[儿童人博卡病毒下呼吸道感染的血清学诊断]

Li Ling, Wang Meijuan, Yan Yongdong, Shao Xuejun, Wan Fengguo, Xu Jun, Shao Huijiang, Ji Wei

Department of Respiratory Diseases, the Children's Hospital Affiliated to Suchow University, Suzhou 215003, China.

Department of Respiratory Diseases, the Children's Hospital Affiliated to Suchow University, Suzhou 215003, China. Email:

Zhonghua Er Ke Za Zhi. 2014 May;52(5):378-82.

OBJECTIVE

To study the application of serodiagnosis of human bocavirus (HBoV) lower respiratory tract infection in children.

METHOD

From January to April, 2013, samples including serum, sputum and bronchoalveolar lavage fluids (BALFs) were obtained from 714 children hospitalized with ALRI. Serums were tested for HBoV-specific IgG and IgM antibodies by ELISA and all kinds of samples were tested for HBoV DNA by quantitative real-time fluorescent PCR. The results of HBoV serologic tests, viral DNA in sputum and their combination were compared with those of HBoV DNA in serums and/or BALFs, which was considered as the "standard". Their consistence and differences were evaluated, and the diagnostic parameters including sensitivity, specificity, positive predictive value, negative predictive value, consistency rate, Kappa value and J value were calculated. Age distributions of the HBoV positive patients tested by the latter two methods were also compared.

RESULT

The positive rate of HBoV serology was 13.2% (94/714) . The results of HBoV serology, its DNA in sputum and their combination were all consistent with those of HBoV DNA in serums and/or BALFs (χ(2) = 91.834, 124.662, 138.643, P < 0.001 for all comparisons) . Differences were significant by McNemar test (χ(2) = 23.547, 33.440, 12.410, P all <0.001) . All the diagnostic parameters for single HBoV serologic test or single viral DNA test in sputa were approximate. However, they were improved to 70.4%, 94.8%, 38.0%, 98.6%, 93.7%, 0.463(P < 0.001), 0.65 for sensitivity, specificity, positive predictive value, negative predictive value, consistency rate, Kappa value and J value, respectively, when the methods were combined. HBoV was found positive mainly in children under 3 years of age, especially in the 1 year group. The positive rates were the highest in both group -1 year, and group -3 years was the next. However, the rate was the lowest in group >3 years and in the group -6 months.

CONCLUSION

Diagnostic power can be improved and age distribution can be demonstrated when serologic tests were combined with traditional sputum DNA detection in children with HBoV lower respiratory tract infection.

目的

探讨人博卡病毒（HBoV）血清学诊断在儿童下呼吸道感染中的应用。

方法

2013年1月至4月，收集714例因急性下呼吸道感染（ALRI）住院儿童的血清、痰液及支气管肺泡灌洗液（BALF）样本。采用酶联免疫吸附测定（ELISA）检测血清中HBoV特异性IgG和IgM抗体，采用实时荧光定量PCR检测各类样本中的HBoV DNA。将HBoV血清学检测结果、痰液中的病毒DNA及其联合检测结果与血清和/或BALF中的HBoV DNA结果（视为“标准”）进行比较。评估它们的一致性和差异，并计算诊断参数，包括敏感性、特异性、阳性预测值、阴性预测值、符合率、Kappa值和J值。同时比较后两种方法检测出的HBoV阳性患者的年龄分布。

结果

HBoV血清学阳性率为13.2%（94/714）。HBoV血清学检测结果、痰液中的病毒DNA及其联合检测结果均与血清和/或BALF中的HBoV DNA结果一致（χ(2) = 91.834、124.662、138.643，所有比较P < 0.001）。McNemar检验差异有统计学意义（χ(2) = 23.547、33.440、12.410，P均<0.001）。单一HBoV血清学检测或单一痰液病毒DNA检测的所有诊断参数相近。然而，两种方法联合时，敏感性、特异性、阳性预测值、阴性预测值、符合率、Kappa值和J值分别提高到70.4%、94.8%、38.0%、98.6%、93.7%、0.463（P < 0.001）、0.65。HBoV阳性主要见于3岁以下儿童，尤其是1岁组。1岁组和3岁组的阳性率均最高，>3岁组和6个月组的阳性率最低。