Article(id=1261728987714302461, tenantId=1146029695717560320, journalId=1146119944283992078, issueId=1261728796072358112, articleNumber=null, orderNo=null, doi=null, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1778749232461, onlineDateStr=2026-05-14, pubDate=1774195200000, pubDateStr=2026-03-23, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1778749232461, onlineIssueDateStr=2026-05-14, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1778749232461, creator=13701087609, updateTime=1778749232461, updator=13701087609, issue=Issue{id=1261728796072358112, tenantId=1146029695717560320, journalId=1146119944283992078, year='2026', volume='4', issue='6', pageStart='1', pageEnd='234', issueExtLink='null', onlineDate='null', pubDate='1774195200000', pubDateStr='2026-03-23', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=1, specialIssue=null, createTime=1778749186771, creator='13701087609', updateTime=1778750183088, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1261732975067148479, tenantId=1146029695717560320, journalId=1146119944283992078, issueId=1261728796072358112, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1261732975071342784, tenantId=1146029695717560320, journalId=1146119944283992078, issueId=1261728796072358112, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=194, endPage=197, ext={CN=ArticleExt(id=1261728992344814113, articleId=1261728987714302461, tenantId=1146029695717560320, journalId=1146119944283992078, language=CN, title=酶联免疫吸附法与实时荧光定量聚合酶链式反应检测不同感染阶段的儿童肺炎支原体感染样本的性能差异, columnId=1261728976733594600, journalTitle=实验室检测, columnName=分析与检测, runingTitle=null, highlight=null, articleAbstract=
目的 对比酶联免疫吸附法（enzyme-linked immunosorbent assay, ELISA）与实时荧光定量聚合酶链式反应（quantitative polymerase chain reaction, qPCR）法在儿童肺炎支原体（Mycoplasma pneumoniae, MP）感染不同病程的性能差异。
方法 收集2024年1—12月本院儿科86例疑似呼吸道支原体感染患儿血清及痰液样本。按病程分为超早期（≤3 d）、早期（4~7 d）、中晚期（>7 d） 3组。采用ELISA检测血清MP-免疫球蛋白M （immunoglobulin M, IgM）/免疫球蛋白G （immunoglobulin G, IgG）抗体，qPCR检测痰液MP-DNA。以临床综合诊断标准为金标准，评估两种方法的诊断灵敏度、特异性、阳性/阴性预测值及总符合率；采用Kappa检验分析一致性；通过受试者工作特征（receiver operating characteristic, ROC）曲线比较不同病程阶段两种方法的诊断效能。
结果 ELISA法测定MP-IgM与qPCR的临床符合率为82.6%，Kappa值为0.618 ［95%置信区间（confidence interval, CI）：0.447~0.788］；MP-IgG的与qPCR的总符合率为62.3%，Kappa值为0.201（95% CI：0.027~0.376）。经ROC曲线比较发现，中晚期MP-IgM［敏感性为90.9%，特异性为94.1%，曲线下面积（area under the curve, AUC）为0.925］相对于超早期的AUC显著升高（P<0.05）；中晚期MP-IgG（敏感性为63.6%，特异性为100.0%，AUC为0.818）相对于超早期、早期患儿的AUC显著升高（P<0.05）。MP-IgM/IgG与qPCR结果一致者多以高热伴湿啰音、呼吸困难或脓痰等下呼吸道感染体征为主，而结果不一致者则主要表现为刺激性干咳、卡他症状及喘息等上呼吸道特征。
结论 对于超早期/早期或不典型病例，建议首选qPCR或联合检测以提高检出率；对于中晚期伴下呼吸道感染症状者，ELISA-IgM可作为经济快速的筛查手段；ELISA-IgG因早期诊断价值有限，建议用于回顾性诊断或流行病学调查。本研究意义旨在为儿童MP感染不同病程阶段的精准检测策略选择提供循证依据，优化临床诊断流程、减少抗生素滥用，提升不典型病例的检出效率。
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