中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2014年
5期
378-382
,共5页
李玲%王美娟%严永东%邵雪君%万凤国%徐俊%邵惠江%季伟
李玲%王美娟%嚴永東%邵雪君%萬鳳國%徐俊%邵惠江%季偉
리령%왕미연%엄영동%소설군%만봉국%서준%소혜강%계위
人博卡病毒%呼吸道感染%抗体,病毒
人博卡病毒%呼吸道感染%抗體,病毒
인박잡병독%호흡도감염%항체,병독
Human bocavirus%Respiratory tract infections%Antibodies,viral
目的 探讨血清特异性抗体检测在儿童急性下呼吸道人博卡病毒(HBoV)感染诊断中的应用价值.方法 选择2013年1至4月苏州儿童医院呼吸科收治的714例急性下呼吸道感染(ALRI)患儿为研究对象,采集患儿血清、痰液及肺泡灌洗液(BALF),用ELISA法检测血清中HBoV特异性IgG、IgM抗体,实时荧光定量PCR法检测血清、痰液及BALF中HBoV DNA.以血清和(或)BALF HBoV DNA检测结果为评价标准,将血清HBoV抗体、痰液HBoV DNA及血清HBoV抗体+痰液HBoV DNA的检测结果分别与评价标准比较,评价其一致性及优劣性,并计算3项检测结果灵敏度、特异度、阳性预测值、阴性预测值、符合率、Kappa值、J指数等各项诊断评价指标.分析血清HBoV抗体+痰液HBoV DNA与血清和(或)BALF HBoV DNA在各年龄组的检出情况.结果 (1)714例患儿血清HBoV抗体检出率13.2％ (94/714)、痰液HBoV DNA检出率14.3％ (102/714)、血清HBoV抗体+痰液HBoV DNA一致检出率8.1％(50/618)与评价标准(检出率6.7％)对照均具有高度一致性(x2 =91.834、124.662、138.643,P均＜0.001);3项方法的检出率均优于评价标准(x2=23.547、33.440、12.410,P均＜0.001).(2)3项检测结果的灵敏度、特异度、阳性预测值、阴性预测值、符合率、J指数分别为:血清HBoV抗体:58.3％、90.1％、29.8％、96.8％、88.0％、0.484(Kappa=0.335,P＜0.001);痰液HBoV DNA:68.8％、89.6％、32.4％、97.5％、88.2％、0.584 (Kappa=0.384,P＜0.001);血清HBoV抗体+痰液HBoV DNA:70.4％、94.8％、38.0％、98.6％、93.7％、0.652(Kappa=0.463,P＜0.001).(3)血清HBoV抗体+痰液HBoV DNA与血清和(或)BALF DNA的检测结果均提示,3岁以下患儿的HBoV检出率较高,尤以～1岁组最高,且同一年龄组两项检测的HBoV检出率差异均无统计学意义(P均＞0.05).但两项检测在各年龄组的检出率差异均有统计学意义(x2=58.303、35.053,P均＜0.01),两者均以～1岁组最高,其次为～3岁组,前者＞3岁组最低,后者～6个月组最低.结论 作为血清学依据的HBoV抗体检测与传统的痰液HBoV DNA检测结合,可以有效提高儿童急性下呼吸道HBoV感染的诊断效力,并反映HBoV感染的年龄分布情况.
目的 探討血清特異性抗體檢測在兒童急性下呼吸道人博卡病毒(HBoV)感染診斷中的應用價值.方法 選擇2013年1至4月囌州兒童醫院呼吸科收治的714例急性下呼吸道感染(ALRI)患兒為研究對象,採集患兒血清、痰液及肺泡灌洗液(BALF),用ELISA法檢測血清中HBoV特異性IgG、IgM抗體,實時熒光定量PCR法檢測血清、痰液及BALF中HBoV DNA.以血清和(或)BALF HBoV DNA檢測結果為評價標準,將血清HBoV抗體、痰液HBoV DNA及血清HBoV抗體+痰液HBoV DNA的檢測結果分彆與評價標準比較,評價其一緻性及優劣性,併計算3項檢測結果靈敏度、特異度、暘性預測值、陰性預測值、符閤率、Kappa值、J指數等各項診斷評價指標.分析血清HBoV抗體+痰液HBoV DNA與血清和(或)BALF HBoV DNA在各年齡組的檢齣情況.結果 (1)714例患兒血清HBoV抗體檢齣率13.2％ (94/714)、痰液HBoV DNA檢齣率14.3％ (102/714)、血清HBoV抗體+痰液HBoV DNA一緻檢齣率8.1％(50/618)與評價標準(檢齣率6.7％)對照均具有高度一緻性(x2 =91.834、124.662、138.643,P均＜0.001);3項方法的檢齣率均優于評價標準(x2=23.547、33.440、12.410,P均＜0.001).(2)3項檢測結果的靈敏度、特異度、暘性預測值、陰性預測值、符閤率、J指數分彆為:血清HBoV抗體:58.3％、90.1％、29.8％、96.8％、88.0％、0.484(Kappa=0.335,P＜0.001);痰液HBoV DNA:68.8％、89.6％、32.4％、97.5％、88.2％、0.584 (Kappa=0.384,P＜0.001);血清HBoV抗體+痰液HBoV DNA:70.4％、94.8％、38.0％、98.6％、93.7％、0.652(Kappa=0.463,P＜0.001).(3)血清HBoV抗體+痰液HBoV DNA與血清和(或)BALF DNA的檢測結果均提示,3歲以下患兒的HBoV檢齣率較高,尤以～1歲組最高,且同一年齡組兩項檢測的HBoV檢齣率差異均無統計學意義(P均＞0.05).但兩項檢測在各年齡組的檢齣率差異均有統計學意義(x2=58.303、35.053,P均＜0.01),兩者均以～1歲組最高,其次為～3歲組,前者＞3歲組最低,後者～6箇月組最低.結論 作為血清學依據的HBoV抗體檢測與傳統的痰液HBoV DNA檢測結閤,可以有效提高兒童急性下呼吸道HBoV感染的診斷效力,併反映HBoV感染的年齡分佈情況.
