发展中国家儿童肺炎球菌肺炎诊断的乳胶凝集试验
Latex agglutination test for diagnosing pneumococcal pneumonia in children in developing countries.
作者信息
O'Neill K P, Lloyd-Evans N, Campbell H, Forgie I M, Sabally S, Greenwood B M
机构信息
Medical Research Council Laboratories, Fajara, The Gambia.
出版信息
BMJ. 1989 Apr 22;298(6680):1061-4. doi: 10.1136/bmj.298.6680.1061.
OBJECTIVE
To prepare and assess the sensitivity and specificity of a latex agglutination test specific for the serotype of antigen in diagnosing pneumococcal pneumonia in Gambian children.
DESIGN
Comparison of agglutination test specific for serotype with culture of blood and lung aspirates, countercurrent immunoelectrophoresis, and commercial latex agglutination tests in diagnosing pneumococcal pneumonia. Cross reaction studies and investigation of 102 control children to determine specificity of agglutination test specific for serotype.
SETTING
General medical ward of Medical Research Council laboratories, The Gambia.
PATIENTS
101 Gambian children aged between 2 months and 10 years admitted with severe pneumonia.
INTERVENTIONS
Serum samples were boiled and treated with edetic acid, and urine samples were boiled and concentrated 25 times before testing.
END POINT
A latex agglutination test specific for the serotype of pneumococcal antigen that is sensitive and highly specific for detecting pneumococcus in the urine of patients with pneumococcal pneumonia.
MEASUREMENTS AND MAIN RESULTS
Concentrated urine samples from 16 of the 21 children (76%) with pneumococcal pneumonia established by results of culture of blood or lung aspirates gave a positive result with the agglutination test specific for serotype, whereas only four of the 102 urine samples obtained from control children without pneumonia gave positive results. The serotypes of antigens detected in the urine of children with pneumococcal pneumonia and the serotypes of pneumococci isolated from cultures of blood or lung aspirates were the same in all cases.
CONCLUSIONS
When performed on urine samples the agglutination test specific for serotype has a high specificity and is more sensitive than culture of blood or lung aspirates, commercial agglutination tests, or countercurrent immunoelectrophoresis in identifying pneumococcal pneumonia. It is easy to use and should be especially useful in communities with limited laboratory facilities.
目的
制备并评估一种针对抗原血清型的乳胶凝集试验在诊断冈比亚儿童肺炎球菌肺炎时的敏感性和特异性。
设计
在诊断肺炎球菌肺炎时，将针对血清型的凝集试验与血培养、肺穿刺液培养、对流免疫电泳及商业乳胶凝集试验进行比较。进行交叉反应研究，并对102名对照儿童进行调查以确定针对血清型的凝集试验的特异性。
地点
冈比亚医学研究理事会实验室的普通内科病房。
患者
101名年龄在2个月至10岁之间因重症肺炎入院的冈比亚儿童。
干预措施
血清样本经煮沸和乙二胺四乙酸处理，尿液样本经煮沸并浓缩25倍后进行检测。
终点
一种针对肺炎球菌抗原血清型的乳胶凝集试验，该试验在检测肺炎球菌肺炎患者尿液中的肺炎球菌时具有敏感性和高特异性。
测量指标及主要结果
通过血培养或肺穿刺液培养结果确诊为肺炎球菌肺炎的21名儿童中，16名儿童（76%）的浓缩尿液样本经针对血清型的凝集试验检测呈阳性，而从无肺炎的对照儿童中获取的102份尿液样本仅有4份呈阳性。在所有病例中，肺炎球菌肺炎患儿尿液中检测到的抗原血清型与从血培养或肺穿刺液培养中分离出的肺炎球菌血清型相同。
结论
对尿液样本进行检测时，针对血清型的凝集试验具有高特异性，在识别肺炎球菌肺炎方面比血培养、肺穿刺液培养、商业凝集试验或对流免疫电泳更敏感。该试验易于操作，在实验室设施有限的社区应特别有用。
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