不孕女性生殖道UU,CT,NG和MG感染状况分析及不同检测方法结果比较

Analysis of UU,CT,NG and MG in Infertile Women and Comparison of Different Detection Methods

目的分析不孕症女性生殖道常见微生物的分布状况,比较核酸恒温扩增检测技术(SAT)与培养法或乳胶法解脲支原体(UU)、沙眼衣原体(CT)、淋病奈瑟菌(NG)和生殖支原体(MG)检出的差异。方法 2016年6月~9月于南京医科大学附属苏州医院生殖中心就诊的467例女性不孕患者,年龄20~48(31.52±6.83)岁,分析UU,CT,NG和MG的感染分布状况。选择其中352例行辅助生殖技术的女性患者,年龄21~46(30.67±6.67)岁,取生殖道拭子标本,一份以培养法或乳胶法检测UU或CT。另一份用SAT法进行检测,根据实验结果评估两种方法检测相应微生物的敏感度和特异度差异。结果 467例不孕女性生殖道拭子检测结果中UU阳性率最高62.53%(292/467),CT阳性率1.93%(9/467),NG阳性率0.21%(1/467),MG阳性率1.71%(8/467)。与正常对照组[23.81%(25/105)]相比不孕女性组UU感染率更高(χ~2=52.01,P<0.01)。对352例行辅助生殖技术的不孕女性患者用不同检测方法检测UU,CT,UU拭子培养的阳性率为48.9%,UU-SAT检测阳性率为63.9%,SAT法阳性率高于培养法。拭子培养和SAT检测结果经配对四格表χ~2检验,差异具有统计学意义(χ~2=41.93,P<0.01),显示SAT法检测UU具有更高的敏感度。CT-SAT检测阳性率为1.71%,CT乳胶法检测阳性率为0.28%。乳胶法检测结果与SAT结果相比差异具有统计学意义(Fisher确切概率法统计分析,P<0.05),SAT阳性率和敏感度更高。结论不孕女性生殖道常见病原体以UU最为多见,其次为CT和MG。SAT法与培养法或乳胶法检测UU和CT相比较,前者具有更高的敏感度。

Objective To analyze the distribution of pathogens in the genital tract of infertile female,and comparing traditional methods with simultaneous amplification and testing（SAT）in the detection of UU,CT,NG and MG.Methods 467 female infertility patients were selected from the reproductive center of Suzhou Hospital Affiliated to Nanjing Medical University between June and September 2016 to analyze the distribution of UU,CT,MG and NG.The age was between 20 to 48 years old（mean 31.52±6.83 years old）.352 cases of female patients with assisted reproductive technology were selected,aged from 21 to 46 years old（mean 30.67±6.67 years old）.The swabs were tested by traditional methods or SAT.The sensitivity and specificity of the methods in detecting the pathogens were evaluated according to the experimental results.ResultsAmong the 467 infertile women,the number of UU positive cases was the highest,the positive rate was 62.53%（292/467）,the positive rate of CT was 1.93%（9/467）and the positive rate of NG was 0.21%（1/467）,and the positive rate of MG was 1.71%（8/467）.UU infection rate was higher in infertile women than normal control group 23.81%（25/105）（χ~2=52.01,P〈0.01）.352 cases of female patients with assisted reproductive technology were selected for further analysis.For UU detection,the positive rate of swab samples detected by liquid culture was 48.9%,while the positive rate detected by SAT was 63.9%.Obviously the positive rate of SAT was higher than that of liquid culture.Swab culture and SAT results were analyzed by pairedχ2 test（χ2=41.93,P〈0.01）.The positive rate of CT-SAT was 1.71%,and the positive rate of CT-latex method was 0.28%.There was significant difference between CT latex method and SAT（Fisher exact probabilistic method statistical analysis,P〈0.005）,which indicated that SAT method had a higher sensitivity.The positive rate（1.7%）and sensitivity（100%）of SAT were also higher than that of traditional method.Conclusion UU was the most common pathogen in female reproductive tract pathogens,followed by CT and MG.The SAT method has higher sensitivity than the conventional method in detecting of UU and CT.