生殖器溃疡病征处理修订方案的有效评价  

Evaluation of Syndromic Approach to the Management of Genital Ulcer Diseases

作　　者：王千秋[1] 谭美丽[2] 翦大明[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]上海市皮肤性病医院,上海200050 [3]四川省皮肤性病防治研究所,四川成都610031

出　　处：《中国皮肤性病学杂志》2003年第2期95-96,122,共3页The Chinese Journal of Dermatovenereology

摘　　要：目的　评价经修改的生殖器溃疡病征处理方案的有效性。方法　选择两家性病门诊就诊、具有生殖器溃疡表现的首诊患者 ,按病征处理原则进行处理。以复合PCR、暗视野显微镜检查及梅毒血清学试验作病原学诊断。结果　在 2 2 7例患者中 ,78( 3 4.4% )患有梅毒 ,43例 ( 18.9% )患有生殖器疱疹 ,2 8例 ( 12 .3 % )同时患梅毒和生殖器疱疹 ,78例 ( 3 4.4% )未检出病原体。未发现软下疳。病征诊断对于梅毒和生殖器疱疹的敏感性分别为 88.7%、69.0 % ,特异性95 .0 %、5 0 .0 % ,阳性预期值 94.0 %、3 8.6% ,阴性预期值 90 .6%、78.0 %。在 12 8例随访的患者中 ,总有效率为 89.0 %。结论　病征诊断对梅毒的敏感性尚不足 ,约有 10 %的梅毒患者被漏诊。对生殖器溃疡的病征处理方案仍需进一步修改和验证。由于在本组患者中未发现软下疳病例 ,因此在修改后的方案中目前不包含软下疳的治疗可能是可行的。Objective To evaluate a modified WHO syndromic management algorithm for patients with genital ulcer diseases(GUDs) presenting to STD clinics in China.Methods Patients with genital ulcers were enrolled at their first visit to two STD clinics,and were managed according to syndromic approach for GUDs.A multiplex PCR which detected T.pallidum,Herpes simplex and H.Ducreyi,dark field microscopy and syphilis serology(RPR and TPPA) were used for etiological diagnosis.Results 227 patients were enrolled.Syphilis alone was diagnosed in 78(34.4%),genital herpes alone in 43(18.9%),and both infections were present in 28(12.3%).No diagnosis was made in 78(34.4%) and no case of chancroid identified.The sensitivity of the algorithm for syphilis and genital herpes was 88.7% and 69.0% respectively,the specificity 95.0% and 50.0%,positive predictive values(PPVs) 94.0% and 38.6%,and negative predictive values(NPVs) 90.6% and 78.0%.In 128 patients that were followed-up,89% responded clinically to the recommended regimens.Conclusion As more than 10% of cases with syphilis were miss diagnosed,it is necessary that the WHO flowchart for GUDs should be revised and reevaluated.No chancroid was found in this group,so the decision to omit treatment for chancroid from the algorithm could be appropriate.

关 键 词：生殖器溃疡 病征处理 修订方案 有效评价 生殖器疱疹 梅毒 

分 类 号：R759.1[医药卫生—皮肤病学与性病学] R752.1[医药卫生—临床医学]