阴道阿托波菌组合在细菌阴道病诊断中的价值

Establishing the combined bacterial detection procedure for the diagnosis of bacterial vaginosis

目的探讨诊断细菌性阴道病（BV）的最佳菌种组合。方法采用回顾性研究方法，根据Amsel标准和Nugent评分，筛选2010年10月至2011年5月在北京友谊医院妇产科门诊和健康体检中心就诊的人群，BV患者230例、健康育龄期妇女360名，提取细菌基因组DNA，应用特异性PCR方法扩增标本中的阴道加德纳菌、阴道阿托波菌等5种BV相关细菌，比较两组间检出率，同时进行优化组合，结合ROC曲线和Kappa一致性检验，选出诊断BV的最佳组合。结果特异性PCR显示BV患者阴道加德纳菌、阴道阿托波菌、纤毛菌属、巨球菌属和羞怯动弯杆菌的检出率分别为91．3％、83．5％、39．1％、42．6％和36．5％，显著高于健康人群检出率，分别为37．2％、14．4％、11．7％、8．9％、5．6％，，值分别为168．848、275．776、60．949、92．886和92．68，P均〈0．05。ROC曲线显示A．vag、GVag＋A．rag、G．Vag＋A．rag＋Lepto、GVag＋A．vag＋Mega和G．Vag＋A．vag＋M.mul等5种组合的曲线下面积分别为0．845、0．862、0．865、0．869和0．867，诊断BV的敏感度和特异度均达到80％以上，是较有价值的BV诊断方法。组间一致性检验的Kappa值均大于0．75，提示5种组合具有较好的一致性。从操作简单、易于标准化、成本低廉角度考虑，单一检测阴道阿托波菌可以较敏感且特异的诊断BV。结论阴道阿托波菌可以作为诊断BV的标志菌，其单独阳性时，诊断BV的敏感度和特异率均达到80％以上。

Objective To discuss the best bacterial combination for the diagnosis of Bacterial vaginosis （BV）. Methods This is a retrospective study, 230 BV-positive patients and 360 healthy women were enrolled based on the Amsel criteria and Nugent score. 5 BV-associated bacteria, including Gardnerella vaginalis, Atopobium vaginae and Leptotrichia/Sneathia species, et al. were amplified by specific-PCR assay, the detection rate were compared between two groups. ROC curve and Kappa test were used to select the best combination. Results The detection rate Of Gardnerella vaginalis, Atopobium vaginae, Leptotrichia/ Sneathia species, Megasphaera species and Mobiluncus mulieris in BV group （ 91.3% , 83.5% , 39. 1% , 42.6% and 36.5% respectively） were markedly higher than that in healthy women （ 37.2% , 14. 4% , 11.7% ,8.9% and 5.6% respectively） , X2 value were 168. 848,275. 776,60. 949,92. 886 and 92. 68, all P 〈 0. 05. The area under ROC curve of A. vag, G. Fag ＋ A. vag, G. Vag ＋ A. vag ＋ Lepto, G. Fag ＋ A. vag ＋ Mega and G. Fag ＋ A. vag ＋ M. mul were 0. 845,0. 862,0. 865,0. 869 and 0. 867, and the sensitivity and specifity were higher than 80% , the value of Kappa were larger than 0. 75 （ P 〈 0. 05 ）. Thus, these five methods were coincident. Conclusion Detection of Atopobium vaginae may be a better way for the diagnosis of BV.