호흡기 바이러스 검출을 위한 코인두 흡인액 검체와 코인두 Flocked Swab 검체의 비교
Comparison of Nasopharyngeal Aspirates and Nasopharyngeal Flocked Swabs for Respiratory Virus Detection
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배경: 바이러스성 호흡기 감염의 정확한 진단을 위해서 검체 채취 시기 및 채취 방법이 매우 중요하다. 코인두 흡인물(nasopharyngeal aspirate, NPA)이 호흡기 바이러스 검출을 위해 가장 좋은 검체로 알려져 왔으나, 소아 환자에서 코인두 흡인물 채취하기가 용이하지 않다. Flocked swab은 기존의 면봉보다 많은 수의 상피세포를 채취할 수 있어 호흡기 바이러스 검출률을 높일 수 있다는 연구 보고가 있으나 국내에서는 아직 이에 관한 평가 보고가 없다. 이에 연구자들은 flocked swab을 이용한 코인두 면봉(nasopharyngeal flocked swab, NPFS) 검체 채취법의 유용성을 평가하고자 하였다. 방법: 하기도 감염을 주소로 입원하였던 소아 환자 111명을 대상으로, 입원 당일 환자의 우측 콧구멍에서 NPA 검체를 먼저 채취하였고, 좌측 콧구멍을 통하여 NPFS 검체를 채취하였다. 두 가지 방법으로 채취한 검체를 간접면역형광법(indirect immunofluorescent method, IIF), 배양법 및 다중 역전사 PCR (reverse transcription PCR, RT-PCR)법으로 검사하여 그 결과를 비교하였다. 결과: 호흡기 상피세포수가 적으면서 IIF에서 양성 세포가 관찰되지 않았던 부적합 검체의 비율은 NPA법에서 23.4%, NPFS법에서 5.4%로 NPA법으로 채취한 검체에서 현저하게 부적합 검체가 많았다. 합의 양성을 기준으로 IIF 검사에서 NPA 검체의 양성률은 30.6%, NPFS 검체의 양성률은 45.7%로 NPFS에서 유의하게 높았다(P=0.048). 그러나 NPFS 검체는 NPA 검체에 비해 위양성률이 높았다(12.4% vs. 1.2%, P＜0.004). 배양에서도 NPA법의 양성률은 27.9%, NPFS법의 양성률은 38.7%로 NPFS에서 유의하게 높았다(P=0.004). 다중 RT-PCR법에서 NPA법의 양성률은 55.9%, NPFS는 67.6%로 둘 사이에 유의한 차이는 없었다(P=0.055). 결론: NPFS 방법은 기존의 표준법인 NPA 방법보다 호흡기 바이러스 검출률이 통계적으로 유의하게 높거나 동등하여 외래 및 응급실에서 임상의가 직접 호흡기 검체를 채취할 때 유용할 것이다. [Ann Clin Microbiol 2015;18:119-125]
Abstract
Background: Nasopharyngeal aspirate (NPA) is known as the best specimen for accurate diagnosis of viral respiratory infections in pediatric patients, but the procedure is very annoying. Recently introduced flocked swabs have been reported to be easy to obtain a good quality specimen and comfortable to patients. The purpose of this study was to compare the sensitivities between NPA and nasopharyngeal flocked swabs (NPFS) for detection of respiratory viruses in children. Methods: For this study, 111 hospitalized children with acute respiratory tract infections were recruited. NPA and NPFS were performed in parallel from each patient. NPFS were always collected after NPA. Specimens were tested for six common respiratory viruses in triplicate using indirect immunofluorescence (IIF), viral cultures, and multiplex reverse transcription PCR (RT- PCR). Results: The proportion of specimens inadequate for IIF was higher in NPA (23.4%) than NPFS (5.4%). According to the consensus positive, the positive rates of NPFS were higher than those of NPA when using IIF (45.7% and 30.6%, P=0.048) and culture (38.7% and 27.9%, P=0.004). However, the false-positive rates of NPFS were higher than those of NPA when using IIF (12.4% and 1.2%, P=0.004). The positive rates of NPFS and those of NPA were not different in multiplex RT-PCR (67.6% and 55.9%, P=0.055). Conclusion: The higher sensitivity of IIF for NPFS specimens and of culture for respiratory viruses and the similar sensitivities in multiplex PCR could make them an alternative to NPA samples, especially in physician clinics or emergency rooms. (Ann Clin Microbiol 2015; 18:-125)
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