Nov mikroskopski metod za analizu preparata bojenog po Gramu u dijagnozi poremećaja vaginalne mikroflore

Dane B Nenadić; Miloš B Pavlović; Tatjana Motrenko

doi:10.2298/6256

Dane B Nenadić Department of Gynecology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
Miloš B Pavlović Dermatology Center Parmova & DCP-VENEX Centre, Ljubljana, Slovenia
Tatjana Motrenko Human Reproduction Center, Budva, Montenegro

DOI: https://doi.org/10.2298/6256

Ključne reči: vaginal smears||, ||vaginalni brisevi, microscopy||, ||mikroskopija, diagnosis||, ||dijagnoza, vaginosis, bacterial||, ||vaginoza, bakterijska,

Sažetak

Uvod/Cilj. Nugentov skor još uvek važi za zlatni standard u velikoj većini studija o proceni vaginalne flore i dijagnozi bakterijske vaginoze (BV). Cilj ovog rada bio je da se ustanovi da je mikroskopska analiza vaginalnog brisa preparata bojenog po Gramu na uvećanju ´200, brza i jednostavna tehnika, lako primenljiva u svakodnevnoj praksi i da bolje odražava kompleksnost vaginalne flore od metodologije po Nugentu. Metode. Preparati bojeni po Gramu kod 394 asimptomatske trudnice (24–28 nedelja trudnoće) klasifikovani su na osnovu Nugentovih mikroskopskih kriterijuma (imerzija, uvećanje ´1000). Slajdovi su ponovo analizirani pod imerzijom na uvećanju ´200. Na osnovu polukvantitativne procene broja (celularnost) i odnosa štapićastih (dužina > 1,5 µm) i malih bakterijskih formi (< 1.5 µm) sve ispitanice bile su podeljene u 6 grupa: hipercelularni (normal full – NF), srednje celularan (normal mid – NM), hipocelularan (normal empty – NE), „bacterial vaginosis full“ (BVF), „bacterial vaginosis mid“ (BVM), i „bacterial vaginosis empty“ (BVE). Takođe, identifikovane su gljivice, koke, bifido i lepto bakterijske forme kao i polimorfonuklearni leukociti (PMN). Rezultati. Na osnovu Nugentovih kriterijuma, BV nađena je kod 78 ispitivanih trudnica, intermedijerni nalaz kod 63, i gljivice kod 48. Na osnovu naših kriterijuma BV je potvrđena kod 88 ispitanica (37 BVF, 24 BVM, i 27 BVN). Generalno, oba pristupa pokazala su visoku podudarnost u dijagnozi BV (Linov koeficijent podudarnosti korelacije = 0,9852). Kod 40% žena pronađena je mešovita flora: gljivice kod 126 (32%), koke kod 145 (37%), bifido forme kod 32 (8%) i lepto forme kod 20 (5%). Skoro polovina žena sa BV imala je, takođe, gljivice (39/88). Povećan broj PMN je nađen kod 102 (33%) trudnica sa normalnim nalazom i kod 36 (41%) trudnica sa BV. Zaključak. Nova metodologija jednostavnija je za primenu i mnogo bolje odražava raznolikost vaginalne mikroflore. Ovakav pristup možda bi bio korisniji molekularnim biolozima i njihovim pokušajima da na osnovu kvantitativne lančane reakcije polimeraze (polymerase chain reaction – PCR) dođu do molekularne „formule“ za dijagnostiku BV.

Biografija autora

Dane B Nenadić, Department of Gynecology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia

potpukovnik, Načelnik dispanzera za ginekologiju VMA

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