本文選題：病原體IgM抗體　切入點：肺炎支原體　出處：《鄭州大學》2017年碩士論文　論文類型：學位論文

【摘要】：背景與目的呼吸道疾病是兒童易感染疾病,且引起感染的病原體多而復雜,易引發(fā)重癥或全身并發(fā)癥。但因病原體不易鑒別、兒童自述準確率不高等原因,造成目前兒童呼吸道感染病原體檢測的困難。醫(yī)生往往只能在病原體不明確的情況下進行治療,導致抗生素的濫用、病原體合并感染增多,給臨床治療帶來極大困難。本研究為尋找更好的兒童呼吸道感染的檢測方法,在臨床常用的九項病原體IgM抗體檢測的基礎上,同時聯(lián)合使用降鈣素原等炎性標志物進行檢測,結(jié)合本地區(qū)兒童呼吸道感染主要特點,探討兒童呼吸道感染病原體的準確快速檢測方法;為臨床兒童呼吸道感染的治療提供診斷依據(jù)。方法收集2013年9月~2015年8月期間,在漯河市中心醫(yī)院就診的呼吸道感染住院患兒3578例(男性1852例、女性1726例、年齡為0~14歲)血液標本,采用間接免疫熒光(ILF)法進行血清中肺炎支原體(MP)、肺炎衣原體(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熱立克次體(COX)、腺病毒(ADV)、呼吸道嗜肺軍團菌1型(LP1)九項病原體的聯(lián)合檢測。選取其中單純肺炎支原體IgM抗體檢測陽性者305例,同時進行用雙抗體標記、化學發(fā)光法檢測血清降鈣素原(PCT);免疫比濁法檢測C-反應蛋白(CRP);并結(jié)合白細胞計數(shù)結(jié)果,分析患兒合并細菌感染情況。數(shù)據(jù)采用SPSS18.0進行數(shù)據(jù)分析,用均數(shù)±標準差(x±s)表示,相關性r0.3,P0.05具有統(tǒng)計學意義。結(jié)果(1)3578例患兒共檢測出IgM抗體陽性1258例(35.15%),其中陽性率由高到低依次是MP、FluB、PIV等;混合感染484例,占總感染人數(shù)的13.52%;總陽性感染人數(shù)中男性為18.89%女性為16.26%;1~3歲組陽性率檢測率最高為13.86%,其次為3~5歲組(8.16%),且各組間有顯著差異(P0.05);(2)對不同季節(jié)患兒感染陽性檢出率進行分析,以冬季(14.08%)、春季(8.30%)感染率較高。(3)九項病原體聯(lián)合檢測結(jié)果肺炎支原體單純陽性患者中,仍有31.14%的患兒炎性標志物檢測陽性,其中PCT陽性較高(30.49%),因而聯(lián)合檢測增加了合并細菌感染的檢出率;(4)對嬰幼兒和學齡前兒童肺炎支原體合并細菌感染情況進行分析,發(fā)現(xiàn)嬰幼兒組陽性患兒較學齡前兒童組有顯著差異(P0.05)。結(jié)論本研究受檢患兒中呼吸道感染以MP病原體感染居多,且存在季節(jié)性和年齡差異。九項病原體抗體檢測聯(lián)合PCT、CRP和WBC提高了肺炎支原體感染合并細菌感染的檢出率,可為臨床診斷用藥提供更為準確的依據(jù)。
[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 鹵standard deviation (x 鹵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.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R725.6;R446.6
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本文編號：1625728