Peipert J F, Boardman L, Hogan J W, Sung J, Mayer K H
Department of Obstetrics and Gynecology, Women & Infants' Hospital, Providence, Rhode Island, USA.
Obstet Gynecol. 1996 May;87(5 Pt 1):730-6. doi: 10.1016/0029-7844(96)00040-3.
To evaluate the diagnostic test characteristics of common tests used to diagnose upper genital tract infection.
Subjects included women who either met the Centers for Disease Control and Prevention's minimal criteria for acute pelvic inflammatory disease or who had other signs of upper genital tract infection (i.e., atypical pelvic pain, abnormal uterine bleeding, or cervicitis). The subjects were evaluated with a baseline interview, comprehensive laboratory testing, and either an endometrial biopsy or laparoscopy for definitive diagnosis of upper genital tract infection. Patients were considered positive for upper genital tract infection if they had any of the following findings: 1) histologic evidence of acute endometriosis or salpingitis, 2) laparoscopic visualization of purulent exudate in the pelvis without another source, or 3) positive testing for Neisseria gonorrhoeae or Chlamydia trachomatis from the endometrium, fallopian tubes, or pelvis.
One hundred twenty women with adequate endometrial samples were evaluated between August 1993 and September 1995. The median age of the study population was 24 years: 38% were white, 52% were smokers, 81% were insured by Medicaid or were uninsured, and 67% were single. Sensitivities for elevated white blood cell count (WBC), erythrocyte sedimentation rate, C-reactive protein, and increased vaginal white blood cells are 57, 70, 71, and 78%, respectively. If any one test is abnormal, the sensitivity is 100% and specificity is 18%. If all four tests are abnormal, sensitivity is 29% and specificity is 95%.
Testing for increased vaginal white blood cells was found to be the most sensitive laboratory indicator for upper genital tract infection, whereas serum WBC was the most specific. No one diagnostic laboratory test is pathognomonic for upper genital tract infection. Combinations of positive tests can improve diagnostic specificity and positive predictive value, but with a diminution of sensitivity and negative predictive value. Combinations of negative tests can reliably exclude upper genital tract infection.
评估用于诊断上生殖道感染的常见检测方法的诊断试验特征。
研究对象包括符合美国疾病控制与预防中心急性盆腔炎最低标准的女性，或有其他上生殖道感染迹象（即非典型盆腔疼痛、异常子宫出血或宫颈炎）的女性。通过基线访谈、全面实验室检测以及子宫内膜活检或腹腔镜检查对研究对象进行评估，以明确诊断上生殖道感染。如果患者有以下任何一项发现，则被认为上生殖道感染呈阳性：1）急性子宫内膜炎或输卵管炎的组织学证据；2）腹腔镜检查发现盆腔内有脓性渗出物且无其他来源；3）子宫内膜、输卵管或盆腔的淋病奈瑟菌或沙眼衣原体检测呈阳性。
1993年8月至1995年9月期间，对120名有足够子宫内膜样本的女性进行了评估。研究人群的中位年龄为24岁：38%为白人，52%为吸烟者，81%由医疗补助计划承保或未参保，67%为单身。白细胞计数（WBC）升高、红细胞沉降率、C反应蛋白以及阴道白细胞增多的敏感性分别为57%、70%、71%和78%。如果任何一项检测异常，敏感性为100%，特异性为18%。如果所有四项检测均异常，敏感性为29%，特异性为95%。
发现阴道白细胞增多检测是上生殖道感染最敏感的实验室指标，而血清白细胞计数是最具特异性的指标。没有一种诊断性实验室检测对上生殖道感染具有确诊意义。阳性检测结果的组合可提高诊断特异性和阳性预测值，但敏感性和阴性预测值会降低。阴性检测结果的组合可可靠地排除上生殖道感染。
