血清学在预测囊性纤维化幼儿铜绿假单胞菌感染中的价值。

Value of serology in predicting Pseudomonas aeruginosa infection in young children with cystic fibrosis.

机构信息

Department of Respiratory Medicine, Princess Margaret Hospital for Children, Roberts Road, Subiaco, Perth, WA 6008, Australia.

出版信息

Thorax. 2010 Nov;65(11):985-90. doi: 10.1136/thx.2009.132845. Epub 2010 Oct 1.

DOI:10.1136/thx.2009.132845

PMID:20889526

Abstract

BACKGROUND

Early detection of Pseudomonas aeruginosa is essential for successful eradication. The accuracy of serum antibodies against specific and multiple P aeruginosa antigens at predicting lower airway infection in young children with cystic fibrosis (CF) was investigated.

METHODS

A commercial P aeruginosa multiple antigen (MAg) ELISA and an in-house exotoxin A (ExoA) ELISA were compared in two populations: a discovery population of 76 children (0.1-7.1 years) undergoing annual bronchoalveolar lavage (BAL)-based microbiological surveillance and a test population of 55 children (0.1-5.6 years) participating in the Australasian CF Bronchoalveolar Lavage Trial.

RESULTS

In the discovery population, P aeruginosa was cultured from BAL fluid (≥10(5) colony-forming units (cfu)/ml) in 15/76 (19.7%) children (median age 1.88 years). Positive MAg and ExoA serological results were found in 38 (50.0%) and 30 (39.5%) children, respectively. Positive (PPV) and negative (NPV) predictive values for serology at diagnosing P aeruginosa infection (≥10(5) cfu/ml) were 0.14 and 0.99 respectively (MAg assay) and 0.11 and 0.98 (ExoA assay). In the test population, P aeruginosa was cultured from BAL fluid (≥10(5) cfu/ml) in 16/55 (29.1%) children (median age 1.86 years) and from oropharyngeal swabs in 32/36 (88.9%). Positive MAg and ExoA serology was detected in 19 (34.5%) and 33 (60.0%) children, respectively. The PPV and NPV of serology were 0.26 and 0.94 respectively (MAg assay) and 0.19 and 0.98 (ExoA assay) and were marginally higher for oropharyngeal cultures.

CONCLUSIONS

Measuring serum antibody responses against P aeruginosa is of limited value for detecting early P aeruginosa infection in young children with CF.

摘要

背景

早期发现铜绿假单胞菌对于成功清除它至关重要。本研究旨在检测血清中针对铜绿假单胞菌特异性和多种抗原的抗体对预测有囊性纤维化（CF）的幼儿下呼吸道感染的准确性。

方法

在两个人群中比较了一种商品化的铜绿假单胞菌多抗原（MAg）酶联免疫吸附测定（ELISA）和内建的外毒素 A（ExoA）ELISA：一个是发现人群，包括 76 名（0.1-7.1 岁）接受年度支气管肺泡灌洗（BAL）为基础的微生物监测的儿童；另一个是测试人群，包括 55 名（0.1-5.6 岁）参加澳大拉西亚 CF 支气管肺泡灌洗试验的儿童。

结果

在发现人群中，15/76（19.7%）名儿童（中位年龄 1.88 岁）的 BAL 液中培养出铜绿假单胞菌（≥10(5)菌落形成单位（cfu）/ml）。38（50.0%）和 30（39.5%）名儿童的 MAg 和 ExoA 血清学结果呈阳性。MAg 检测法诊断铜绿假单胞菌感染（≥10(5)cfu/ml）的阳性（PPV）和阴性（NPV）预测值分别为 0.14 和 0.99，ExoA 检测法分别为 0.11 和 0.98。在测试人群中，16/55（29.1%）名儿童（中位年龄 1.86 岁）的 BAL 液中培养出铜绿假单胞菌（≥10(5)cfu/ml），36 名儿童的咽拭子培养出铜绿假单胞菌（88.9%）。19（34.5%）和 33（60.0%）名儿童的 MAg 和 ExoA 血清学检测结果呈阳性。血清学的 PPV 和 NPV 分别为 0.26 和 0.94（MAg 检测法）和 0.19 和 0.98（ExoA 检测法），咽拭子培养的结果略高。