环介导恒温扩增技术在检测儿童下呼吸道病原菌的临床应用分析

目的利用环介导恒温扩增技术探究儿童下呼吸道病原菌检测结果的临床分布特点，为实际临床工作提供参考。 方法收集2018年8月至2019年7月在天津市某儿童医院初诊为呼吸道病原菌感染的2517例患者，采集支气管肺泡灌洗液标本或深部痰标本，采用环介导恒温扩增芯片法检测下呼吸道的13种病原菌，并对检测结果进行分析。 结果应用环介导恒温扩增芯片法检测2517例下呼吸道感染住院患儿，共检出1771例病原菌阳性(痰液1174例(46.64%)，肺泡灌洗液597例(23.72%))。芯片法检出的主要病原菌为肺炎支原体934例(37.11%)、肺炎链球菌557例(22.13%)、耐甲氧西林葡萄球菌397例(15.78%)、流感嗜血杆菌295例(11.72%)和金黄色葡萄球菌214例(8.50%)。不同季节感染呼吸道病原菌的阳性率不同，小儿肺炎支原体感染全年均有发生，以秋冬季多见，肺炎链球菌冬季多见，耐甲氧西林葡萄球菌春季多发，流感嗜血杆菌以春夏多发。单一病原菌感染1179例(46.84%)，混合感染1338例(53.16%)。 结论对儿童检测下呼吸道病原菌感染，芯片法具有操作简单、快速、准确，明显缩短标准周转时间(TAT)，且灵敏度更高、病原体覆盖面广等优势，能更好地服务于感染性疾病的快速诊断、抗生素的早期筛选以及合理使用。

Clinical application of loop-mediated isothermal amplification in the detection of pathogenic bacteria in children's lower respiratory tract

ObjectiveTo investigate the clinical distribution of pathogenic bacteria in children's lower respiratory tract by using loop-mediated isothermal amplification (LAMP), so as to provide reference for practical clinical work. Methods2517 patients with respiratory tract pathogenic bacteria infection (from Autumn, 2018 to July, 2019) initially diagnosed in Tianjin Children's Hospital-Pediatrics Research Institute were enrolled in the study. The bronchoalveolar lavage fluid samples or deep sputum samples were collected and 13 kinds of pathogenic bacteria in the lower respiratory tract were detected by LAMP microarray, and the detection results were analyzed. ResultsThe LAMP microarray was used to detect 2517 cases of lower respiratory tract infections in hospitalized children, and a total of 1771 cases were positive for pathogenic bacteria (sputum 1174 cases (46.64%) and alveolar lavage solution 597 cases (23.72%). The main pathogenic bacteria were Mycoplasma pneumoniae in 934 cases (37.11%), Streptococcus pneumoniae in 557 cases (22.13%), methicillin-resistant Staphylococcus in 397 cases (15.78%), Haemophilus influenzae in 295 cases (11.72%) and Staphylococcus aureus in 214 cases (8.50%). The positive rates of respiratory tract pathogenic bacteria in different seasons are different. Mycoplasma pneumoniae infection in children occurs throughout the year, mostly in autumn and winter, Streptococcus pneumoniae infection occurs mainly in winter, and methicillin-resistant Staphylococcus aureus in spring, and Haemophilus influenzae in spring and summer. There were 1179 cases of single pathogen infections (46.84%) and 1338 cases of mixed infections (53.16%). ConclusionFor the detection of lower respiratory tract pathogenic infection in children, the LAMP microarray is a simple, rapid and accurate method. It can significantly shorten the standard turnover time (TAT), and has the advantages of higher sensitivity and wide pathogen coverage, which can better serve the rapid diagnosis of infectious diseases, early screening and rational use of antibiotics.