Pastore Lisa M, Thorp John M, Royce Rachel A, Savitz David A, Jackson Tracy P
Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC 27517-9212, USA.
J Perinatol. 2002 Mar;22(2):125-32. doi: 10.1038/sj.jp.7210654.
Develop a clinical risk score to screen for antenatal bacterial vaginosis (BV), irrespective of symptoms.
Cohort study of 913 pregnant women with last menstrual periods between January 30, 1995 and February 22, 1997. BV was evaluated by Nugent-scored vaginal smears (scores of 7 to 10 considered positive) between 24 and 29 weeks' gestation. Forty-four potential risk factors were assessed.
17.8% of women had BV, of whom 22% were screened for BV by the usual care provider. Logistic regression-adjusted analyses found six predictors: vaginal pH>4.5 (OR=11.6, 95% confidence interval [CI] [7.8, 17.2]); black race (OR=1.9, 95% CI [1.3, 2.8]); condom use during pregnancy (OR=1.6, 95% CI [1.0, 2.5]); antenatal BV (OR=1.7, 95% CI [1.0, 2.8]); absence of sperm on smear (OR=1.7, 95% CI [1.0, 2.9]); and no history of sexually transmitted diseases (OR=1.6, 95% CI [1.0, 2.5]). Risk score weights were 5 for an elevated vaginal pH and 1 otherwise. The sensitivity and specificity of screening women with scores > or =4 were both 77%; this would involve screening 33% of patients.
Approximately 80% of our BV cases were asymptomatic, emphasizing the need for objective risk assessment. Using six factors, clinicians can identify pregnant women at risk for BV.
制定一种临床风险评分，用于筛查产前细菌性阴道病（BV），无论有无症状。
对1995年1月30日至1997年2月22日末次月经的913名孕妇进行队列研究。在妊娠24至29周期间，通过Nugent评分阴道涂片评估BV（评分7至10视为阳性）。评估了44个潜在风险因素。
17.8%的女性患有BV，其中22%由常规护理提供者进行了BV筛查。逻辑回归调整分析发现六个预测因素：阴道pH>4.5（比值比[OR]=11.6，95%置信区间[CI][7.8,17.2]）；黑人种族（OR=1.9，95%CI[1.3,2.8]）；孕期使用避孕套（OR=1.6，95%CI[1.0,2.5]）；产前BV（OR=1.7，95%CI[1.0,2.8]）；涂片上无精子（OR=1.7，95%CI[1.0,2.9]）；无性传播疾病史（OR=1.6，95%CI[1.0,2.5]）。阴道pH升高时风险评分为5，否则为1。评分≥4的女性筛查的敏感性和特异性均为77%；这将涉及筛查33%的患者。
我们的BV病例中约80%无症状，强调了客观风险评估的必要性。利用六个因素，临床医生可以识别有BV风险的孕妇。