목적 탐토혈청특이성항체검측재인동급성하호흡도인박잡병독(HBoV)감염진단중적응용개치.방법 선택2013년1지4월소주인동의원호흡과수치적714례급성하호흡도감염(ALRI)환인위연구대상,채집환인혈청、담액급폐포관세액(BALF),용ELISA법검측혈청중HBoV특이성IgG、IgM항체,실시형광정량PCR법검측혈청、담액급BALF중HBoV DNA.이혈청화(혹)BALF HBoV DNA검측결과위평개표준,장혈청HBoV항체、담액HBoV DNA급혈청HBoV항체+담액HBoV DNA적검측결과분별여평개표준비교,평개기일치성급우렬성,병계산3항검측결과령민도、특이도、양성예측치、음성예측치、부합솔、Kappa치、J지수등각항진단평개지표.분석혈청HBoV항체+담액HBoV DNA여혈청화(혹)BALF HBoV DNA재각년령조적검출정황.결과 (1)714례환인혈청HBoV항체검출솔13.2％ (94/714)、담액HBoV DNA검출솔14.3％ (102/714)、혈청HBoV항체+담액HBoV DNA일치검출솔8.1％(50/618)여평개표준(검출솔6.7％)대조균구유고도일치성(x2 =91.834、124.662、138.643,P균＜0.001);3항방법적검출솔균우우평개표준(x2=23.547、33.440、12.410,P균＜0.001).(2)3항검측결과적령민도、특이도、양성예측치、음성예측치、부합솔、J지수분별위:혈청HBoV항체:58.3％、90.1％、29.8％、96.8％、88.0％、0.484(Kappa=0.335,P＜0.001);담액HBoV DNA:68.8％、89.6％、32.4％、97.5％、88.2％、0.584 (Kappa=0.384,P＜0.001);혈청HBoV항체+담액HBoV DNA:70.4％、94.8％、38.0％、98.6％、93.7％、0.652(Kappa=0.463,P＜0.001).(3)혈청HBoV항체+담액HBoV DNA여혈청화(혹)BALF DNA적검측결과균제시,3세이하환인적HBoV검출솔교고,우이～1세조최고,차동일년령조량항검측적HBoV검출솔차이균무통계학의의(P균＞0.05).단량항검측재각년령조적검출솔차이균유통계학의의(x2=58.303、35.053,P균＜0.01),량자균이～1세조최고,기차위～3세조,전자＞3세조최저,후자～6개월조최저.결론 작위혈청학의거적HBoV항체검측여전통적담액HBoV DNA검측결합,가이유효제고인동급성하호흡도HBoV감염적진단효력,병반영HBoV감염적년령분포정황.
Objective To study the application of serodiagnosis of human bocavirus (HBoV) lower respiratory tract infection in children.Method From January to April,2013,samples including serum,sputum and bronchoalveolar lavage fluids (BALFs) were obtained from 714 children hospitalized with ALRI.Serums were tested for HBoV-specific IgG and IgM antibodies by ELISA and all kinds of samples were tested for HBoV DNA by quantitative real-time fluorescent PCR.The results of HBoV serologic tests,viral DNA in sputum and their combination were compared with those of HBoV DNA in serums and/or BALFs,which was considered as the "standard".Their consistence and differences were evaluated,and the diagnostic parameters including sensitivity,specificity,positive predictive value,negative predictive value,consistency rate,Kappa value and J value were calculated.Age distributions of the HBoV positive patients tested by the latter two methods were also compared.Result The positive rate of HBoV serology was 13.2％ (94/714).The results of HBoV serology,its DNA in sputum and their combination were all consistent with those of HBoV DNA in serums and/or BALFs(x2 =91.834,124.662,138.643,P ＜ 0.001 for all comparisons).Differences were significant by McNemar test(x2 =23.547,33.440,12.410,P all ＜ 0.001).All the diagnostic parameters for single HBoV serologic test or single viral DNA test in sputa were approximate.However,they were improved to 70.4％,94.8％,38.0％,98.6％,93.7％,0.463 (P ＜ 0.001),0.65 for sensitivity,specificity,positive predictive value,negative predictive value,consistency rate,Kappa value and J value,respectively,when the methods were combined.HBoV was found positive mainly in children under 3 years of age,especially in the 1 year group.The positive rates were the highest in both group-1 year,and group-3 years was the next.However,the rate was the lowest in group ＞3 years and in the group-6 months.Conclusion Diagnostic power can be improved and age distribution can be demonstrated when serologic tests were combined with traditional sputum DNA detection in children with HBoV lower respiratory tract infection.
