妇科门诊实施阴道宫颈炎病征处理方案的有效性评价

Validation of Syndromic Approach for the Management of Vaginal Discharge in Gynecologic Clinics

目的在妇科门诊对阴道宫颈炎病征处理方案的有效性进行评价。方法对妇科门诊具有阴道分泌物异常症状的就诊者进行危险因素评估和病征处理,同时与病原学诊断进行比较。结果共1565例调查对象,宫颈淋球菌和沙眼衣原体感染率20.7%。与病原学诊断相比,病征诊断淋病和(或)沙眼衣原体感染的敏感性为42.5%,特异性为72.6%,阳性预期值为26.2%,阴性预期值为84.6%。结论病征处理方案的敏感性和阳性预期值较低,可能造成过度治疗或漏诊漏治的比例增加。如何进一步改进病征处理方案值得进一步研究。

Objective To evaluate the performance of syndromic management of abnormal vaginal discharge in gynecologic clinics. Methods Women with abnormal vaginal discharge were undergone risk assessment and syndromic management accordingly in two gynecologic clinics. Comparison of syndromic and etiologic diagnoses was conducted. Results Cervical gonococcal and/or chlamydial infections accounted for 20.7% in a total of 1565 women. The sensitivity, specificity, positive predictive value, and negative predictive value were 42.5 % ,72.6%, 26.2% ,84.6% , respectively, for the diagnosis of gonococcal and/or chlamydial infections by syndromic approach. Conclusion The low sensitivity and positive predictive value of syndromic management may lead to over-treatment,or,missed diagnosis and treatment. Further improvement of syndromic protocols is needed.