Korppi M, Heiskanen-Kosma T, Leinonen M, Halonen P
Department of Paediatrics, Kuopio University Hospital, Finland.
Acta Paediatr. 1993 Feb;82(2):137-41. doi: 10.1111/j.1651-2227.1993.tb12624.x.
The diagnostic efficacy of two methods--demonstration of seroconversion in paired sera and detection of antigen in clinical specimens--was evaluated in 183 children with respiratory syncytial, parainfluenza or adenoviral, or pneumococcal respiratory tract infection. Viral infection was diagnosed in 46 (37%) of the 125 cases by antigen assay alone, in 36 (29%) by antibody assay alone and in 43 (34%) by both methods. In respiratory syncytial viral infections, antigen assays were more often positive than antibody assays; 80% of the cases were antigen positive and 63% solely antigen positive. In parainfluenza and adenoviral infections, antigen assays were not as useful; a positive result was seen in 59% and 44% of cases, respectively. Pneumococcal infection was diagnosed in 25 (30%) of the 84 cases by antigen assay alone, in 54 (64%) by antibody assay alone and in only 5 (6%) by both methods. Thus nearly all pneumococcal infections were diagnosed by only one method. The efficacy of antigen and antibody assay was clearly dependent on the age of the patients. In infants less than six months of age, nearly all (27 (90%)) of the 30 infections were diagnosed by antigen detection; 25 solely by antigen detection. In older patients, antigen and antibody assays supplemented each other. We conclude that antigen detection should be used as the primary method for the diagnosis of viral or pneumococcal respiratory tract infection. In infants, antigen detection is the only reliable method of microbial diagnosis. In addition, antigen detection is the method of rapid microbial diagnosis. In pneumococcal infections, the sensitivities of antigen detection methods are not sufficient; this is an important area for further research.
在183例患有呼吸道合胞病毒、副流感病毒或腺病毒感染，或肺炎球菌呼吸道感染的儿童中，评估了两种诊断方法的效果，即检测双份血清中的血清转化以及检测临床标本中的抗原。在125例病例中，仅通过抗原检测诊断出46例（37%）病毒感染，仅通过抗体检测诊断出36例（29%），两种方法均诊断出43例（34%）。在呼吸道合胞病毒感染中，抗原检测比抗体检测更常呈阳性；80%的病例抗原呈阳性，63%仅抗原呈阳性。在副流感病毒和腺病毒感染中，抗原检测的作用不大；分别有59%和44%的病例检测结果呈阳性。在84例病例中，仅通过抗原检测诊断出25例（30%）肺炎球菌感染，仅通过抗体检测诊断出54例（64%），两种方法均诊断出仅5例（6%）。因此，几乎所有肺炎球菌感染仅通过一种方法诊断。抗原和抗体检测的效果明显取决于患者的年龄。在6个月以下的婴儿中，30例感染中几乎所有（27例，90%）通过抗原检测诊断；25例仅通过抗原检测诊断。在年龄较大的患者中，抗原和抗体检测相互补充。我们得出结论，抗原检测应作为诊断病毒或肺炎球菌呼吸道感染的主要方法。在婴儿中，抗原检测是微生物诊断的唯一可靠方法。此外，抗原检测是快速微生物诊断方法。在肺炎球菌感染中，抗原检测方法的敏感性不足；这是一个需要进一步研究的重要领域。
