Nanfang Hospital, Southern Medical University, Guangzhou 510515, China; Laboratory Department of Zengcheng Branch, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
Laboratory Department of Zengcheng Branch, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
Int Immunopharmacol. 2022 Nov;112:109196. doi: 10.1016/j.intimp.2022.109196. Epub 2022 Sep 7.
The levels of serum M. pneumoniae typing antibodies in children with community-acquired pneumonia (CAP) were detected by chemiluminescent immunoassay (CLIA) to explore the clinical role of M. pneumoniae typing antibody (MP-IgM, MP-IgG) in M. pneumoniae pneumonia.
A total of 387 Child patients with CAP diagnosed at the Pediatric outpatient department of Zengcheng Branch, Nanfang Hospital, Southern Medical University, were enrolled between January 2020 to December 2021 and divided into M. pneumoniae pneumonia (MPP) group (n = 210) and non-M. pneumoniae pneumonia (NMPP) group (n = 177). Firstly, Clinical data, full blood count (WBC, NEU%, LYM%, MONO%, EOS%, BASO%, RBC, HGB, PLT) and biochemical tests (AST, LDH, ɑ-HBDH, CK, CKMB, CRP, PCT, IL-6) as well as laboratory diagnostic tests (MP-IgM, MP-IgG) were compared between the two groups. Secondly, we assessed the correlation between the average level of M. pneumoniae typing antibody detected by CLIA and the titer of anti-M. pneumoniae antibody (MP-Ab) tested by passive agglutination (PA) method. Thirdly, receiver operating characteristic (ROC) curve for the MP-IgM and MP-IgG was examined to evaluate the value of diagnosing M. pneumoniae pneumonia. Finally, we follow-up 120 cases of MPP group and analysis medication results.
(1) Mean age, runny nose, expectoration, LYM%, NEU%, HGB, AST, MP-IgM and MP-IgG were statistically significant in the MPP group and NMPP group (all P < 0.05). (2) Correlation analysis showed that MP-IgM average level was linearly associated with MP-Ab titer (R = 0.84) and MP-IgG average level was exponentially correlated with MP-Ab titer under 1:640 (R = 0.96). (3) The ROC curve of MP-IgM and MP-IgG were significantly different (both P < 0.001). A serum MP-IgM level above 1 S/CO and MP-IgG level above 14.15 AU/mL were significant predictors for M. pneumoniae pneumonia: area under the curve (AUC) of 0.810, 0.815; standard error (SE) of 0.021, 0.022; 95 % confidence interval (CI) of 0.768-0.852, 0.773-0.858; the diagnostic sensitivity of 74.3 %, 62.1 %; and specificity of 72.9 %, 87.0 %; respectively. (4) Of the 120 children with M. pneumoniae pneumonia followed up, 79 (65.8 %) cases took azithromycin and 68 (86.1 %) cases were recovered.
A series of our studies shown that, CLIA, speedy and automated clinical examination method, has higher specificity and sensitivity for the quantitative detection of MP-IgM and MP-IgG, playing an important role of early diagnosis as well as prompt intervention to reduces macrolide-resistant strains and sequelae of children with M. pneumoniae pneumonia.
采用化学发光免疫分析法（CLIA）检测儿童社区获得性肺炎（CAP）患者血清肺炎支原体（MP）分型抗体水平，探讨 MP 分型抗体（MP-IgM、MP-IgG）在肺炎支原体肺炎（MPP）中的临床价值。
选取 2020 年 1 月至 2021 年 12 月南方医科大学附属南方医院增城院区儿科门诊收治的 387 例 CAP 患儿为研究对象，分为 MPP 组（n=210）和非 MPP 组（n=177）。首先，比较两组患儿的临床资料、血常规（WBC、NEU%、LYM%、MONO%、EOS%、BASO%、RBC、HGB、PLT）、生化指标（AST、LDH、ɑ-HBDH、CK、CKMB、CRP、PCT、IL-6）和实验室诊断指标（MP-IgM、MP-IgG）。其次，评估 CLIA 检测的 MP 分型抗体平均水平与被动凝集（PA）法检测的抗 MP 抗体（MP-Ab）滴度之间的相关性。然后，绘制 MP-IgM 和 MP-IgG 的受试者工作特征（ROC）曲线，评估其诊断 MPP 的价值。最后，对 120 例 MPP 患儿进行随访，分析药物治疗效果。
（1）MPP 组和 NMPP 组在平均年龄、流涕、咳痰、LYM%、NEU%、HGB、AST、MP-IgM 和 MP-IgG 方面差异均有统计学意义（均 P<0.05）。（2）相关性分析显示，MP-IgM 平均水平与 MP-Ab 滴度呈线性相关（R=0.84），MP-IgG 平均水平与 MP-Ab 滴度呈指数相关（当滴度<1:640 时，R=0.96）。（3）MP-IgM 和 MP-IgG 的 ROC 曲线有显著差异（均 P<0.001）。血清 MP-IgM 水平>1 S/CO 和 MP-IgG 水平>14.15 AU/mL 是 MPP 的显著预测指标：AUC 为 0.810、0.815；标准误（SE）为 0.021、0.022；95%置信区间（CI）为 0.768-0.852、0.773-0.858；诊断灵敏度为 74.3%、62.1%；特异性为 72.9%、87.0%。（4）120 例 MPP 患儿随访中，79 例（65.8%）患儿使用阿奇霉素治疗，68 例（86.1%）患儿痊愈。
CLIA 作为一种快速、自动化的临床检测方法，对 MP-IgM 和 MP-IgG 的定量检测具有较高的特异性和敏感性，对儿童 MPP 的早期诊断及及时干预具有重要作用，可减少大环内酯类耐药菌株的产生及 MPP 患儿的后遗症。
