Li Qing-Ling, Dong He-Ting, Sun Hui-Ming, Zhang Xin-Xing, Gu Wen-Jing, Huang Li, Wang Yu-Qing, Yan Yong-Dong, Ji Wei, Hao Chuang-Li, Zhu Can-Hong, Chen Zheng-Rong
Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou 215003, China.
The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi 445000, China.
Ann Transl Med. 2020 Mar;8(6):386. doi: 10.21037/atm.2020.03.121.
This study set out to evaluate the clinical significance and diagnostic effectiveness of serological tests and real-time polymerase chain reactions (RT-PCR) in children of different age groups and disease durations infected with Mycoplasma pneumoniae (MP).
Pediatric patients with lower respiratory tract infection (LRTI) confirmed by polymerase chain reaction (PCR) were enrolled and subjected to bronchoalveolar lavage fluid PCR (BALF-PCR) for MP infection. The diagnostic values of the serum immunoglobulin M (IgM) test, paired sera immunoglobulin G (IgG) test, RT PCR applied to nasopharyngeal aspirates (NPA-PCR), and combined IgM and NPA-PCR test were evaluated.
When BALF PCR was used as the gold standard, the MP positivity rate of combined IgM and NPA PCR was 78.85%in children aged 3-5 years. The positivity rates of IgM, NPA PCR, and combined IgM and NPA PCR in children older than 5 years were 71.21%, 72.72%, and 84.85%, respectively. The detection rate of combined IgM and NPA PCR was consistent with BALF PCR (Kappa =0.727). The MP positivity rates of combined IgM and NPA PCR at 1-2 weeks was as high as 91.11%, and was consistent with the BALF PCR (Kappa =0.756). Moreover, the positivity rates of IgM or NPA PCR at 2-3 weeks were 63.16%, and were consistent with each other (Kappa =0.771).
Combined IgM and NPA PCR is the optimal test to confirm MP infection among children aged 3-5 years in cases with a disease duration of less than2 weeks, and either NPA PCR or IgM is recommended for children older than 5 years with a disease duration of 2-3 weeks.
Mycoplasma pneumoniae pneumonia (MPP); diagnosis; children; age; disease duration.
本研究旨在评估血清学检测和实时聚合酶链反应（RT-PCR）在不同年龄组和病程的肺炎支原体（MP）感染儿童中的临床意义和诊断效能。
纳入经聚合酶链反应（PCR）确诊的小儿下呼吸道感染（LRTI）患者，并对其进行支气管肺泡灌洗液PCR（BALF-PCR）检测MP感染情况。评估血清免疫球蛋白M（IgM）检测、双份血清免疫球蛋白G（IgG）检测、应用于鼻咽抽吸物的RT-PCR（NPA-PCR）以及联合IgM和NPA-PCR检测的诊断价值。
以BALF-PCR作为金标准时，3至5岁儿童联合IgM和NPA-PCR的MP阳性率为78.85%。5岁以上儿童IgM、NPA-PCR以及联合IgM和NPA-PCR的阳性率分别为71.21%、72.72%和84.85%。联合IgM和NPA-PCR的检测率与BALF-PCR一致（Kappa=0.727）。联合IgM和NPA-PCR在1至2周时的MP阳性率高达91.11%，且与BALF-PCR一致（Kappa=0.756）。此外，2至3周时IgM或NPA-PCR的阳性率为63.16%，两者之间一致（Kappa=0.771）。
联合IgM和NPA-PCR是确诊病程小于2周的3至5岁儿童MP感染的最佳检测方法，对于病程为2至3周的5岁以上儿童，推荐使用NPA-PCR或IgM检测。
肺炎支原体肺炎（MPP）；诊断；儿童；年龄；病程
