液基细胞学制片巴氏染色临床诊断真菌性阴道炎的价值

Value of liquid-based cytology preparation and papanicolaou stain in clinical diagnosis of fungal vaginitis

目的探讨液基细胞学制片巴氏染色诊断真菌性阴道炎的临床价值。方法选取2020年4月至2021年6月期间在河南中医药大学第三附属医院门诊或住院的具有典型临床症状、初步诊断为真菌性阴道炎的251例患者进行研究。共采集到有效标本230例,阴道微生态方法检测128例(有效标本122例),白带常规检测123例(有效标本108例),所有标本均接受液基细胞学制片巴氏染色方法检测,以真菌培养结果作为诊断金标准,绘制2×2配对四格表计算相关诊断学指标,绘制受试者工作特征(ROC)曲线计算曲线下面积(AUC)分析液基细胞学制片巴氏染色用于诊断真菌性阴道炎的价值。结果采用阴道微生态、液基细胞学两种方法检查的122例患者,经真菌培养共计检测出真菌感染患者52例,其中最主要的真菌类型为白色念珠球菌25例(48.08%),其次为光滑念珠球菌18例(34.62%);阴道微生态诊断阴道真菌感染的灵敏度为75.00%、特异度为91.43%、阳性预测值为86.67%、阴性预测值为83.12%、ROC曲线下面积AUC值为0.784;液基细胞学诊断阴道真菌感染的灵敏度为95.74%、特异度为90.67%、阳性预测值为86.53%、阴性预测值为97.14%、ROC曲线下面积AUC值为0.918;接受白带常规、液基细胞学两种方法检查的108例患者,经真菌培养共计检测出真菌感染患者51例,其中最主要的真菌类型为白色念珠球菌27例(51.92%),其次为光滑念珠球菌15例(28.85%);白带常规诊断阴道真菌感染的灵敏度为96.08%、特异度为75.44%、阳性预测值为77.78%、阴性预测值为95.56%、ROC曲线下面积AUC值为0.824;液基细胞学诊断阴道真菌感染的灵敏度为96.97%、特异度为88.71%、阳性预测值为86.27%、阴性预测值为96.49%、ROC曲线下面积AUC值为0.914。结论液基细胞学制片巴氏染色作为一种新的真菌定性检测方法,应用于临床诊断真菌性阴道炎较阴道微生态方法具有更高的灵敏度,较白带常规具有更高的特异性,同时保证诊断的准确性,具有一定的临床应用价值。

Objective To investigate the clinical value of liquid-based cytology preparation and papanicolaou stain in the clinical diagnosis of fungal vaginitis.Methods A total of 251 patients with typical clinical symptoms and preliminary diagnosis of fungal vaginitis were selected from the Third Affiliated Hospital of Henan University of Tradi-tional Chinese Medicine from April 2020 to June 2021 for the study.A total of 230 valid specimens were collected,128 were detected by vaginal microecological methods(122 valid specimens),and 123 were detected by routine leukorrhea(108 valid specimens).All specimens were tested by liquid-based cytology preparation and Papanicolaou stain.Fungal culture results were used as the diagnostic gold standard,and a 2×2 paired four-cell table was drawn to calculate the rele-vant diagnostic indicators.Receiver operating characteristic(ROC)curve was drawn,and the area under the curve(AUC)was calculated to analyze the value of liquid-based cytology preparation and Papanicolaou stain in the diagnosis of fungal vaginitis.Results Among 122 patients examined by vaginal microecology and liquid-based cytology,a total of 52 cases of fungal infection were detected by fungal culture,with Candida albicans as the main fungal type(25 cases,48.08%),followed by Candida glabla(18 cases,34.62%).The sensitivity,specificity,positive predictive value,negative predictive value,and AUC were 75.00%,91.43%,86.67%,83.12%,and 0.784 for vaginal microecology,and 95.74%,90.67%,86.53%,97.14%,and 0.918 for liquid-based cytology,respectively.Among 108 patients examined by leucor-rhea routine and liquid-based cytology,a total of 51 cases of fungal infection were detected by fungal culture,with Can-dida albicans as the main fungal type(27 cases,51.92%),followed by Candida glabra(15 cases,28.85%).The sensitivi-ty,specificity,positive predictive value,negative predictive value,and AUC were 96.08%,75.44%,77.78%,95.56%,and 0.824 for leucorrhea routine,and 96.97%,88.71%,86.27%,96.49%,and 0.914 for liquid-based cytology,respective-ly.Conclusion As a new qualitative fungal detection method,liquid-based cytology preparation and papanicolaou stain has higher sensitivity and specificity than leucorrhea routine in the clinical diagnosis of fungal vaginitis while ensuring the accuracy of diagnosis,which has certain clinical application value.