利用阴道分泌物病征处理流程图诊断淋球菌和沙眼衣原体感染的研究

Evaluation of Syndromic Management in Women with Vaginal Discharge in China

目的对世界卫生组织推荐的阴道分泌物病征处理流程图进行修订,对修订后的病征处理流程图进行了有效性评价,以确定其敏感性、特异性和阳性预期值。方法选择具有阴道分泌物异常的性病门诊初诊患者,根据修订后的流程图,对其进行规范的病征处理。同时进行病原学诊断。资料输入微机,利用EPIINFO5软件进行分析。结果具有阴道分泌物异常病征的女性患者334例,病原学检查发现淋病27例(8.1%),沙眼衣原体感染57例(17.1%),两者合并感染18例(5.4%)。病征诊断淋病和(或)沙眼衣原体感染的敏感性为70.6%,特异性为54.7%,阳性预期值为40.7%,阴性预期值为80.9%。结论阴道分泌物异常病征处理的特异性和阳性预期值不够理想。阴道分泌物异常病征方案还需作多个地区、不同方法的进一步验证。

ObjectiveToevaluateourrevisedsyndromicalgorithmforthemanagementinpatientswithvaginaldischargeanddetermineitssensitivity,specificity,andpositivepredictivevalue(PPV).MethodsPatientswithvaginaldischargesyndromewereselectedintheirfirstvisitstotwoSTDclinicsinShanghaiandSichuan.Theyweremanagedaccordingtorevisedsyndromicflowcharts.Theetiologyofthesyndromewasdetectedbylaboratorytesting.ThedatawereanalyzedusingEPIINFOV5.0software.ResultsTherewere27(8.1%)patientswithgonorrhea,57(17.1%)withchlamydialinfection,and18(5.4%)withbothinfectionsin334patientswithvaginaldischarge.Thesensitivitywas70.6%,specificity54.7%,PPV40.7%,andnegativepredictivevalue(NPV)80.9%forthediagnosisofgonorrheaand/orchlamydialinfectionbysyndromicapproach.ConclusionThespecificityandPPVforsyndromicmanagementofvaginaldischargearenotsatisfied.Furthervalidationandrevisionareneededforsyndromicapproachesofvaginaldischarge.