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目的探讨鼻咽抽吸物(NPA)和肺泡灌洗液(BALF)中肺炎支原体(MP)-DNA检测对儿童MP肺炎(MPP)诊断的意义。方法收集164例MPP患儿入院24 h内的NPA及BALF,荧光定量PCR法检测MP-DNA;同时在入院24 h内及治疗7~10 d病情好转时采集所有患儿静脉血,ELISA法检测血清特异性MPIg M。结果 164例患儿NPA的MP-DNA阳性检出率为51.8%,低于双份血清MP-Ig M阳性检出率(63.4%)(P=0.044),两者检出一致性中等(Kappa=0.618,P<0.01);BALF的MP-DNA阳性检出率为71.3%,与双份血清MP-Ig M阳性检出率比较差异无统计学意义(P>0.05),两者检出一致性好(Kappa=0.793,P<0.01);NPA的MP-DNA阳性检出率低于BALF(P<0.01),两者检出一致性中等(Kappa=0.529,P<0.01)。BALF中MP的中位拷贝数高于NPA(P<0.01)。NPA和BALF MP-DNA的检出率均随病程延长有下降趋势(P<0.05),病程~2周及~4周患儿BALF MP-DNA检出率高于NPA(P<0.05)。结论 BALF中MP-DNA检出敏感性高,对临床早期诊断MPP具有重要意义;而NPA MP-DNA检测可能会引起漏诊。
Objective To investigate the significance of detection of Mycoplasma pneumoniae (MP) -DNA in nasopharyngeal aspirate (NPA) and bronchoalveolar lavage fluid (BALF) in children with MP pneumonia (MPP). Methods Collected NPA and BALF in 164 children with MPP within 24 hours after admission, MP-DNA was detected by real-time fluorescence quantitative PCR. Venous blood was collected within 24 hours and 7 to 10 days after treatment. Serum specific MPIg M. Results The positive rate of MP-DNA in NPA of 164 children was 51.8%, lower than the positive rate of MP-Ig M in serum (63.4%) (P = 0.044). The Kappa = 0.618, P <0.01). The positive detection rate of MP-DNA in BALF was 71.3%, which was not significantly different from the positive detection rate of MP-Ig M in serum of two groups (P> 0.05) (Kappa = 0.793, P <0.01). The positive rate of MP-DNA in NPA was lower than that in BALF (P <0.01). The median copy number of MP in BALF was higher than that of NPA (P <0.01). The detection rate of MP-DNA in NPA and BALF decreased with the duration of disease (P <0.05). The detection rate of MP-DNA in BALF was higher than that in NPA in patients with course of disease of ~ 2 weeks and ~ 4 weeks (P <0.05). Conclusion The detection of MP-DNA in BALF is highly sensitive and it is of great significance for the early diagnosis of MPP in clinic. However, the detection of NP-MP-DNA may cause missed diagnosis.