摘要
目的针对肺炎支原体(MP)、肺炎衣原体(CP)和嗜肺军团菌(LP),评价多重聚合酶链反应(mPCR)、血清IgM及尿LP抗原检测在成人社区获得性肺炎(CAP)诊疗中的临床应用价值。方法前瞻性选取2018年10月~2022年1月北京同仁医院收治的275例确诊为CAP的住院成人患者作为研究对象,采集275例下呼吸道标本、195例血清、50例尿标本分别进行一代测序及mPCR,血清IgM和尿LP抗原检测。以一代测序结果作为病原学诊断依据,评价三种检测方法的临床应用价值。结果成人CAP患者的非典型病原体感染率为26.5%(73/275),其中MP,CP和LP感染率分别为21.8%(60/275),2.2%(6/275)和2.5%(7/275)。mPCR,血清IgM和尿LP抗原的敏感度分别为100%(72/72),31.0%(18/58)和100%(7/7),特异度分别为99.5%(202/203),76.6%(105/137)和100%(43/43)。与发病至采样时间>7天相比,≤7天的血清IgM敏感度显著降低(41.9%vs 14.3%),差异具有统计学意义(χ^(2)=5.483,P<0.05)。血清IgM假阴性结果以25~<41岁(57.5%)占比最高,各年龄组之间差异具有统计学意义(χ^(2)=25.069,P<0.001);假阳性以41~<66岁(37.5%)占比最高,各年龄组之间差异无统计学意义(χ^(2)=6.404,P=0.171)。三种非典型病原体血清IgM交叉反应率为33.3%(13/39)。结论血清IgM检测不适于成人非典型病原体感染诊断的单独使用,mPCR与尿LP抗原检测对成人CAP的早期诊断具有明显的优势。
Objective To evaluate the clinical value of multiplex polymerase chain reaction(mPCR),serum IgM and urinary Legionella pneumophila antigen detection in the diagnosis and treatment of adult community-acquired pneumonia(CAP)for Mycoplasma pneumoniae(MP),Chlamydia pneumoniae(CP)and Legionella pneumophila(LP).Methods A total of 275 inpatients diagnosed with CAP from October 2018 to January 2022 in Beijing Tongren Hospital were selected as the study objects.275 lower respiratory tract samples,195 serum samples and 50 urine samples were collected for sanger sequencing,mPCR,serum IgM and urinary LP antigen test,respectively.With the result of sanger sequencing as the reference standard,the clinical application value of the three detection methods was evaluated.Results The infection rate of atypical pathogens in adult patients with CAP was 26.5%(73/275).The infection rates of MP,CP and LP were 21.8%(60/275),2.2%(6/275)and 2.5%(7/275),respectively.The sensitivity of mPCR,serum IgM and urinary LP antigen test were 100%(72/72),31.0%(18/58),100%(7/7),and the specificity were 99.5%(202/203),76.6%(105/137),100%(43/43),respectively.The sensitivity of serum IgM was significantly decreased in patients with time≤7 days compared to patients with time>7 days from onset to sampling(41.9%vs 14.3%),the difference was statistically significant(χ^(2)=5.483,P<0.05).The proportion of false negative for serum IgM was the highest in 25~<41 years old(57.5%),and the difference was statistically significant among all age groups(χ^(2)=25.069,P<0.001).The proportion of false positive for serum IgM was the highest among 41~<66 years old(37.5%),and there was no significant difference among all age groups(χ^(2)=6.404,P=0.171).The IgM cross-reactivity rate of the three atypical pathogens was 33.3%(13/39).Conclusion Serum IgM is not suitable for the diagnosis of atypical pathogen infection in adults alone,mPCR and urinary LP antigen test have obvious advantages in the early diagnosis of CAP in adults.
作者
周倩倩
赵建玉
王玫
鲁辛辛
ZHOU Qianqian;ZHAO Jianyu;WANG Mei;LU Xinxin(Department of Laboratory Medicine,Beijing Huilongguan Hospital,Peking University Huilongguan Clinical Medical School,Beijing 100096,China;Department of Laboratory Medicine,Beijing Shunyi District Hospital,Beijing 101312,China;Department of Laboratory Medicine,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)
出处
《现代检验医学杂志》
2025年第4期194-198,213,共6页
Journal of Modern Laboratory Medicine
基金
国家科技重大专项(2017ZX10103004,2018ZX10102001,2018ZX10103001)
国家重点研发计划(2019YFC1200700)。
关键词
成人社区获得性肺炎
非典型病原体
多重聚合酶链反应
血清免疫球蛋白M
尿嗜肺军团菌抗原检测
community-acquired pneumonia in adults
atypical pathogen
multiplex polymerase chain reaction
serum immunoglobulin M
urinary Legionella pneumophila antigen detection
