CAJ | 학술논문

目的应用环介导等温扩增(LAMP)技术对下呼吸道感染患者痰标本中常见致病菌进行核酸检测,调查病原菌的分布,研究LAMP技术对下呼吸道感染病原体检测的临床意义.方法收集福建省立医院呼吸科下呼吸道感染患者289例的合格痰标本289份,LAMP技术检测病原体,分析下呼吸道感染病原菌的分布,并与传统的培养法进行比较.将细菌浓度＞1×103拷贝/ml的病例分为初治已覆盖病原体组和初治未覆盖病原体组,比较两组患者年龄、有无基础疾病、抗感染治疗时间、总住院时间、初治有效率及治愈率.结果 289例患者中培养法阳性44例(15.2％).LAMP技术检测以细菌浓度＞1 ×103拷贝/ml为界值,判定为阳性结果的有124例(43.0％).下呼吸道分离的病原菌中细菌144株(77.8％),非典型病原菌41株(22.2％);革兰阴性杆菌为主要致病菌,依次为铜绿假单胞菌、流感嗜血杆菌、肺炎克雷伯菌及肺炎链球菌.初治已覆盖病原体组(95例)和初治未覆盖病原体组(29例)的总住院时间分别为(13.9±9.1)和(16.3±11.2)d,差异有统计学意义(t=-2.083,P=0.039);初治有效率两组分别为31.0％(29/95)和93.1％(27/29),差异有统计学意义(x2 =31.0,P＜0.01);两组的抗感染治疗时间[(13.9±9.1)和(16.3±11.2)d]比较,差异无统计学意义(t=-1.073,P=0.285);两组的治愈率分别为84.2％(80/95)和95.7％(28/29),差异无统计学意义(x2 =0.6,P=0.4).结论 LAMP技术简便,可快速扩增肺部感染患者痰液中常见致病菌核酸,检出率明显高于传统的痰培养法.LAMP技术有利于治疗前明确致病菌并进行针对性治疗,缩短患者的住院时间,提高初始治疗的有效率.
목적 응용배개도등온확증(LAMP)기술대하호흡도감염환자담표본중상견치병균진행핵산검측,조사병원균적분포,연구LAMP기술대하호흡도감염병원체검측적림상의의.방법 수집복건성립의원호흡과하호흡도감염환자289례적합격담표본289빈,LAMP기술검측병원체,분석하호흡도감염병원균적분포,병여전통적배양법진행비교.장세균농도＞1×103고패/ml적병례분위초치이복개병원체조화초치미복개병원체조,비교량조환자년령、유무기출질병、항감염치료시간、총주원시간、초치유효솔급치유솔.결과 289례환자중배양법양성44례(15.2％).LAMP기술검측이세균농도＞1 ×103고패/ml위계치,판정위양성결과적유124례(43.0％).하호흡도분리적병원균중세균144주(77.8％),비전형병원균41주(22.2％);혁란음성간균위주요치병균,의차위동록가단포균、류감기혈간균、폐염극뢰백균급폐염련구균.초치이복개병원체조(95례)화초치미복개병원체조(29례)적총주원시간분별위(13.9±9.1)화(16.3±11.2)d,차이유통계학의의(t=-2.083,P=0.039);초치유효솔량조분별위31.0％(29/95)화93.1％(27/29),차이유통계학의의(x2 =31.0,P＜0.01);량조적항감염치료시간[(13.9±9.1)화(16.3±11.2)d]비교,차이무통계학의의(t=-1.073,P=0.285);량조적치유솔분별위84.2％(80/95)화95.7％(28/29),차이무통계학의의(x2 =0.6,P=0.4).결론 LAMP기술간편,가쾌속확증폐부감염환자담액중상견치병균핵산,검출솔명현고우전통적담배양법.LAMP기술유리우치료전명학치병균병진행침대성치료,축단환자적주원시간,제고초시치료적유효솔.
Objective To investigate the spectrum of common pathogenic bacteria of low respiratory tract infection by loop-mediated isothermal amplification (LAMP) of nucleic acid test and to prove the clinical significance of this method.Methods A total of 289 qualified sputum samples from patients with lower respiratory tract infections in Fujian Province were detected by LAMP technique,and then the distribution of pathogenic bacteria was analyzed.The positive cases (the patients whose specific bacterial copies in their sputum samples ＞ 1 × 103 copies/ml) were divided into 2 groups according to whether their treatment had covered this pathogen or not.The underlying diseases,duration of anti-bacterial treatment,the hospital days,and the effectiveness of initial treatment and cure rate were compared.Results The culture method in the 289 patients showed that 44 (15.2％) were positive.Tests by the LAMP method with a bacteria concentration ＞ 1 × 103 copies/ml as cutoff value,showed positive results in 124 patients (43.0％).The lower respiratory tract pathogens included 144 strains of bacteria (77.8％),and 41 strains of atypical pathogens (22.2％).Gram-negative bacteria were the predominant pathogens,such as Pseudomonas aeruginosa,H.influenzae,Klebsiella pneumoniae,and Streptococcus pneumoniae.In 95 cases the initial therapy had covered the pathogens,while in 29 cases the initial therapy had not.The effectiveness of the initial treatment (x2 =31.0,P ＜ 0.01) and the total days of hospital stay (t =-2.083,P =0.039)in the group whose antibiotics had covered the pathogens were significantly higher than those of the other group.However,there were no significant difference in duration of anti-bacterial treatment (t =-1.073,P =0.285) and cure rates (x2 =0.6,P =0.4) between the 2 groups.Conclusions LAMP method can detect the nuclear acid of the bacteria in the sputum much more rapidly and sensitively than the routine culture method.LAMP technique may be helpful to know the pathogenic bacteria before treatment,and therefore may improve the choice of initial antibiotic therapy.