Bakterijska vaginoza – dijagnostičke dileme i implikacije
Sažetak
Uvod/Cilj. Bakterijska vaginoza (BV) je najčešća vaginalna disbioza koja se karakteriše smanjenjem broja bakterija roda Lactobacillus spp. i povećanjem broja i vrsta različitih anaerobnih bakterija (Gardnerella vaginalis, Atopobium vaginae, Prevotella spp, Mobiluncus spp i dr.). BV može izazivati veliki broj ginekološlkih i opsteteričkih komplikacija i zbog toga je važno definisati tačne i pouzdane metode za njenu dijagnostiku. Cilj ove studije je bio poređenje rezultat različitih metoda za dijagnostiku BV.
Metode. U studiju je uključeno 235 uzoraka vaginalnih briseva pacijentkinja u reporoduktivnom periodu. Kao zlatni standard korišćeni su Nugentov kriterijumi čiji su rezultati upoređeni sa Amselovim, Ison/Hay kriterijumima kao i multipleks kvantitativnim RT PCR testom koji se bazira na detekciji i kvantifikaciji DNK prisutnih vrsta bakterija. Kappa koeficijent je koriščen kako mi se utvridilo slaganje između ovih metoda.
Rezultati. Naša analiza rezultata je pokazala vrlo dobro slaganje između Ison/Hay i Nugentovih kriterijuma (kappa = 0.95), dobro slaganje izmedju Amselovih i Nugentovih kriterijuma (kappa = 0.78) i umereno slaganje izmedju Nugenta i RT PCR za detekciju BV. Ukupno slaganje sa Nugentovim kriterijuma je 94.9%, 90.2% i 74%, respektivno. Nugentovom metodem je detektovan najveći broj intermedijarnih pacijenata-60 (25,2%). Najveći broj pacijenata sa BV detekovano je RT PCR metodom, dok je Amselovim kriterijumima utvrđen najveći broj normalnih nalaza.
Zaključak. Zaključili smo da je RT PCR najbolji izbor za dijagnostiku BV zato što efikasno diferencira pacijentkinje sa intermedijarnim nalazom. U poredjenju sa Amselovim i Nugnetovim kriterijumima koji dele pacijentkinje na 2 i 3 kategorije RT PCR prepoznaje i druga stanja vaginalne flore koja su važna za tačnu dijagnostiku i primenu boljeg terapeutskog pristupa u lečenju BV i prevenciji mogućih posledica ove disbioze.
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