男性尿道不同样本中淋病奈瑟菌和沙眼衣原体的检出率分析

Prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis in different samples obtained from male urethra

目的应用荧光探针PCR技术比较尿液和尿道拭子用于检测性病门诊男性患者泌尿生殖道淋病奈瑟菌(Neisseria gonorrhoeae,NG)和沙眼衣原体(Chlamydia trachomatis,CT)的阳性率和一致性,探究尿液样本是否能替代尿道拭子作为检测NG和CT的样本。方法收集2021年1—4月上海市皮肤病医院性病门诊147例男性患者的尿道拭子和尿液样本,采用荧光探针PCR法检测尿道拭子、尿液、尿沉渣和尿上清液NG-DNA和CT-DNA。选取NG或CT阳性的尿液,保存于4℃,在不同时间段检测分析样本中NG-DNA、CT DNA及其稳定时间。结果NG-DNA在尿道拭子、尿液、尿沉渣和尿上清液中的阳性率分别为25.2%(37/147)、21.8%(32/147)、24.5%(36/147)和17.7%(26/147)。尿道拭子与尿液样本检测NG-DNA的阳性率无统计学差异(χ^(2)=0.02,P=0.89),两者检测结果符合率为92.5%(136/147),且一致性较好(Kappa=0.80,P<0.01)。CT-DNA在尿道拭子、尿液、尿沉渣和尿上清液中的阳性率分别为9.5%(14/147)、10.9%(16/147)、10.9%(16/147)和10.2%(15/147)。尿道拭子和尿液样本检测CT-DNA的阳性率无统计学差异(χ^(2)=0.15,P=0.70),两者检测结果符合率为95.9%(141/147),且一致性较好(Kappa=0.78,P<0.01)。结论尿液样本可替代尿道拭子用于男性患者泌尿生殖道NG和CT检测,其中尿沉渣NG阳性率高于尿液及尿上清液。

Objective This study aims to compare the prevalence of Neisseria gonorrhoeae(NG)and Chlamydia trachomatis(CT)detected by fluorescent PCR with urine and urine swab and to examine whether urine could be served as a non-invasive alternative of urine swab for the tests of NG and CT.Methods The urine and urethral swabs taken from 147 male patients were collected in the sexually transmitted disease(STD)clinic at Shanghai Skin Disease Hospital during the period from January through April,2021.The NG-DNA and CT-DNA in urethral swabs,urine,urine sediment,and urine supernatant were detected by fluorescent PCR,respectively.The NG-or CT-positive urine samples were stored at 4℃and NG-DNA or CT-DNA were detected at different time points to investigate their stability.Results The prevalence rate of NG-DNA was 25.2%(37/147)in urethral swabs,21.8%(32/147)in urine,24.5%(36/147)in urine sediment,and 17.7%(26/147)in urine supernatant.No significant difference was found between urine and urethral swab(χ^(2)=0.02,P=0.89).Furthermore,the results were consistent between urine and urethral swabs(Kappa=0.80,P<0.01)with an agreement rate of 92.5%(136/147).The prevalence rate of CT was 9.5%(14/147)in urethral swabs,10.9%(16/147)in urethral,10.9%(16/147)in urine sediment,and 10.2%(15/147)in urine supernatant.No significant difference was found between urine and urethral swab(χ^(2)=0.15,P=0.70).The results were consistent between urine and urethral swabs(Kappa=0.78,P<0.01)with an agreement rate of 95.9%(141/147).Conclusions Urine is a relatively non-invasive alternative of urethral swabs for the tests of NG and CT in men.Urine sediment is superior to urine and urine supernatant for detection of NG and CT.