上下呼吸道吸出物对儿童下呼吸道感染病原学诊断的意义

doi:10.3969 j.issn.1000-3606.2015.02.007

临床儿科杂志 ›› 2015, Vol. 33 ›› Issue (2): 126-.doi: 10.3969 j.issn.1000-3606.2015.02.007

上下呼吸道吸出物对儿童下呼吸道感染病原学诊断的意义

张新星¹,陈正荣¹,黄莉¹,王美娟¹,严永东¹,顾文婧¹,邵雪军²,张学兰²,季伟¹

苏州大学附属儿童医院 1. 呼吸科，2. 检验科( 江苏苏州　215003)

收稿日期:2015-02-15 出版日期:2015-02-15 发布日期:2015-02-15
通讯作者: 季伟 E-mail:szdxjiwei@163.com

A comparative study of upper and lower respiratory aspirates on pathogen detection of lower respiratory tract infection in children

ZHANG Xinxing¹, CHEN Zhengrong¹, HUANG Li¹, WANG Meijuan¹, YAN Yongdong¹, GU Wenjing¹, SHAO Xuejun², ZHANG Xuelan², LI Wei¹

1.Department of Respiratory Medicine, 2. Department of Laboratory, Soochow University Affiliated Children’s Hospital, Suzhou 215003, Jiangsu, China

Received:2015-02-15 Online:2015-02-15 Published:2015-02-15

摘要/Abstract

摘要： 目的　比较呼吸道感染儿童鼻咽抽吸物(NPA)和肺泡灌洗液(BALF)的病原学差异。方法　收集210例下呼吸道感染患儿NPA及BALF，进行多病原联合检测并进行分析。直接免疫荧光法检测7种常见呼吸道病毒，荧光定量PCR法检测肺炎支原体(MP)、肺炎衣原体(CP)及博卡病毒(HBoV)，RT-PCR法检测鼻病毒(HRV)及偏肺病毒(hMPV)等，并作细菌培养。结果　210例患儿NPA和BALF病原总阳性检出率为91.9%(193/210)，高于NPA检出率75.2%(158/210)及BALF检出率85.2%(179/210)，且BALF检出率高于NPA，差异有统计学意义(P均<0.05)。210例患儿细菌总检出率17.1%，NPA与BALF细菌检出率分别为13.3%和8.6%，差异无统计学意义(P=0.118)，但菌种检出一致性较差(Kappa=0.262)；病毒总检出率28.1%，NPA病毒检出率(24.3%)高于BALF(15.2%)，差异有统计学意义(P=0.012)，NPA和BALF的HBoV检出一致性较好(Kappa=0.508)；MP总检出率为80.0%，BALF的MP检出率(77.6%)高于NPA(53.3%)，差异有统计学意义(P=0.000)；BALF的MP中位拷贝数为4.28×106，高于NPA的1.31×105，差异有统计学意义(P=0.000)。病程>2周患儿NPA的MP检出率低于病程≤2周的患儿，差异有统计学意义(P<0.01)。结论　NPA的病毒、MP检测可作为下呼吸道感染的参考依据，其与BALF联合检测可提高呼吸道病原学检测敏感性。BALF检测是重症或疑难下呼吸道感染病例病原学的补充。

Abstract: Objective　To study the pathogenic etiology between nasopharyngeal aspirates (NPA) and bronchoalveolar lavage fluid (BALF) in children with lower respiratory infection. Methods Multiple pathogen in NPA and BALF from 210 cases with lower respiratory tract infection was detected. Seven common respiratory virus (respiratory syncytial virus, adenovirus, influenza virus A, influenza virus B, parainfluenza 1, parainfluenza 2, parainfluenza 3) were detected by direct immunofluorescence assay. MP, CP and HBoV were detected by fluorescence quantitative PCR.HRV and hMPV were detected by RT-PCR. Aspirates were cultured for bacteria. The results of pathogen detection in secretions of upper and lower respiratory tract were analyzed. Results Total positive detection rate of NPA and BALF in 210 cases was 91.9% (193/210), which is higher than that in NPA 75.2% (158/210) and that in BALF 85.2% (179/210). Bacteria detection rate in NPA was 13.3% (28/210), and 8.6% (18/210) in BALF, without significant difference (P=0.118). Bacteria detection rate in NPA and BALF was of poor consistency (Kappa=0.262). Virus detection rate in NPA was 24.3%, which is higher than that in BALF15.2%. BALF-MP detection rate was 77.6% (163/210), significantly higher than that in NPA 53.3% (112/210). There are 95.5% (107/112) cases with positive results in NPA-MP detectioncan also be detected in the BALF-MP. MP copies in BALF were significantly higher than that in NPA (4.28×106 vs. 1.31×105), and its positive rate in NPA was still higher than that in BALF. MP detection rate in NPA in children with clinical course of longer than two weeks was much lower than those with clinical course of two weeks or less. Conclusions The pathogen detection of virus and MP in NPA can be used as a reference for lower respiratory tract infection. The joint detection of NPA and BALF can improve the detection power. The sensitivity of virus detection in NPA is higher than that in BALF. NPA pathogen detection of virus and MP is of great important evidence-based medicine in the diagnosis of lower respiratory infection. MP detection rate and its copies in BALF are significantly higher than that in NPA. BALF detection is the supplement of pathogen diagnosis in severe or refractory lower respiratory infections.

张新星,陈正荣,黄莉,王美娟,严永东,顾文婧,邵雪军,张学兰,季伟. 上下呼吸道吸出物对儿童下呼吸道感染病原学诊断的意义[J]. 临床儿科杂志, 2015, 33(2): 126-.

ZHANG Xinxing, CHEN Zhengrong, HUANG Li, WANG Meijuan, YAN Yongdong, GU Wenjing, SHAO Xuejun, ZHANG Xuelan, LI Wei. A comparative study of upper and lower respiratory aspirates on pathogen detection of lower respiratory tract infection in children[J]. , 2015, 33(2): 126-.

上下呼吸道吸出物对儿童下呼吸道感染病原学诊断的意义

A comparative study of upper and lower respiratory aspirates on pathogen detection of lower respiratory tract infection in children

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