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中国循证儿科杂志

中国循证儿科杂志 ›› 2016, Vol. 11 ›› Issue (2): 109-112.

• 论著 • 上一篇    下一篇

肺炎支原体RNA检测在儿童肺炎支原体肺炎疗效监测中的应用价值

郭丽1,2 孙琳1 郭琰1 李勤静1 吴喜蓉1 刘芳1 李颖佳1 王杏云1 王婷1 徐保平1 冯雪莉1 申阿东1   

  1. 1 首都医科大学附属北京儿童医院，北京市儿科研究所，儿科学国家重点学科，教育部儿科重大疾病研究重点实验室，儿童呼吸道感染性疾病研究北京市重点实验室 北京，100045；2 北京市平谷区妇幼保健院 北京，101200
  • 收稿日期:2016-03-01 修回日期:2016-04-21 出版日期:2016-04-25 发布日期:2016-04-21
  • 通讯作者: 申阿东

Clinical value of Mycoplasma pneumoniae RNA detection in the monitoring of Mycoplasma pneumoniae pneumonia treatment in children

GUO Li1,2,  SUN Lin1,GUO Yan1, LI Qin-jing1, WU Xi-rong1, LIU Fang1, LI Ying-jia1, WANG Xing-yun1, WANG Ting1, XU Bao-ping1, FENG Xue-li1, SHEN A-dong1   

  1. 1 Department of Respiratory, Beijing Children′s Hospital, Capital Medical University,  Beijing Key Laboratory of Pediatric Respiratory Infection Diseases; Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics (Capital Medical University), Ministry of Education; National Clinical Research Center for Respiratory Diseases; Respiratory Infection Diseases Lab, Beijing Pediatric Research Institute, Beijing Children′s Hospital, Capital Medical University, Beijing, 100045; 2 Maternal and Child Health Care Center of Pinggu District; Beijing 101200, China
  • Received:2016-03-01 Revised:2016-04-21 Online:2016-04-25 Published:2016-04-21
  • Contact: SHEN A-dong

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摘要：

目的 探讨应用肺炎支原体RNA检测（RNA实时荧光恒温扩增技术,MP-SAT）作为儿童肺炎支原体肺炎（MPP）治疗效果监测指标的可行性和应用价值。方法 纳入北京市平谷区妇幼保健院住院的社区获得性肺炎患儿，其中符合MPP诊断标准者为MPP组，余为非MPP组。①以血清肺炎支原体（MP）抗体（MP-Ab）检测为诊断MP感染的参照试验，考察MP-SAT诊断MP感染的敏感度和特异度。②对MP-SAT和血清MP-Ab均阳性MPP病例行动态观察，比较MP-SAT和血清MP-Ab在大环内酯类药物标准治疗不同时间的阳性率， MP-SAT转阴时间和临床痊愈时间。③比较不同MP-SAT转阴时间MPP病例发热时间、入院24 h内血常规（WBC、N、L），超敏C反应蛋白(hs-CRP)和血清乳酸脱氢酶（LDH）及胸部X线指标的差异。结果 MPP组73例，非MPP组150 例。MP-SAT诊断MP感染的敏感度和特异度分别为83.6%（61/73）、97.3%（146/150）。MPP组MP-SAT和血清MP-Ab均阳性61例，随治疗时间的延长，MP-SAT阳性率显著降低（P<0.05），而血清MP-Ab的阳性率呈增高趋势（P<0.05）。61例临床痊愈时间平均为(3.0±0.9)周，MP-SAT转阴时间为（3.3±0.8）周，差异无统计学意义（P＞0.05）。 MP-SAT转阴时间越长的病例表现为发热持续时间越长，入院24 h内中性粒细胞百分比、CRP、LDH水平越高，X线胸片大片实变比例越高，淋巴细胞百分比越低 (P<0. 05)。结论 MP-SAT可作为评价MPP 转归以及判断大环内酯类药物疗效的指标。

Abstract:

Objective To evaluate the clinical utility of mycoplasma pneumonia RNA detection （real-time isothermal transcription-mediated RNA amplification assay, MP-SAT） in the treatment of Mycoplasma pneumoniae pneumonia in children. Methods Children with community-acquired pneumonia in Beijing Pinggu District Maternal and Child Health Care Hospital, according to the mycoplasma pneumoniae diagnostic criteria，were divided into the Mycoplasma pneumoniae pneumonia and non-Mycoplasma pneumoniae pneumonia groups. ①When the results of serological tests were considered as the standard，the sensitivity and specificity of MP-SAT were evaluated. ②MP - SAT and serum MP -Ab positive cases were observed dynamically，the detection rate of MP-SAT and MP-Ab in different treatment course and the times of MP-SAT turning to negative and clinical recovery were compared. ③The differences of fever duration after macrolide administration，blood routine inspection （WBC, N, L）, hypersensitive c-reactive protein (hs-CRP), serum lactate dehydrogenase (LDH) and the imaging results admitted to hospital within 24 hours were compared. Results Mycoplasma pneumoniae pneumonia group included 73 cases, non-Mycoplasma pneumoniae pneumonia group included 150 cases. The sensitivity, specificity of MP-SAT were 83.6%（61/73） and 97.3%（146/150）,respectively. Children with both MP-SAT and MP-Ab positive results were followed to evaluate the treatment effect. After the treatment, the detection rate of SAT reduced significantly (P<0.05), while detection rate of serum MP-Ab increased significantly (P<0.05). The time of clinical recovery was (3.0±0.9) weeks, similar to that of MP-SAT turning to negative（3.3±0.8) weeks (P＞0.05). Those with longer time of turning to negative had a longer fever duration after macrolide administration，increasing neutrophil，decreasing lymphocyte， higher level CRP and LDH, and large field of consolidation were more frequently observed on X-ray film (P<0.05). Conclusion MP-SAT can be used as an index for evaluation of the treatment outcome of MPP.