[논문]소아에서의 마이코플라스마 폐렴의 진단을 위한 항체 검사에 관한 연구

김진수; 고정희; 오성희

doi:10.14776/kjpid.2013.20.2.71

소아에서의 마이코플라스마 폐렴의 진단을 위한 항체 검사에 관한 연구
Indirect Particle Agglutination Antibody Testing for Early Diagnosis of Mycoplasma pneumoniae pneumonia in Children 원문보기

소아감염 = Korean journal of pediatric infectious diseases, v.20 no.2, 2013년, pp.71 - 80

김진수 (한양대학교 의과대학 소아과학교실) , 고정희 (한양대학교 의과대학 소아과학교실) , 오성희 (한양대학교 의과대학 소아과학교실)

초록
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목 적 : 이 연구의 목적은 항체 검사를 어느 시기에 검사해야 마이코플라스마 폐렴을 가장 적절하게 진단을 내릴 수 있는지를 파악하기 위함이다. 방 법 : 2011년 6월부터 2011년 10월까지의 한양대학교병원에서 진단받은 206 명의 폐렴 환아들을 대상으로 후향적으로 분석하였다. 결 과 : 마이코플라스마 폐렴으로 진단받은 160명의 평균 연령은 5.4세이었다. 마이코플라스마 간접입자 응집항체의 측정을 위한 혈청 획득 시간은 마이코플라스마 항체가가 1:640 이상인 혈청들과(8.58일) 1:640 미만인 혈청들(5.44일) 사이에서 통계학적으로 유의한 차이가 있었다(P<0.001). 결 론 : 본 연구의 결과는 폐렴 환아에서 증상 시작일로부터 8일 전에 획득한 마이코플라스마 항체가가 음성이면 확진을 위해 반복 검사가 필요한 것으로 보였다. 이 제안으로 마이코플라스마 폐렴에서 최적의 진단을 내릴 수 있게 도움을 줄 수 있을 것이다.

Abstract ▼ AI-Helper

Objectives: Outbreaks of pneumonia caused by Mycoplasma pneumoniae (MP) occur every 3-4 years in Korea, most recently in 2011. The aim of our study was to determine the optimal time to perform indirect particle agglutination antibody assays to improve early diagnosis of MP pneumonia in children. Methods: A database of 206 pediatric patients treated for pneumonia at the Hanyang University Hospital from June to October 2011 was analyzed retrospectively for demographic characteristics and laboratory test results. Results: Among the 206 patients treated for pneumonia during the study period, there were 160 children (mean age, 5.44 years) diagnosed with MP pneumonia, who were studied further. The mean age of these MP pneumonia patients was 5.44 years. Antibody titers increased with increasing time between symptom onset and the collection of serum collection: MP titers were <1:640 for sera collected after 5.44 days and titers ${\geq}1:640$ for those collected after 8.58 days; P<0.001). Antibody titers were considered positive when they reached ${\geq}1:640$. In 42 MP pneumonia patients in whom there was a four-fold or greater increase in titer between successive serum samples, the optimal cut-off time-point for distinguishing between the initial and second titer groups was 7.5 days after the onset of symptoms (sensitivity, 90.5%; specificity, 92.9%). Conclusions: Negative MP antibody titers earlier than 8 days after the onset of symptoms in children with pneumonia may require repeating to confirm the diagnosis. This finding could optimize diagnosis and result in better therapeutic outcomes of MP pneumonia in children.

주제어

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제안 방법

For one of the limitations of our study is its retrospective design, a prospective study with several cohorts, and MP antibody titers obtained at scheduled intervals could shed more light on the diagnostic performance of MP serological tests. Secondly, it is possible that the small number of patients without MP pneumonia may have contributed to the low specificity of the PCR and the MP antibody assays in our study (52.
In this study we examined the clinical and laboratory findings for a group of children diagnosed with pneumonia and tested for MP antibody at presentation with fever and respiratory symptoms. We investigated the application of indirect particle agglutination antibody testing in early diagnosis of MP pneumonia in Korean children.

대상 데이터

Characteristics of patients with MP pneumonia was diagnosed in 160 patients. Their mean age was 5.
Coinfected viruses were detected in the 54 patients (35.3%) with MP pneumonia patients. The percentage was higher than Kim et al.
Of the 206 pneumonia patients, 160 were diagnosed with MP pneumonia. Of these, 152 were inpatients, and eight were outpatients. MP pneumonia was diagnosed in 108 (67.
The study included 206 patients (196 inpatients and 10 outpatients) diagnosed with pneumonia and tested for MP by measuring indirect particle agglutination (MP) antibody titers from June to October 2011 at the department of Pediatrics, Hanyang University Hospital, Seoul, Korea. Pneumonia was defined as the presence of an infiltrate on chest x-ray, and respiratory symptoms including cough, difficulty breathing, tachypnea, and/or fever.

데이터처리

Time from the onset of pneumonia symptoms to specimen collection for testing was compared between patients with positive and negative MP antibody titers, and between patients with positive and negative MP PCR, using the Wilcoxon rank sum test. The mean antibody titers and the mean times from symptom onset to specimen collection were compared between the paired titers using the Wilcoxon signed rank test. The optimal time for MP antibody testing was estimated by performing receiver operating characteristic (ROC) analysis.

성능/효과

In conclusion, a four-fold or greater increase in antibody titers could be detected 8 days after the onset of symptoms in MP pneumonia patients. Repeating the titer in patients whose initial titer (performed <8 days from symptom onset) was negative could help to confirm the diagnosis of MP pneumonia and lead to better therapeutic outcomes.
The results of MP PCR assays, performed on samples from 90 patients, were compared according to the MP antibody titer levels and showed that patients with titers ≥1:640 had positive PCR results in 63.6-80.0% of cases.
When compared with the PCR results, the serological assay had a sensitivity of 82.5% (47 of 57) and a specificity of 33.3% (11 of 33). When compared with the serological assay, PCR had a sensitivity of 68.

후속연구

Repeating the titer in patients whose initial titer (performed <8 days from symptom onset) was negative could help to confirm the diagnosis of MP pneumonia and lead to better therapeutic outcomes. However, the validity of our findings must be confirmed in further studies with larger patient populations before it can be applied in clinical practice.

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