Validation of a simplified grading of Gram stained vaginal smears for use in genitourinary medicine clinics
Validation of a simplified grading of Gram stained vaginal smears for use in genitourinary medicine clinics
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DOI：
10.1136/sti.78.6.413
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发表时间：
2002-12-01
影响因子：
3.6
通讯作者：
Hay, PE
中科院分区：
文献类型：
--
作者：
Ison, CA;Hay, PE
目的：根据公认的 Amsel 综合标准“金”标准，验证用于诊断细菌性阴道病 (BV) 的阴道液革兰氏染色涂片的简化分级方案。 方法：作为多中心研究的一部分，到泌尿生殖医学 (GUM) 诊所就诊的女性，如果满足以下三个或更多标准，则被诊断为患有 BV；均匀分泌物、阴道pH值升高、胺的产生以及“线索”细胞的存在。低于三个标准的女性被视为正常。同时，用阴道液进行涂片并进行革兰氏染色，然后定性评估为正常（I级）、中间（II级）或与BV一致（III级）。使用了两个新的等级，0级，仅上皮细胞，没有细菌，IV级，仅革兰氏阳性球菌。结果：使用综合标准在83/162名就诊的患者中诊断出BV，其余的被视为正常。大多数 BV 患者的涂片评估为 III 级（80/83，96%），大多数正常女性的涂片评估为 I 级（正常，48/79，61%），阳性（94.1%）和阴性（96%）测试具有高敏感性（97.5%）、特异性（96%）和预测值，kappa 指数 = 0.91。涂片评估为 II 级的患者主要 (12/13) 被诊断为正常，综合标准少于三个。 O 级和 IV 级均仅在正常女性中发现。结论：这种革兰氏染色涂片的简化评估可以用作 Amsel 标准的替代方法，并且更适用于繁忙的 GUM 诊所。
Objectives: To validate a simplified grading scheme for Gram stained smears of vaginal fluid for the diagnosis of bacterial vaginosis (BV) against the accepted "gold" standard of Amsel's composite criteria.Methods: Women attending genitourinary medicine (GUM) clinics, as part of a multicentre study, were diagnosed as having BV if three or more of the following criteria were present; homogeneous discharge, elevated vaginal pH, production of amines, and presence of "clue" cells. Women with less than three of the criteria were considered as normal. Simultaneously, smears were made of vaginal fluid and Gram stained and then assessed qualitatively as normal (grade I), intermediate (grade II), or consistent with BV (grade III). Two new grades were used, grade 0, epithelial cells only with no bacteria, and grade IV, Gram positive cocci only.Results: BV was diagnosed in 83/162 patient visits using the composite criteria, the remainder being regarded as normal. The majority of patients with BV had a smear assessed as grade III (80/83, 96%) and the majority of normal women had a smear assessed as grade I (normal, 48/79, 61%), giving a high sensitivity (97.5%), specificity (96%), and predictive value for a positive (94.1%) and negative (96%) test, kappa index = 0.91. Smears assessed as grade II were found predominantly (12/13) among patients diagnosed as normal, with less than three of the composite criteria. Grades O and IV were both only found among normal women.Conclusion: This simplified assessment of Gram stained smears can be used as an alternative to Amsel's criteria and is more applicable for use in busy GUM clinics.