治疗前后加德纳菌载量对细菌性阴道病患者复发风险的预测价值  

Predictive value of Gardnerella′s load before and after treatment for the risk of recurrence of bacterial vaginitis

作　　者：钟汇 陈惠瑜[1] 邱华红[1] 方娇宁[2] 吴志辉[1] ZHONG Hui;CHEN Huiyu;QIU Huahong;FANG Jiaoning;WU Zhihui(Department of Clinical Laboratory,Fujian Provincial Maternity and Children′s Hospital,Fuzhou,Fujian 350001,China)

机构地区：[1]福建省妇幼保健院检验科,福建福州350001 [2]福建省妇幼保健院妇产科,福建福州350001

出　　处：《中国微生态学杂志》2019年第10期1174-1177,1198,共5页Chinese Journal of Microecology

摘　　要：目的评价治疗前后加德纳菌载量预测细菌性阴道病(bacterial vaginosis,BV)患者复发风险的临床价值。方法将2017年1月至2018年1月于我院就诊的312例BV患者纳入研究,根据治疗后BV是否复发分为复发组(114例)及未复发组(198例),分别比较两组患者治疗前后阴道分泌物的pH值、Nugent评分、乳杆菌数量和加德纳菌载量,并应用受试者工作曲线(ROC)对上述指标预测BV复发的诊断价值及诊断效能进行评价。结果治疗前及治疗后复发组患者的pH值(t=2.187、3.822,均P<0.05)、Nugent评分(t=1.976、5.611,均P<0.05)、加德纳菌载量(t=5.089、16.204,均P<0.05)均明显高于未复发组,乳杆菌数量(t=8.245、8.899;均P<0.05)明显低于未复发组;多因素Logistic回归分析显示治疗后阴道分泌物Nugent评分及加德纳菌载量均是BV复发的独立危险因素,而乳杆菌数量为保护因素;对上述指标预测BV复发的相关性进行分析,ROC曲线显示,加德纳菌载量预测BV复发的AUC为0.892,明显高于pH值、Nugent评分、乳杆菌数量(AUC=0.580、0.648、0.772),诊断最佳截点为<1.761×10^5 copy/mL,此时的敏感性和特异性分别为93.5%和75.4%。结论BV患者治疗后的加德纳菌载量在预测其复发方面具有较高的敏感性及特异性,可用于预测BV复发。Objective To evaluate the clinical value of Gardnerella′s load before and after treatment in predicting the risk of recurrence of bacterial vaginosis(BV).Methods A total of 312patients with BV admitted to our hospital from 2017.01to 2018.01were divided into recurrence group(114cases)or non-recurrence group(198cases)according to the recurrence of BV after treatment.The pH value,Nugent score,Lactobacillus amount and Gardnerellaload of vaginal secretions before and after treatment were measured,and the diagnostic value and diagnostic efficacy of the above indicators for predicting BV recurrence were evaluated using the receiver operating curve(ROC).Results The pH values of patients before and after treatment(t=2.187,3.822;all P<0.05),Nugent scores(t=1.976,5.611;all P<0.05)and Gardnerella′s load(t=5.089,16.204;all P<0.05)were significantly higher in recurrence group than in non-recurrence group,while the amount of Lactobacillus(t=8.245,8.899;all P<0.05)was significantly lower than in non-recurrence group.Multivariate logistic regression analysis showed that Nugent score and Gardnerella load after treatment were independent risk factors for BV recurrence,while the amount of Lactobacillus was aprotective factor.As to the correlation between the above indicators and BV recurrence,ROC curve showed that the AUC of Gardnerellaload for prediction of BV recurrence was 0.892,significantly higher than pH value,Nugent score and Lactobacillus amount(AUC=0.580,0.648,0.772respectively),and the optimal cut-off point was<1.761×10^5 copy/mL with the sensitivity and specificity being 93.5%and 75.4%respectively.Conclusion The Gardnerella′s load after treatment has high sensitivity and specificity in predicting recurrence of BV and can be used to predict BV recurrence.

关 键 词：加德纳菌 细菌性阴道病 复发 预测价值 

分 类 号：R711.31[医药卫生—妇产科学]