Improving Gram-Stained Reproducible Result by Further Adding Clue Cells in Diagnosing Bacterial Vaginosis

細菌性陰道炎的再現性診斷，除了藉由Spiegel和Nugent的判斷標準外，也許可再加上膿細胞或線索細胞來增加診斷率。本研究目的在於找出何種參考值可提供更理想的再現性。100個以Amsel 的判斷標準來診斷為細菌性陰道炎的病人被收集起來作為實驗組，另外收集100個來做子宮頸抹片的正常婦科門診病人做為對照組。以棉棒在陰道壁兩側轉動，然後做成兩片葛蘭氏染色之陰道抹片，包括原始片和複製片。三個技術員被要求判讀這些不同號碼的片子，而且不知他們可能會判讀二次的原始片。他們用兩種標準判讀細菌性陰道炎：Spiegel氏和Nugent氏的方法同一觀察者之一致性方面，不論實驗組或對照組最好的是線索細胞(kappa值0.708~1.000)，對細菌性陰道炎診斷的一致性方面，Nugent氏的方法優於Spiegel氏的診斷方法，各個觀察者間之一致性方面，不論實驗組和對照組最好的仍是線索細胞(kappa值：0.557~0.849)，其它如Lactobacillus , Gardnerella , Mobiluncus等細茵在判讀過時並無良好的一致性。以Amsel criteria 為標準來測定細菌性陰道炎與用Nugent criteria為標準來測定細菌性陰道炎，其敏感度為95.7%，精確度為55.4%，陰性預測值為62.1%，陽性預測值為85.1%。若以Nugent criteria或以clue cells其中之一都可診斷細菌性陰道炎時，其敏感度為95.7%，精確度為56.7%，陰性預測值為81.2%，陽性預測值為787.0%。可知增加線索細胞來評分會增加診斷的正確再現性，所以我們建議葛蘭氏染色抹片在診斷細菌性陰道炎時，若能加上線索細胞來評八會更優於Nugent criteria 和 Spiegel criteria。

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並列摘要

The reproducibility of interpretation in diagnosing bacterial vaginosis may be enhanced by adding pus cells and clue cells into two different criteria, developed by Spiegel et al. and Nugent et al. The purpose of study was designed to find out which parameter was more reproducible. 100 patients were collected with the diagnosis of bacteria) vaginosis as an experimental group, while the other 100 patients who were with routine Papanicolaou smears in gynecologic clinic the collected as a control group. Two slides, including the original and reproducible ones, were obtained from vaginal smears for each patient. Three technicians read the slides randomly by using two different criteria, plus pus cells and clue cells. This showed the agreement for clue cells is the best method regardless of experimental group or control group (Kappa values between 0.708 and 1.000). The intra-observer agreement for the diagnosis of bacterial vaginosis by the method of Nugent et al. is superior to the method of Spiegel et al. Our data show the comparison of Amsel criteria versus Nugent criteria for the diagnosis of bacterial vaginosis with sensitivity of 88.9%, specificity of 55.4 %, negative positive value of62.1 %, and positive predictive value of 85.8%. Moreover, our data also demonstrate the comparison of Amsel criteria versus the diagnosis either based on Nugent criteria or the presence of clue cells with sensitivity of 95.7%, specificity of 56.7%, negative positive value of 81.2%, and positive predictive value of 87.1 %. The results demonstrate further adding score of the clue cells can enhance the reproducible diagnosis of bacterial vaginosis, which is superior to the methods of Nugent et al and Spiegel et al.

並列關鍵字

bacteria vaginosis ； clue cell

國際替代計量

Improving Gram-Stained Reproducible Result by Further Adding Clue Cells in Diagnosing Bacterial Vaginosis

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