Nugent评分方法技术改良及在细菌性阴道病诊断中的应用评价

Technical improvement of Nugent scoring method and evaluation of its application in the diagnosis of bacterial vaginosis

目的针对Nugent评分方法在采样检测过程中的不定量、不精准带来的诊断结果差异的问题,建立改良细菌性阴道病(BV)的分泌物涂片的定量检测方法,通过与传统采样方法的诊断结果进行比较,探讨分析前操作规范在Nugent评分方法诊断BV的重要作用。方法通过选取不同重量的阴道分泌物在规定的面积下进行涂布,对菌群镜下分布情况进行评价,制定标准化阴道分泌物取样及涂片方案,建立改良BV诊断方法。随机选取233例女性作为研究对象,分别使用改良方法及传统方法同步进行检测,比较两种方法在菌群密集度、多样性、Nugent评分的差异,并对这两种方法进行方法学评价。结果建立改良方法为取样一平勺(约重0.01 g),涂片面积20 mm×20 mm。改良方法与传统方法的菌群密集度比较,差异有统计学意义(P<0.05);改良方法与传统方法多样性比较,差异有统计学意义(P<0.05);改良方法与传统方法Nugent评分结果比较,差异有统计学意义(P<0.05)。改良方法与传统方法对BV的诊断结果比较,差异有统计学意义(P<0.05)。两种方法的方法学评价结果显示,改良方法优于传统方法(P<0.05)。结论建立分析前的定量操作规范,是对Nugent评分标准在诊断细菌性阴道病的准确性的前提条件,改良方法的建立和使用可提高BV诊断的一致性和准确性。

Objective To establish a quantitative detection method of modified bacterial vaginosis(BV)secretion smear,and to compare the diagnostic results with traditional sampling methods to explore the important role of pre⁃analytical practice in the diagnosis of BV by Nugent scoring method.Methods Our improved BV diagnosis method was established by developing a standardized vaginal secretion sampling and smear plan after selecting vaginal secretions of different weights and spreading them under a prescribed area and then evaluating the distribution of the microflora.A total of 233 women were randomly selected as the research subjects,and the improved method and the traditional method were used for simultaneous detection.The differences in bacterial density,diversity and Nugent score of the two methods were compared,and the methodological evaluation of the two methods was carried out.Results The improved method was established by sampling a flat spoon(about 0.01 g in weight)with a smear area of(20×20)mm.There was a statistically significant difference in bacterial density between the improved method and the traditional method(P<0.05).There was a statistically significant difference in diversity between the improved method and the traditional method(P<0.05);the Nugent score between the improved method and the traditional method showed a statistically significant difference(P<0.05).There was a statistically significant difference in the diagnostic results of BV between the improved method and the traditional method(P<0.05).The methodological evaluation results of the two methods showed that the improved method was superior to the traditional method(P<0.05).Conclusion Establishing the quantitative operation specification before analysis is the precondition for the accuracy of Nugent scoring standard in diagnosing bacterial vaginosis.The establishment and use of improved methods can improve the consistency and accuracy of BV diagnosis.