不同微生物检验法对念珠菌性阴道炎患者阴道分泌物的检验效果对比

Comparison of different microbiological tests for vaginal secretions in patients with Candida vaginitis

目的研究革兰染色法、细菌培养法、聚合酶链反应(PCR)检测法对念珠菌性阴道炎患者阴道分泌物的检验效果。方法145例疑似念珠菌性阴道炎患者,均进行革兰染色法、细菌培养法、PCR检测法诊断及病理诊断,分析四种检验方法的诊断结果,并以病理诊断作为金标准,比较革兰染色法、细菌培养法、PCR检测法诊断念珠菌性阴道炎的阳性预测值、阴性预测值、灵敏度、特异度、准确度、约登指数、误诊率、漏诊率。结果病理诊断检出阳性141例,阴性4例;细菌培养法检出阳性134例,阴性11例;革兰染色法检出阳性136例,阴性9例;PCR检测法检出阳性135例,阴性10例。细菌培养法诊断念珠菌性阴道炎的阳性预测值为98.51%、阴性预测值为18.18%、灵敏度为93.62%、特异度为50.00%、准确度为92.41%、约登指数为0.4362、误诊率为50.00%、漏诊率为6.38%;革兰染色法诊断念珠菌性阴道炎的阳性预测值为98.53%、阴性预测值为22.22%、灵敏度为95.04%、特异度为50.00%、准确度为93.79%、约登指数为0.4504、误诊率为50.00%、漏诊率为4.96%;PCR检测法诊断念珠菌性阴道炎的阳性预测值为98.52%、阴性预测值为20.00%、灵敏度为94.33%、特异度为50.00%、准确度为93.10%、约登指数为0.4433、误诊率为50.00%、漏诊率为5.67%。三种检验方法诊断念珠菌性阴道炎的阳性预测值、阴性预测值、灵敏度、特异度、准确度、约登指数、误诊率、漏诊率比较,差异无统计学意义(P>0.05)。结论革兰染色法、细菌培养法、PCR检测法均可以实现对念珠菌性阴道炎患者阴道分泌物的检验,临床可以根据患者的实际情况灵活的选择这三种检验手段。

Objective To study the effectiveness of Gram staining method,bacterial culture method and polymerase chain reaction(PCR)assay in testing vaginal secretions of patients with Candida vaginitis.Methods All 145 patients suspected of Candida vaginitis were diagnosed by Gram staining,bacterial culture and PCR assay and pathological diagnosis.The diagnostic results of four tests were analyzed,and the positive predictive value,negative predictive value,sensitivity,specificity,accuracy,Youden's index,misdiagnosis rate and missed diagnosis rate of Gram staining,bacterial culture and PCR assay for detecting Candida vaginitis were compared using pathological diagnosis as the gold standard.Results There were 141 positive cases and 4 negative cases of Candida vaginitis by pathological diagnosis;134 positive cases and 11 negative cases by bacterial culture method;136 positive cases and 9 negative cases by Gram staining;135 positive cases and 10 negative cases by PCR assay.For the diagnosis of Candida vaginitis,acterial culture had a positive predictive value of 98.51%,a negative predictive value of 18.18%,a sensitivity of 93.62%,a specificity of 50.00%,an accuracy of 92.41%,a Youden's index of 0.4362,a misdiagnosis rate of 50.00%,and a missed diagnosis rate of 6.38%;Gram staining had a positive predictive value of 98.53%,a negative predictive value of 22.22%,a sensitivity of 95.04%,a specificity of 50.00%,an accuracy of 93.79%,a Yordon's index of 0.4504,a misdiagnosis rate of 50.00%,and a missed diagnosis rate of 4.96%;PCR assay test had a positive predictive value of 98.52%,a negative predictive value of 20.00%,a sensitivity of 94.33%,a specificity of 50.00%,an accuracy of 93.10%,a Yordon's index of 0.4433,a misdiagnosis rate of 50.00%,and a missed diagnosis rate of 5.67%.There was no statistically significant difference in the comparison of positive predictive value,negative predictive value,sensitivity,specificity,accuracy,Youden's index,misdiagnosis rate,and missed diagnosis rate among the three tests(P>0.05).Conclusion Gram staining,bacterial culture and PCR assay can be used to test the vaginal secretions of patients with Candida vaginitis,and these three tests can be chosen flexibly according to the actual situation of the patients.