소아 마이코플라즈마 폐렴에서 진단 방법의 비교 및 IgG 아군의 변화
Comparison of Diagnostic Methods and the Changes of IgG Subclasses in Children with Mycoplasma pneumoniae pneumonia
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목 적 : 마이코플라즈마 폐렴에서 3가지 혈청학적 방법과 polymerase chain reaction (PCR)의 진단 양성률과 마이코플라즈마 감염 후 IgG 및 IgG 아군의 변화를 알아보고자 하였다. 방 법 : 마이코플라즈마 폐렴이 유행한 시기에 가톨릭대학교 대전성모병원 소아청소년과에 폐렴으로 입원한 50명의 환아들을 대상으로 하였다. 환아들의 입원 시와 퇴원 시의 혈청으로부터 미세입자 응집 반응법(Seradia-Myco II), 냉응집소 검사 및 효소면역 측정법으로 마이코플라즈마 항체와 IgG 및 IgG 아군(IgG1, IgG2, IgG3 & IgG4) 값을 측정하였다. 또한 입원 시에 마이코플라즈마 PCR법을 실시하였으며, 각각의 결과를 비교하였다. 결 과 : 입원 시기 검사만을 분석한 마이코플라즈마 폐렴 양성률은 미세입자 응집 반응법, 냉응집소 검사, 효소면역 측정법과 PCR에서 각각 52%, 38%, 30% 및 12%를 보였다. 2차례 측정 결과로 분석한 마이코플라즈마 폐렴 양성률은 미세입자 응집 반응법, 냉응집소 검사와 효소면역 측정법에서 76%, 60% 및 56%로 미세입자 응집 반응법이 가장 높았다. IgG 값은 퇴원 시 통계적으로 유의하게 증가였으며, 38명의 마이코플라즈마 폐렴 환아에서 혈청 총 IgG 값은 30명에서 증가를, 8명에서 감소가 관찰되었다. 마이코플라즈마 환아들 27명의 IgG 아군 변화에서 유의하게 IgG1과 IgG3가 증가하였으며 IgG2, IgG4의 변화는 차이를 보이지 않았다. 결 론 : 마이코플라즈마의 진단에 있어서 혈청학적 방법으로 2차례의 검사가 확정 진단과 비교적 빠른 진단을 위해 필요하며, 이용한 혈청학적 방법에 따라 민감도에 차이를 보였다. 마이코플라즈마 감염 후 증가된 IgG 항체에서 IgG1과 IgG3가 유의하게 증가하였다.
Abstract
Purpose : This study aimed to investigate the positive rate of 3 serologic methods and polymerase chain reaction (PCR) and the changes of IgG and IgG subclasses in children with Mycoplasma pneumoniae pneumonia (MP). Methods : Fifty children with pneumonia admitted to Daejeon St. Mary's Hospital, Korea, during MP outbreaks were evaluated for the diagnostic antibody status using 3 serologic methods: indirect micro-particle agglutinin assay (MAA, Serodia-Myco II, Fujirebio, Tokyo, Japan), cold agglutinins and enzyme-linked immunoassay (EIA, Platelia M. pneumoniae IgM & IgG BIO-RAD, Marnes-la-Coquette, France) and PCR. The levels of antibody for MP in each method were measured 2 times during hospitalization: at presentation and at discharge (mean interval, 6.5 days). The levels of IgG and IgG subclasses (IgG1, IgG2, IgG3 and IgG4) were also analyzed 2 times (at presentation and at discharge) using stored sera. Results : At presentation, the positive rates of the diagnostic methods were 52%, 38%, 30% and 12% for MAA, cold agglutinins, EIA and PCR assay, respectively. Following analysis of the repetitive measurement of the antibody, the positive rates of the diagnostic methods were 76%, 60% and 56% for MAA, cold agglutinins and EIA, respectively. The mean IgG level of MP patients increased during hospitalization (973±184 vs. 1,040±205 mg/dL; P=0.008). Among the IgG subclasses, the levels of IgG1 and IgG3 showed a significant increase during hospitalization (553±129 vs. 611±151 mg/dL, P=0.003 for IgG1; 43±27 vs. 47±30 mg/dL, P=0.005 for IgG3). Conclusions : For the accurate and relatively rapid diagnosis of MP, a paired sample examination is mandatory, especially within a short-time period. The sensitivity of serologic tests for the diagnosis of MP may differ among commercially available kits. IgG1 and IgG3 appear to be the main IgG subclasses that show an increase after MP infection.
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