阴道分泌物念珠菌感染检测方法对比分析

Comparative analysis on candida infection detection methods of vaginal secretion

目的分析常规镜检、荧光PCR核酸扩增法和真菌显色培养法在阴道分泌物真菌检测结果的相关性。方法选取2014-2016年于该院就诊的疑似阴道炎患者,收集镜检阴道分泌物真菌阳性和阴性标本各500例,用荧光PCR核酸扩增法鉴定念珠菌类型,并将100份荧光PCR核酸扩增法检测结果阳性标本进行真菌微生物培养,验证分型结果的正确率。结果荧光PCR核酸扩增法和常规镜检一致性检验Kappa值为0.632,二者一致性差。500例患者阴道分泌物常规镜检阳性标本,荧光PCR核酸扩增法测得白色念珠菌感染382例(76.4%),光滑假丝酵母菌感染73例(14.6%),热带假丝酵母菌感染10例(2.0%),白色念珠菌合并光滑假丝酵母菌感染3例(0.6%),其他真菌感染32例(6.4%)。500例患者阴道分泌物常规镜检阴性标本,荧光PCR核酸扩增法鉴定阳性共152例,其中白色念珠菌130例,光滑假丝酵母菌16例,热带假丝酵母菌6例。荧光PCR核酸扩增法与CHROMAgar快速显色法检测结果比较,差异无统计学意义(χ2=0.131,P=0.936)。结论对于有临床表现而镜检阴性的患者,建议行荧光PCR核酸扩增快速分型鉴定或真菌培养鉴定。

Objective To analyze the correlation among 3 kinds of detection methods of routine microscopic examination,fluorescence PCR nucleic acid amplification and fungal color culture in the fungal detection of vaginal secretion. Methods The patients with suspected vaginitis treated in this hospital during 2014--2016 were selected. Each 500 cases of negative and positive vaginal secretion samples by microscopic examinanon were collected. The candida types were identified by using the fluorescence PCR nucleic acid amplification, then 100 samples with the positive results of fluorescence PCR nucleic acid amplification for detecting fungal were performed the fungal microbial culture to verify the accuracy rate of typing results. Results The Kappa value of consistency test between fluorescence PCR nucleic acid amplification and routine microscopic examination was 0. 632, the consistency between them was poor. Among 500 positive samples of vaginal secretion detected by routine microscopic examination, 382 cases （76.4 % ） of Candida albiCans infection were detected by fluorescence PCR nucleic acid amplification, 73 cases （14.6 %） were Candida glabrata infection, 10 cases （2.0%） were Candida tropicalis infection, 3 cases （0.6 %） were Candida albicans combined Candida glabrata infection and 32 cases （6.4 %） were other fungal infection. Among 500 negative samples by conventional microscopic examination, 152 positive cases were identified by fluorescence PCR nucleic acid amplification, including 130 cases of Candida albicans, 16 cases of Candida gtabrata and 6 cases of Candida tropicalis. There was no statistical significant difference in positive rate between the fluorescence PCR nucleic acid amplification and CHROMAgar rapid color method （x2 = 0. 131, P= 0. 936）. Conclusion For the patients with clinical manifestations and negative microscopic examination results, it is recommended to conduct fluorescence PCR nucleic acid amplification rapid type identification or fungal culture identification.