of nine respiratory pathogens detection of IgM. Methods 625 children with ALRI were divided into three age groups： ~1 year old（infant group）,1~3years old（preschool group）,and 3~10 years old（children＇s group）. Meanwhile,100 cases of healthy children were selected as a control group. IgM antibodies nine major pathogens were detected by indirect immunofluorescence assay（IFA）,including Legionella pneumophila（LP）,Mycoplasma pneumoniae（MP）,Q fever Rickettsia（COX）,Chlamydia pneumoniae（CP）,adenovirus（ADV）,respiratory syncytial virus（RSV）,influenza A virus（IFA）,influenza B virus（IFB）,and parainfluenza virus types 1,2 and 3（PIVS）. Results Pathogens were detected in 345 cases from 625 cases of children with ALRI, with the total detection rate of 55.2%. Single pathogen infections were found in 132 cases, accounting for 38.26% of positive cases,among which MP was most, followed by IFV,RSV and ADV, with the detection rate of 62.88%, 27.27%,5.30% and 4.55%,respectively. Mixed infections with two kinds of pathogens were found in 148 cases of pathogens,with the positive rate of 69.48%,and mixed infections three kinds of pathogens and above were found in 65 cases,with the positive detection rate of 30.52%. MP and IFB infection rate increased with age in single respiratory pathogen infection,while the RSV and ADV infection rates decreased. There was a significant difference only in RSV among the three age groups（χ^2= 8.143,P = 0.017）, while in mixed infections with two kinds or ≥ three kinds of pathogens, the infection rate increased with age, and the differences were significant among three groups（χ^2= 26.899,P 〈0.001） /（χ^2= 6.138, P〈0.046）. Moreover, the total mixed infec