米诺环素治疗沙眼衣原体泌尿生殖道感染临床判愈与病原学判愈的比较

摘要/Abstract

摘要：

目的用不同的判愈标准评估米诺环素治疗沙眼衣原体泌尿生殖道感染的临床确切疗效。方法回顾性收集2006—2010年在天津医科大学总医院性病门诊通过病史、临床症状和病原学检测确诊的沙眼衣原体泌尿生殖道感染患者的临床资料，患者均经米诺环素治疗后完成3次规则随访。比较以症状消失为主要判愈标准的临床治愈率与3次随访病原学检查阴性的病原学判愈率之间的差异，并分析两者的关联。结果 5年期间诊断为泌尿生殖道沙眼衣原体感染、系统服用米诺环素治疗的患者2 638例，924例完成3次随访。924例患者临床治愈率为84.85%（784例），并显著高于第1、2、3次病原学判愈率［分别为69.16%（639例）、63.53%（587例）、62.88%（581例）］，差异均有统计学意义（配对χ2值分别为58.565、111.841、109.308，均P < 0.001），且第1次病原学判愈率显著高于第2次病原学判愈率（χ2 = 6.553，P < 0.05），而第2次病原学判愈率与第3次比较，差异无统计学意义（χ2 = 0.084，P > 0.05）。第1、2、3次病原学判愈与临床判愈的关联性均不大（均rc c < 0.1）。结论以临床症状消失为判愈依据高估了米诺环素治疗沙眼衣原体感染的效果，应以病原学检测为主，且应治疗后每月复查1次，至少复查2次。

Abstract:

Shao Lili, Zhan Xiaofei, Qi Manli, Wang Huiping, Wang Shuchun, Liu Quanzhong Department of Dermatology, Tianjin Medical University General Hospital/ Tianjin Institute of Sexually Transmitted Diseases, Tianjin 300052, China （Shao LL, Qi ML, Wang HP, Wang SC, Liu QZ）; Department of Dermatology and Venereology, Chongqing Three Gorges Central Hospital, Chongqing 404000, China （Zhan XF） Corresponding author: Liu Quanzhong, Email: liuquanzhong@medmail.com.cn 【Abstract】 Objective To assess efficacy of minocycline for the treatment of Chlamydia trachomatis （C.t） urogenital infection by using different standards. Methods Clinical data were collected from patients with C.t urogenital infection confirmed based on medical history, clinical symptoms and pathological findings in STD clinics of Tianjin Medical University General Hospital between 2006 and 2010, and retrospectively analyzed. Patients were treated with minocycline and then followed up once a month for at least 3 times. Cure was defined as disappearance of clinical symptoms （clinical standard） or absence of C.t in male urethral or female cervical swab samples as shown by indirect immunofluorescence assay （pathogenic standard） at three follow?up visits. Both differences and associations were assessed between cure rates calculated according to the two standards. Results From 2006 to 2010, a total of 2 638 patients diagnosed with C.t urogenital infection were treated with oral minocycline, and 924 completed three times of follow?up. Of the 924 patients, 784 （84.85%） were considered to be cured based on the clinical standard, and the clinical cure rate was significantly higher than the pathogen clearance rate at the first （69.16%［639/924］, χ2 = 58.565, P < 0.001）, second （63.53%［587/924］, χ2 = 111.841, P < 0.001） and third （62.88%［581/924］, χ2 = 109.308, P < 0.001） follow?up visits. Moreover, the first pathogen clearance rate was significantly higher than the second pathogen clearance rate （χ2 = 6.553, P < 0.05）, but no significant difference was observed between the second and third pathogen clearance rates （χ2 = 0.084, P > 0.05）. There were no evident associations between the clinical cure rate and the first, second or third pathogen clearance rate （all rc c < 0.1）. Conclusion The therapeutic effect of minocycline on C.t urogenital infection may be overestimated according to the disappearance of symptoms, and in order to objectively evaluate it, pathogenic detection should be carried out once a month for at least 2 times after treatment.

邵丽丽展小飞齐蔓莉王惠平王树椿刘全忠. 米诺环素治疗沙眼衣原体泌尿生殖道感染临床判愈与病原学判愈的比较[J]. 中华皮肤科杂志, 2016, 49(12): 885-888.

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