Quinlivan J A, Petersen R W, Gurrin L C
Department of Obstetrics and Gynaecology, University of Western Australia, and King Edward Memorial Hospital, Perth.
Aust N Z J Obstet Gynaecol. 1998 Aug;38(3):254-7. doi: 10.1111/j.1479-828x.1998.tb03060.x.
A prospective cohort of pregnant adolescent patients who planned to deliver at 1 of 3 Perth metropolitan hospitals was studied; 1 subgroup of this cohort was offered universal screening for cervical chlamydial infection and Pap-smear abnormalities (screened), and the remainder of the cohort were offered screening at the discretion of the attending medical staff (control). High prevalences of both chlamydial infection (27%) and Pap-smear abnormalities (38%) were detected in the screened cohort. The majority of Pap-smear abnormalities were inflammatory atypia, but high-grade Bethesda lesions were also diagnosed. In the control group, the prevalence of positive swabs and abnormal Pap-smear reports in those tested was also high (22% and 35% respectively), but significantly fewer patients were tested (18% and 33% respectively in the control group, compared to 92% and 94% in the screened group; both p<0.001). Screening and treatment of chlamydia was associated with a significant decrease in the incidence of newborn febrile morbidity (10% versus 25%; p=0.02). In view of the high prevalence of positive results, it is cost-effective to offer universal screening in this setting. Failure to introduce a specific screening policy can result in a significant number of patients being denied the advantages of diagnosis and treatment.
对一组计划在珀斯市3家医院之一分娩的怀孕青少年患者进行了前瞻性队列研究；该队列中的1个亚组接受了宫颈衣原体感染和巴氏涂片异常的普遍筛查（筛查组），队列中的其余患者由主治医务人员酌情决定是否进行筛查（对照组）。在筛查组中检测到衣原体感染（27%）和巴氏涂片异常（38%）的高患病率。大多数巴氏涂片异常为炎性异型性，但也诊断出高级别贝塞斯达病变。在对照组中，检测呈阳性拭子和巴氏涂片报告异常的患病率也很高（分别为22%和35%），但接受检测的患者明显较少（对照组分别为18%和33%，而筛查组为92%和94%；p均<0.001）。衣原体的筛查和治疗与新生儿发热发病率的显著降低相关（10%对25%；p=0.02）。鉴于阳性结果的高患病率，在这种情况下进行普遍筛查具有成本效益。未能引入特定的筛查政策可能导致大量患者无法获得诊断和治疗的益处。
