通讯作者: 胡秀秀, 906064726@qq.com

DOI：10.12201/bmr.202510.00052

Evaluation of the Application of Wright-Giemsa Staining in the Comprehensive Diagnosis of Vaginitis

• 摘要：目的　系统评估瑞氏-吉姆萨染色在阴道炎综合诊断中的应用潜力及诊断效能。方法　连续纳入1222例妇科门诊患者，均行窥镜检查并采集阴道分泌物样本，分别进行湿片显微镜检查、瑞氏-吉姆萨染色显微镜检查、革兰染色显微镜检查，及pH值、白细胞酯酶、唾液酸酶等功能学指标检测。采用Wilcoxon符号秩检验、McNemar检验和Kappa一致性检验分析三种显微镜检查方法检测白细胞（white blood cell，WBC）评分、基底旁细胞（parabasal cell，PBC）评分、需氧性阴道炎（aerobic vaginitis，AV）背景菌评分、乳酸杆菌等级（lactobacillus grading，LBG）、LBG评分、乳酸杆菌丰度评分、动弯杆菌评分、加德纳菌评分、真菌、滴虫和线索细胞的差异和一致性。用Spearman相关性检验分析WBC评分、LBG、加德纳菌评分与其对应功能学指标的相关性。瑞氏-吉姆萨染色的观察者间一致性分析采用Kappa一致性检验。计算灵敏度、特异性、ROC曲线下面积（area under the curve，AUC）等指标评估瑞氏-吉姆萨染色的诊断效能。结果　Wilcoxon符号秩检验结果显示，瑞氏-吉姆萨染色对LBG、PBC评分、AV背景菌评分、WBC评分、加德纳菌评分、动弯杆菌评分的等级判断显著高于革兰染色（均P<0.0167）；其乳酸杆菌丰度评分显著低于革兰染色（P<0.0001）。其对WBC评分、LBG、LBG评分、AV背景菌和乳酸杆菌丰度评分的等级判断显著低于湿片法（均P<0.0001），而对加德纳菌评分的等级判断显著高于湿片法（P<0.0001），且湿片法未检出动弯杆菌。Spearman相关性检验结果显示，瑞氏-吉姆萨染色的加德纳菌评分和LBG分别与唾液酸苷酶和pH的相关性最好（r=0.6922、0.7861）。McNemar检验结果显示，瑞氏-吉姆萨染色对真菌的检出率显著高于湿片法（P<0.0001），对滴虫的检出率显著高于革兰染色（P=0.002），对线索细胞的检出率显著高于湿片法和革兰染色（均P<0.0001）。观察者间一致性分析结果显示，除线索细胞（部分观察者Kappa=0.390）外，其余指标（如PBC评分、LBG、真菌、滴虫）均表现为中至高度一致性，其中动弯杆菌评分、PBC评分的Kappa值高达0.829~0.854。其诊断念珠菌性阴道炎（vulvovaginal candidiasis，VVC）、滴虫性阴道炎（trichomonosis vaginosis，TV）、细菌性阴道病（bacterial vaginosis，BV）和细胞溶解性阴道炎（cytolytic vaginitis，CV）的灵敏度和特异性均达0.90以上。结论　瑞氏-吉姆萨染色在阴道炎诊断中兼具高检出率、高一致性、低成本、易操作的优势，且可以实现阴道炎的综合诊断，有望成为阴道炎综合诊断的常规方法，尤其在医疗资源有限地区具有重要推广价值。且可与AI技术结合，实现阴道炎自动辅助诊断，提高诊断效率和一致性。

  关键词： 瑞氏-吉姆萨染色；革兰染色；阴道炎；综合诊断; ; ; 

   

  Abstract: Objective　To systematically evaluate the application potential and diagnostic efficacy of Wright-Giemsa staining in the comprehensive diagnosis of vaginitis. Methods　A total of 1,222 consecutive outpatients in the gynecology department were enrolled. All patients underwent speculum examination and vaginal secretion sample collection. The samples were subjected to wet-mount microscopy, Wright-Giemsa stained smear microscopy, Gram-stained smear microscopy, and functional index detection (including pH value, leukocyte esterase, and sialidase). Wilcoxon signed-rank test, McNemar test, and Kappa consistency test were used to analyze the differences and consistency of three microscopic examination methods in detecting WBC score, PBC score, AV background bacteria score, LBG, LBG score, lactobacillus abundance score, Mobiluncus score, Gardnerella score, fungi, trichomonas, and clue cells. Spearman correlation test was applied to analyze the correlation between WBC score, LBG, Gardnerella score and their corresponding functional indices. Kappa consistency test was used to analyze the inter-observer consistency of Wright-Giemsa staining. Indicators such as sensitivity, specificity, and area under the ROC curve (AUC) were calculated to evaluate the diagnostic efficacy of Wright-Giemsa staining. Results　Wilcoxon signed-rank test showed that Wright-Giemsa staining had significantly higher grade judgments than Gram staining for LBG, PBC score, AV background bacteria score, WBC score, Gardnerella score, and Mobiluncus score (all P<0.0167), while its Lactobacillus abundance score was significantly lower than that of Gram staining (P<0.0001). Compared with wet mount method, Wright-Giemsa staining had significantly lower grade judgments for WBC score, LBG, LBG score, AV background bacteria, and Lactobacillus abundance score (all P<0.0001), but significantly higher grade judgment for Gardnerella score (P<0.0001); additionally, Mobiluncus was not detected by wet mount method. Spearman correlation test indicated that Gardnerella score and LBG of Wright-Giemsa staining had the best correlation with sialidase and pH, respectively (r=0.6922, 0.7861). McNemar test showed that the detection rate of fungi by Wright-Giemsa staining was significantly higher than that by wet mount method (P<0.0001), the detection rate of trichomonas was significantly higher than that by Gram staining (P=0.002), and the detection rate of clue cells was significantly higher than that by both wet mount method and Gram staining (all P<0.0001). Inter-observer consistency analysis revealed moderate to high consistency for all indicators except clue cells (Kappa=0.390 for some observers), with Kappa values as high as 0.829~0.854 for Mobiluncus score and PBC score. The sensitivity and specificity of Wright-Giemsa staining in diagnosing VVC, TV, BV, and CV all exceeded 0.90. Conclusion　Wright-Giemsa staining boasts the advantages of high detection rate, high consistency, low cost, and easy operation in the diagnosis of vaginitis. It enables the comprehensive diagnosis of vaginitis and is expected to become a routine method for this purpose, especially holding significant promotion value in areas with limited medical resources. Furthermore, it can be combined with AI technology to achieve automatic auxiliary diagnosis of vaginitis, thereby improving diagnostic efficiency and consistency.

  Key words: Wright-Giemsa staining; Gram staining; vaginitis; comprehensive diagnosis

  提交时间：2025-10-28

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• 序号	提交日期	编号	操作
  1	2025-10-23	bmr.202510.00052V1	下载

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