联合检测病原体抗体和炎性标志物对儿童呼吸道感染诊断的意义

发布时间：2018-03-17 17:24

  本文选题：病原体IgM抗体　切入点：肺炎支原体　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景与目的呼吸道疾病是儿童易感染疾病,且引起感染的病原体多而复杂,易引发重症或全身并发症。但因病原体不易鉴别、儿童自述准确率不高等原因,造成目前儿童呼吸道感染病原体检测的困难。医生往往只能在病原体不明确的情况下进行治疗,导致抗生素的滥用、病原体合并感染增多,给临床治疗带来极大困难。本研究为寻找更好的儿童呼吸道感染的检测方法,在临床常用的九项病原体IgM抗体检测的基础上,同时联合使用降钙素原等炎性标志物进行检测,结合本地区儿童呼吸道感染主要特点,探讨儿童呼吸道感染病原体的准确快速检测方法;为临床儿童呼吸道感染的治疗提供诊断依据。方法收集2013年9月~2015年8月期间,在漯河市中心医院就诊的呼吸道感染住院患儿3578例(男性1852例、女性1726例、年龄为0~14岁)血液标本,采用间接免疫荧光(ILF)法进行血清中肺炎支原体(MP)、肺炎衣原体(CP)、甲型流感病毒(IFA)、乙型流感病毒(IFB)、副流感病毒(PIV)、呼吸道合胞病毒(RSV)、Q热立克次体(COX)、腺病毒(ADV)、呼吸道嗜肺军团菌1型(LP1)九项病原体的联合检测。选取其中单纯肺炎支原体IgM抗体检测阳性者305例,同时进行用双抗体标记、化学发光法检测血清降钙素原(PCT);免疫比浊法检测C-反应蛋白(CRP);并结合白细胞计数结果,分析患儿合并细菌感染情况。数据采用SPSS18.0进行数据分析,用均数±标准差(x±s)表示,相关性r0.3,P0.05具有统计学意义。结果(1)3578例患儿共检测出IgM抗体阳性1258例(35.15%),其中阳性率由高到低依次是MP、FluB、PIV等;混合感染484例,占总感染人数的13.52%;总阳性感染人数中男性为18.89%女性为16.26%;1~3岁组阳性率检测率最高为13.86%,其次为3~5岁组(8.16%),且各组间有显著差异(P0.05);(2)对不同季节患儿感染阳性检出率进行分析,以冬季(14.08%)、春季(8.30%)感染率较高。(3)九项病原体联合检测结果肺炎支原体单纯阳性患者中,仍有31.14%的患儿炎性标志物检测阳性,其中PCT阳性较高(30.49%),因而联合检测增加了合并细菌感染的检出率;(4)对婴幼儿和学龄前儿童肺炎支原体合并细菌感染情况进行分析,发现婴幼儿组阳性患儿较学龄前儿童组有显著差异(P0.05)。结论本研究受检患儿中呼吸道感染以MP病原体感染居多,且存在季节性和年龄差异。九项病原体抗体检测联合PCT、CRP和WBC提高了肺炎支原体感染合并细菌感染的检出率,可为临床诊断用药提供更为准确的依据。
[Abstract]:Background and objective Respiratory diseases are susceptible to infection in children, and cause many and complex pathogens, which can easily lead to severe or systemic complications. However, due to the difficulty in distinguishing pathogens, the accuracy of self-reporting in children is not high, and so on. It is difficult to detect the pathogens of respiratory tract infections in children. Doctors often have to treat children with unclear pathogens, which leads to the abuse of antibiotics and the increase of co-infection of pathogens. In order to find a better method for the detection of respiratory tract infection in children, based on the detection of IgM antibodies of nine pathogens commonly used in clinic, we combined the use of procalcitonin and other inflammatory markers. Combined with the main characteristics of respiratory tract infection in children in this area, the accurate and rapid detection method of respiratory tract infection pathogen in children was discussed, and the diagnostic basis for the treatment of respiratory tract infection in clinical children was provided. Methods the period from September 2013 to August 2015 was collected. Blood samples were collected from 3 578 hospitalized children with respiratory tract infection (1852 males and 1726 females aged 0 ~ 14 years) in Luohe Central Hospital. Detection of Mycoplasma pneumoniae MPP, Chlamydia pneumoniae, Influenza A virus (IFA), Influenza B virus (Influenza B), parainfluenza virus (PIVP), Respiratory Syncytial virus (RSVV), Rikkettsiella, adenovirus ADVV, Respiratory tract, Pulmonopneumonia by indirect Immunofluorescence Assay (ILF) in patients with Mycoplasma pneumoniae, Chlamydia pneumoniae, Influenza A Influenza virus. Combined detection of nine pathogens of Legionella pneumoniae type 1 (LP1). 305 cases of mycoplasma pneumoniae IgM antibody positive were selected. At the same time, we used double antibody labeling, chemiluminescence method to detect serum calcitonin protopril, immunoturbidimetric method to detect C-reactive protein CRPX, and combined with the results of white blood cell count, to analyze the situation of children with bacterial infection. The data were analyzed by SPSS18.0. In the mean 卤standard deviation (x 卤s), the correlation between R0.3 and P05 was statistically significant. Results 1258 cases with positive IgM antibody were detected in 3 578 cases, in which the positive rate was from high to low, the positive rate was MPG FluBPIV et al, and the mixed infection was 484 cases. The positive rate of infection was 13.52% of the total number of infected persons, and the positive rate of male 18.89% female was 16.26%. The highest positive rate was 13.86% in the 3-year-old group, followed by 8.16% in the 3-year-old group, and there was significant difference among the three groups (P0.05 / 2) the positive rate of infection in different seasons was analyzed. The results of combined detection of nine pathogens showed that 31.14% of the patients with simple positive mycoplasma pneumoniae were still positive for inflammatory markers. The positive rate of PCT was higher than 30.49%, so the combined detection increased the detection rate of bacterial infection. (4) to analyze the infection of mycoplasma pneumoniae in infants and preschool children, and to analyze the situation of mycoplasma pneumoniae combined with bacteria infection in infants and preschool children. It was found that there was a significant difference in positive infants and infants compared with preschool children. Conclusion in this study, the majority of respiratory tract infections were caused by MP pathogens. Moreover, there were seasonal and age differences. Nine pathogen antibodies combined with PCTV-CRP and WBC increased the detection rate of mycoplasma pneumoniae infection combined with bacterial infection, which could provide a more accurate basis for clinical diagnosis of drug use.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.6;R446.6
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本文编号：1625728