尿道分泌物病征处理有效性评价的研究  

Syndromic management of urethral discharge in patients with sexually transmitted diseases and evaluation

作　　者：王千秋[1] 翦大明[2] 谭美丽[3] 杨凭[1] 钟铭英[1] 王广聚[1] 

机构地区：[1]中国医学科学院,中国协和医科大学皮肤病研究所,江苏南京210042 [2]四川省皮肤性病防治研究所,四川成都610031 [3]上海市皮肤性病医院,上海200050

出　　处：《临床皮肤科杂志》2002年第3期155-157,共3页Journal of Clinical Dermatology

基　　金：中国-欧盟性病艾滋病防治培训合作项目科研基金

摘　　要：对尿道分泌物病征处理流程图进行有效性评价,以确定其敏感性、特异性、阳性预期值和成本-效益比。对290例具有尿道分泌物病征的男性性病门诊就诊者进行了性病病征处理,收集了完整的临床和实验室资料。在290例患者中,病原学检查发现淋病104例(35.9%),沙眼衣原体感染79例(27.2%),两者合并感染58例(20.0%)。对淋球菌感染来说,病征诊断未能识别13例淋球菌感染,因此其敏感性为92.0%;特异性为93.0%。病征诊断对衣原体感染的敏感性为100%。总的阳性预期值为83.1%。成本-效果分析结果显示,在尿道分泌物病征中,用病征处理则平均每一病人承担的费用为41.4元,用病原学诊断则为145.3元。尿道分泌物病征处理方案具有较高的敏感性和特异性,临床应用较适宜。病征处理是一种效果/成本比高的性病诊疗手段。This study was to evaluate syndromic algorithm for the management of patients with urethral discharge and to determine its sensitivity, specificity, positive predictive value and cost effectiveness in diagnosing sexually transmitted diseases. Patients with urethral discharge syndrome(290 cases) were selected in their first visits to two STD clinics in Shanghai and Sichuan. Of 290 cases 104(35.7%) patients had gonorrhea, 79(27.2%) had chlamydial infection, and 58(20.0%) had both infections. Syndromic diagnosis could not identify 13 cases of gonococcal infection;so the sensitivity for gonococcal infection was 92.0%;the specificity was 93.0%. The sensitivity for chlamydial infection was 100%. The total positive predictive value(PPV) was 83.1%. Cost effectiveness analysis indicated that the average cost of a patient with urethral discharge was 41.4 RMB Yuan by syndromic management, in comparison with 145.3 RMB Yuan by etiological management. The syndromic management of urethral discharge is relatively effective and suited to clinical application. Syndromic approach seems to be cost effective for the management of sexually transmitted diseases.

关 键 词：性传播疾病 尿道分泌物 病征处理 淋病奈瑟菌 沙眼衣原体 有效性评价 

分 类 号：R759[医药卫生—皮肤病学与性病学]