Dijagnoza bakterijske vaginoze: poređenje Nugent-ove i nove mikroskopske metode

Dane Nenadic; Snezana; Miloš Pavlović; Dejan  Baskic

doi:10.2298/VSP200405105N

Dane Nenadic Military Medical Academy, Department of Gynecology, Belgrade, Serbia
Snezana University Clinical Center of Kragujevac, Department of Microbiology, Kragujevac, Serbia
Miloš Pavlović Infinity Family Medicine Clinic, Dubai, UAE
Dejan Baskic University of Kragujevac, Faculty of Medical Sciences, Center for Molecular Medicine and Stem Cell Research, Kragujevac, Serbia

DOI: https://doi.org/10.2298/VSP200405105N

Keywords: dijagnoza;, mikroskopija;, vaginalni brisevi;, vaginoza, bakterijska.

Abstract

Uvod/Cilj. Bakterijska vaginoza (BV) je čest uzrok vaginalne nelagodnosti kod žena. Cilj ovog istraživanja bio je poređenje Nugent-ovog sistema vrednovanja mikroskopskih preparata i nove mikroskopske metode koju smo uveli u našoj laboratoriji radi dijagnoze BV. Metode. Istraživanjem je obuhvaćeno 705 asimptomatskih trudnica između 24. i 28. nedelje trudnoće. Stepen slaganja između metoda je određivan kappa (κ) indeksom. Senzitivnost, specifičnost, pozitivna i negativna prediktivna vrednost nove mikroskopske metode su poređene sa Nugent-ovom metodom kao standardom. Rezultati. Na osnovu sistema vrednovanja obe metode, po Nugent-u i nove mikroskopske metode, BV je dijagnostikovana kod 21%, i 25% žena, redom. Bez obzira na razlike između dijagnostičkih kriterijuma, koje su se uglavnom odnosile na klasifikaciju intermedijarnih rezultata, stepen slaganja između kategorija, određen kappa indeksom, bio je zadovoljavajući: Nugent-ov i novi mikroskopski metod su pokazali dobro slaganje (κ = 0,68), dok su Nugent-ov i novi mikroskopski metod bez intermedijarnih rezultata, pokazali veoma dobro slaganje (κ = 0,83). Takođe, pokazali smo da je u poređenju sa Nugent-ovom metodom, kao zlatnim standardom, nova mikroskopska metoda imala

visoku senzitivnost i specifičnost (od 75% do 99,3%), kao i dobru pozitivnu i negativnu prediktivnu vrednost (od 88,8% do 99,5%). Naša metoda je bazirana na relativnom broju bakterijskih morfotipova, bilo štapićastih formi (˃ 1,5 μm, lactobacilli), ili neštapićastih formi (< 1,5 μm, bakterije udružene sa BV) pod 200× uvećanjem, što povećava površinu preparata koji se pregleda, ali bez produžavanja vremena za koje posmatrač pregleda preparat. Zaključak. Nova mikroskopska metoda se dobro podudarila sa Nugent-ovim sistemom skorovanja ukazujući na to da se može koristiti kao alternativna mikroskopska metoda u dijagnostici BV. Novi mikroskopski metod je baziran na relativnom broju bakterijskih morfotipova i pokazao se fleksibilnim u smislu reorganizovanja tako da se sve kategorije uzoraka klasifikuju u samo dve grupe: normalan nalaz i BV, što ga čini komparabilnim dihotomnom kliničkom kriterijumu po Amsel-u.

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