使用新一代分子檢測法BD MAX Vaginal Panel進行陰道炎診斷之評估

Evaluation of BD MAX Vaginal Panel, a New Molecular Method for the Diagnosis of Vaginitis

陰道炎為女性常見的感染症之一，其臨床症狀為搔癢、異常分泌物或異味。其中細菌性陰道炎為最常見的陰道炎，其次是念珠菌陰道炎及滴蟲陰道炎。BD MAX系統的陰道炎試劑套組可針對細菌性陰道炎、念珠菌陰道炎及滴蟲陰道炎中常見的致病原進行分子檢測，提供細菌性陰道炎、念珠菌屬、克魯斯念珠菌、光滑念珠菌與陰道滴蟲等5種結果。本實驗收集100份臨床檢體，以革蘭氏染色鏡檢Nugent score與BD MAX陰道炎試劑套組進行測試，並與傳統細菌培養結果比對。結果顯示100份檢體以BD MAX陰道炎檢測套組共檢測出14例細菌性陰道炎陽性，13例念珠菌屬陽性，3例平滑念珠菌陽性。而其中4例為細菌性陰道炎混和念珠菌感染，1例為念珠菌屬與平滑念珠菌混和感染，共有5例存在多重陽性結果。且14 例細菌性陰道炎陽性檢體與鏡檢評分結果一致性為78.6% (11/14)，而檢測細菌性陰道炎之陰性結果與染色評分結果一致性達98.8% (85/86)。另外念珠菌陰道炎檢測結果亦與臨床念珠菌培養結果一致，顯示此檢測套組可以準確的作為細菌性陰道炎與念珠菌陰道炎鑑別診斷之用途。而在86例BD MAX陰道炎檢測套組檢測細菌性陰道炎陰性結果中，有40% (35例)在傳統細菌培養出現非特異性之細菌培養結果，因此我們認為，使用BD MAX陰道炎檢測套組先進行篩選後再加以細菌培養鑑定菌種能夠更加準確地對陰道炎進行鑑別診斷。

Vaginitis is a common infectious disease with three diffe rential diagnoses including bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and trichomoniasis. The BD MAX Vaginal Panel is polymerase chain reaction (PCR) assay for direct detection these conditions. In thi s study, we evaluated the results of the BD Panel, Nugent score, and bacterial culture using 100 vaginal or cervical samples obtained from our outpatient clinic. The BD Panel correctly identified all BV-positive samples , while the Nugent score had an accuracy rate of only 78.6%. The BD Panel also correctly identified 98.8% of BV-negative samples. The results of VVC in the BD MAX Vaginal Panel corresponded to the culture results. However, 86 samples that were BV-negative in the BD MAX Vaginal Panel showed non-specific results in bact erial culture. We believe that the BD MAX Vaginal Panel could play a role in screening of vaginitis before ba cterial culture and that would be able to reduce the unnecessary antibiotic medication.