Multiplex RT-PCR 검사를 이용한 호흡기 바이러스 검출에서 비인두흡인법과 비면봉법의 비교
Comparison of Nasopharyngeal Aspirates and Nasal Swabs for the Detection of Respiratory Viruses by Multiplex RT-PCR
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목 적 : 호흡기 바이러스를 정확히 검출하기 위하여 흔히 비인두흡인법을 사용하고 있으나, 비면봉법은 비인두흡입법보다 덜 아프고 편리하다. 최근 항원검출법이나 배양으로 검사를 할 때 두 검체간의 비교에서 비면봉법이 비인두흡인법만큼 검출률이 우수하다는 보고가 있었다. 본 연구에서는 소아에서 Multiplex RT-PCR 검사로 호흡기 바이러스를 검출할 때 비인두흡인법과 비면봉법간의 바이러스 검출률의 차이를 비교하고자 하였다. 방 법 : 2008년 12월부터 2009년 6월까지 순천향대학교 천안병원 소아청소년과에 급성 호흡기 감염으로 입원한 소아 250명으로부터 비인두흡인법과 비면봉법으로 검체 250세트를 얻어 12개의 바이러스에 대한 두 검체간 multiplex RT-PCR검사 결과의 일치도를 구하고 민감도를 비교하였다. 결 과 : 대상 환아 들의 중간연령은 1.3년(생후 20일부터 16.5세)이었고, 대부분(228명 91.2%) 5세 미만이었다. 비인두흡인법과 비면봉법에서 바이러스 검사 결과의 일치도는 파라인플루엔자 3형은 우수(Cohen's kappa＞0.8)하였고 라이노바이러스 A, RSV A, RSV B는 충분(0.6-0.8)하였다. 아데노바이러스와 메타뉴모바이러스의 일치도는 미약(0.4 to 0.6)하였고 A형 인플루엔자 바이러스는 불량(poor＜0.4)하였다. 바이러스 전체에 대한 검출률은 비인두흡인법에서 0.96 (CI ; 0.92-0.98)로 비면봉법에서의 0.59 (0.51-0.66)보다 의미 있게 높았다.(P＜0.05) 결 론 : 입원한 환자의 경우에는 정확한 검사를 위해 비인두흡인법을 시행해야 하겠다. 비면봉법은 개원가나 외래 그리고 대규모 역학조사에서 제한하여 사용될 수 있겠으나 검체 방법에 따른 검출률의 차이를 고려할 때 A형 인플루엔자 바이러스, 메타뉴모바이러스 그리고 아데노바이러스 경우에는 결과를 해석할 때 보다 세심한 주의가 필요하다.
Abstract
Purpose : Although the nasopharyngeal aspirate (NPA) is more commonly used because of relatively higher accuracy, the nasal swab (NS) is a less painful and easier method than NPA. A few recent reports have shown that NS is more effective than NPA for the detection of respiratory virus using immunofluorescence or viral culture. The objective of the present study was to compare the results of NPA and NS sampling specimens in children for respiratory viruses detection using multiplex RT-PCR. Methods : From December 2008 to June 2009 Paired NPA and NS specimens were collected from 250 children admitted with symptoms of acute respiratory infections at the Department of Pediatrics, Soonchunhyang University Cheonan Hospital, Cheonan, Korea. The sensitivity and agreement of virus detection between NPA and NS using multiplex RT-PCR were compared and analyzed. Results : The median age of the subjects was 1.3 years (range, 20 days to 16.5 years), and 228 patients (91.2%) were under the age of 5 years. The agreement of virus detection between NPA and NS was excellent (Cohen's kappa ＞0.8) for parainfluenza virus type 3 or substantial (0.6 to 0.8) for rhinovirus A, RSV A and RSV B, moderate (0.4 to 0.6) for adenovirus and metapneumovirus and poor (＜0.4) for influenza A. The overall sensitivity of detection of respiratory viruses was significantly higher in NPA (0.96) than in NS (0.59, P<0.05). Conclusion : We recommend NPA may be more accurate specimen for detection of respiratory viruses in hospitalized children. NS might be used in limited cases at a office setting or for larger epidemiological studies. However, results obtained from NS for influenza virus type A, metapneumovirus and adenovirus, should be interpreted carefully.
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