不同方法对外阴阴道假丝酵母菌病的检出效果  

Performance evaluation of different methods for the detection of Candida vulvovaginalis

作　　者：董一红 王丽芳[2] 张梦 车冬丽[1] 王雪 高萱 王迎辰 李格[1] 刘勍 李佩[1] 张岩[1] 谭延国[1] DONG Yihong;ZHANG Meng;WANG Lifang;CHE Dong Li;WANG Xue;GAO Xuan;WANG Yingchen;LI Ge;LIUQing-;LI Pei;ZHANG Yah;TAN Yanguo(Department of Clinical Laboratory;Department of Obstetrics and Gynecology,Fuxing Hospital Affiliated to Capital Medical University,Beijing 100038,China)

机构地区：[1]首都医科大学附属复兴医院检验科,北京100038 [2]首都医科大学附属复兴医院妇产科,北京100038

出　　处：《国际检验医学杂志》2018年第23期2869-2872,共4页International Journal of Laboratory Medicine

摘　　要：目的探讨湿片镜检、革兰染色镜检、阴道炎干化学五联检、阴道炎抗原三联检、核酸杂交和真菌培养等方法对阴道分泌物标本中外阴阴道假丝酵母菌(即念珠菌)的检出效果。方法同时使用上述方法检测211例阴道分泌物标本,并以真菌培养法为金标准对数据进行统计分析。结果湿片镜检、革兰染色镜检、阴道炎干化学五联检、阴道炎抗原三联检及核酸杂交法检测外阴阴道假丝酵母菌(即念珠菌)的灵敏度分别为43.48%、58.70%、63.04%、34.78%和71.74%,特异度分别为98.79%、98.18%、79.39%、96.36%和98.79%,诊断符合率分别为86.73%、89.57%、75.83%、82.94%和92.89%;5种方法分别与真菌培养法比较,Kappa值(一致性检验)分别为0.521、0.650、0.374、0.384和0.772;相对于真菌培养法,曲线下面积(AUC)分别为0.711、0.784、0.712、0.656和0.853,核酸杂交法AUC值最大,阴道炎抗原三联检AUC值最小;5种方法总符合率为60.66%。结论 5种方法中,核酸杂交法对念珠菌的检出效果最佳,革兰染色镜检法和湿片镜检法次之,阴道炎干化学五联检、阴道炎抗原三联检效果很不理想,不建议单独使用;5种方法间总体符合率非常低,不建议不同实验室和不同方法间进行比较。Objective To explore the performance of different methods including wet-film microscopy,Gram staining microscopy,dry-chemistry based five joint tests,vaginitis pathogenic antigen based triplet tests,nucleic acid hybridization based method and fungal culture,for the detection of Candida in patients with Candida vulvovaginalis（Candida）.Methods 211 vaginal secretions specimens were tested simutaneously for the existence of Candida with the methods menthioned above.Their performance was evaluated by comparing with fungal culture method,which serves as the golden standard.Results The sensitivity of the five methods（wetfilm microscopy,Gram staining microscopy,dry-chemistry based five joint tests,vaginitis pathogenic antigen based triplet tests,nucleic acid hybridization based method and fungal culture）,was 43.48%,58.70%,63.04%,34.78% and 71.74%,respectively,their specificity was 98.79%,98.18%,79.39%,96.36% and98.79%,respectively,and their diagnostic conformity rates were 86.73%,89.57%,75.83%,82.94%,and92.89%,respectively.In comparison with fungal culture method,the Kappa values（consistency test）were0.521,0.650,0.374,0.384 and 0.772,respectively,the area under the curve（AUC）was 0.711,0.784,0.712,0.656 and 0.853,respectively,and the total conformity rate of all of the five methods was 60.66%.Conclusion For the detection of Candida,the performance of nucleic acid hybridization based method is the best among 5 methods evaluated,followed by Gram staining microscopy and wet-film microscopy,but the performance of dry-chemical quintuple examination of vaginitis and triple detection of vaginitis antigen were very poor,which are not recommended to be used alone.Since the overall conformity rate among the five methods is very low,it is meaningless to compare results obtained by different methods across different laboratories.

关 键 词：念珠菌病 外阴阴道 酵母菌属 内窥镜检查 染色与标记 核酸杂交 

分 类 号：R446.5[医药卫生—诊断学]