Thomason J L, Gelbart S M, Anderson R J, Walt A K, Osypowski P J, Broekhuizen F F
Department of Obstetrics and Gynecology, University of Wisconsin Medical Center, Milwaukee.
Am J Obstet Gynecol. 1990 Jan;162(1):155-60. doi: 10.1016/0002-9378(90)90839-y.
Bacterial vaginosis is the most common cause of vaginitis in women of reproductive age. In an attempt to clarify diagnosis of this condition, various parameters of signs and symptoms and groups of parameters were compared with classical diagnostic criteria in 310 patients. There was no significant difference in positive diagnosis rates between the Amsel et al. criteria and those of Thomason et al. (p = 0.25). The single most reliable indicator of bacterial vaginosis was the presence of clue cells on wet mount examination of vaginal secretions (sensitivity 98.2%, specificity 94.3%, positive predictive value 89.9%, negative predictive value 99.0%). The best two combinations of parameters for rapid accurate clinical diagnosis were clue cells and odor on alkalinization (sensitivity 99.5%) positive predictive value 98.8%, negative predictive value 92.1%). Gram stain criteria (bacterial morphologic types) were less accurate predictors of the disease (sensitivity 97.0%, specificity 66.2%, positive value 57.2%, negative predictive value 97.9%). Even when the bacterial morphologic type criteria were combined with presence of clue cells, predictive accuracy did not exceed that of clue cells on wet mount examination alone (sensitivity 93.9%, specificity 84.7%, positive predictive value 74.2%, negative predictive value 96.8%). Homogeneous discharge was found to be of little diagnostic value.
细菌性阴道病是育龄期女性阴道炎最常见的病因。为了明确该病的诊断，在310例患者中，将各种体征和症状参数及参数组与经典诊断标准进行了比较。阿姆塞尔等人的标准与托马森等人的标准在阳性诊断率上无显著差异（p = 0.25）。细菌性阴道病最可靠的单一指标是阴道分泌物湿片检查发现线索细胞（敏感性98.2%，特异性94.3%，阳性预测值89.9%，阴性预测值99.0%）。用于快速准确临床诊断的最佳两项参数组合是线索细胞和碱化后气味（敏感性99.5%，阳性预测值98.8%，阴性预测值92.1%）。革兰氏染色标准（细菌形态类型）对该病的预测准确性较低（敏感性97.0%，特异性66.2%，阳性值57.2%，阴性预测值97.9%）。即使将细菌形态类型标准与线索细胞的存在相结合，预测准确性也未超过单独进行阴道分泌物湿片检查时线索细胞的预测准确性（敏感性93.9%，特异性84.7%，阳性预测值74.2%，阴性预测值96.8%）。发现均匀性分泌物的诊断价值不大。
