目的 分析肺炎支原体RNA实时荧光恒温扩增技术(MP-SAT)作为肺炎支原体肺炎(MPP)患儿疗效监测指标的可行性。方法 选择2017年10月—2018年10月我院儿科收治的因CAP住院的患儿178例为研究对象,其中MPP组80例,非MPP组98例,分别检测血清MP抗体(MP-Ab)和咽拭子MP-RNA,对两种方法检测结果进行统计学分析,以MP-Ab检测为诊断MPP的参照试验,分析MP-SAT诊断MPP的准确性,对MP-SAT和MP-Ab均阳性的MPP病例行动态观察,比较MP-SAT和MP-Ab在患儿不同治疗时间点的检出率,分析MP-SAT转阴时间与临床痊愈时间的相关性,分析MP-SAT转阴时间与MPP患儿临床症状、实验室指标及X线胸片的相关性。结果 MP-SAT和MP-Ab结果不一致的比例在MPP组和非MPP组分别为60.00% (48/80)和19.39%(19/98);MP-SAT、MP-Ab在特异性和阳性预测值方面,差异有统计学意义(P＜0.05);MP-SAT、MP-Ab在敏感度和阴性预测值方面,差异无统计学意义(P＞0.05);MP-SAT、MP-Ab均为阳性28例(35.00%),MP-SAT阳性检出率随治疗时间的延长降低(P＜0.05),MP-Ab阳性检出率随治疗时间的延长升高(P＜0.05);28例临床痊愈时间为(3.11±0.88)周,MP-SAT转阴时间为(3.25±0.74)周,差异无统计学意义(P＞0.05);MP-SAT转阴时间越长的病例表现为发热持续时间越长,X线胸片肺大片实变比例越高,CRP水平越高,LDH水平越高,中性粒细胞百分比越高,淋巴细胞百分比越低(P＜0.05)。结论 MP-SAT作为新一代RNA活菌检测技术在支原体肺炎患儿疗效监测中有较高的价值,值得推广。

Objective To investigate the feasibility of Mycoplasma pneumoniae-simultaneous amplification and testing (MP-SAT)as a monitoring index for children with Mycoplasma pneumoniae pneumonia (MPP). Methods 178 hospitalized children with community-acquired pneumonia (CAP)in our hospital from October 2017 to October 2018 were selected and divided into two groups, namely MPP group (n=80)and non-MPP group (n=98). Serum MP antibody (MP-Ab)and throat swab MP-RNA were detected separately. The MP-Ab test was used as a reference for the analysis of accuracy of MP-SAT for MPP diagnosis. The MPP patients with positive MP-SAT and positive MP-Ab were observed dynamically. The detection rates of MP-SAT and MP-Ab in different treatment time points were compared. The correlation of MP-SAT negative time with clinical recovery time, clinical symptoms, laboratory parameters and chest X-ray was analyzed. Results The ratio of inconsistent MP-SAT and MP-Ab results was 60.00% (48/80)and 19.39% (19/98)in the MPP group and the non-MPP group, respectively. The MP-SAT and MP-Ab were statistically different in terms of specificity and positive predictive value (P<0.05), while no difference was found in the sensitivity and negative predictive value (P>0.05). Both MP-SAT and MP-Ab were positive in 28 cases (35.00%). The positive rate of MP-SAT was decreased with the prolongation of treatment time (P<0.05), meanwhile the positive rate of MP-Ab was increased with the treatment time (P<0.05); the clinical recovery time of 28 cases was (3.11±0.88)weeks, and the MP-SAT negative time was (3.25±0.74)weeks, with no statistical difference (P>0.05). The long-term duration of MP-SAT was characterized by long duration of fever, high consolidation rate of X-ray chest radiograph, high CRP level, high LDH level, high percentage of neutrophils, and low percentage of lymphocytes (P<0.05). Conclusion MP-SAT, as a new generation of RNA live bacteria detection technology, has high value in monitoring the efficacy of Mycoplasma pneumonia in children, and it is worth promoting.