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Analysis of Four Common Pathogens of Sexually Transmitted Diseases in Peking Union Medical College Hospital from 2013 to 2018
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摘要:
目的 探究北京协和医院诊治的疑似性传播疾病(sexually transmitted diseases, STD)患者沙眼衣原体(Chlamydia trachomatis, CT)、解脲支原体(Ureaplasma urealyticum, UU)、生殖支原体(Mycoplasma genitalun, MG)及淋病奈瑟球菌(Neisseria gonorrhoeae，NG)感染情况，旨在为临床诊治提供依据。 方法 回顾性收集2013年1月—2018年12月北京协和医院疑似STD患者的送检标本(包括尿液标本及生殖道拭子标本)。采用实时荧光核酸恒温扩增检测技术检测样本中CT、UU、MG、NG，并计算其阳性率。 结果 2013—2018年，共接收CT、UU、MG、NG检测标本12 804份。4种病原体阳性率由高至低依次为UU(42.88%，4833/11 271)、CT(8.43%，905/10 739)、MG(5.44%，231/4246)、NG(3.78%，338/8932)；合并感染以UU+CT(4.13%，402/9725)、UU+MG(1.98%，74/3745)较常见。女性患者UU阳性率均高于同年龄段男性患者，CT、NG、MG阳性率低于同年龄段男性患者。除女性患者NG、UU单一感染外，4种病原体单一感染率及合并感染率(UU+CT、UU+MG)均以≤20岁患者最高。NG、MG阳性率整体呈下降趋势，CT、UU阳性率呈小范围波动。男性患者中，尿道拭子标本NG阳性率明显高于尿液标本(12.37% 比5.27%，P＜0.001)；女性患者中，宫颈拭子标本UU阳性率明显高于尿液标本(61.78% 比54.74%，P＜0.001)，CT阳性率低于尿液标本(6.16% 比7.73%，P=0.022)。 结论 2013—2018年北京协和医院诊治疑似STD患者中，4种常见病原体阳性率由高至低依次为UU、CT、MG、NG；UU+CT、UU+MG是常见的合并感染类型；≤20岁患者病原体阳性率较高；不同类型标本中病原体检出率存在差异。 Abstract:Objective To explore the prevalence of Chlamydia trachomatis(CT), Neisseria gonorrhoeae(NG), Ureaplasma urealyticum(UU), and Mycoplasma genitalium(MG) in patients with suspected sexually transmitted diseases(STD) in Peking Union Medical College Hospital(PUMCH), and to provide evidence for clinical treatment. Methods The samples (including urine and genital swabs) of suspected STD patients in PUMCH between January 2013 and December 2018 were collected retrospectively. CT, UU, MG, and NG were detected using the simultaneous amplification and testing technique. Results A total of 12 804 samples were analyzed. The positive rates of the four pathogens were 42.88% (4833/11 271)for UU, 8.43% (905/10 739) for CT, 5.44% (231/4246) for MG and 3.78% (338/8932) for NG. UU+CT(4.13%, 402/9725) and UU + MG (1.98%, 74/3745) were common co-infections. The positive rates of UU in female patients were higher than those in male patients of the same age, while the positive rates of CT, NG, and MG in female patients were lower than those in male patients. Except for NG and UU in female, the positive rate of single infection and co-infection(UU+CT, UU+MG) in patients ≤20 years old was the highest. The positive rates of NG and MG decreased, while the positive rates of CT and UU fluctuated in a small range. Among male patients, the positive rate of NG in urethral swabs was significantly higher than that in urine samples (12.37% vs. 5.27%, P < 0.001). Among female patients, the positive rate of UU in cervical swabs was significantly higher than that in urine (61.78% vs. 54.74%, P < 0.001) and the positive rate of CT in cervical swabs was significantly lower than that in urine (6.16% vs. 7.73%, P=0.022). Conclusions From 2013 to 2018, the prevalence rates of four common STD pathogens from high to low were UU, CT, MG, and NG. UU+CT and UU+MG were common co-infections. The young people at the age of ≤20 had the highest positive rates. The positive detection rate of different items varies with different specimen types. 作者贡献：杜娟负责论文撰写和修改；杨启文负责研究设计、论文审阅；所有作者均参与样本检测、临床信息收集；杜娟、张栋参与数据整理及分析、图表制作。利益冲突：无 -
表 1 12 804份样本检测项目及患者年龄分布(n)
年龄(岁) 检测项目 CT UU MG NG ≤20 224 223 73 205 21~30 3710 3931 1480 3031 31~40 4461 4744 1784 3628 41~50 1512 1543 538 1316 51~60 569 582 230 511 ＞60 263 248 141 241 合计 1 0739 11271 4246 8932 CT：沙眼衣原体；UU：解脲支原体；MG：生殖支原体；NG：淋病奈瑟球菌 
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表 2 不同类型标本4种病原体阳性率比较
标本类型 CT UU MG NG 样本份数(N) 阳性份数[n(%)] 样本份数(N) 阳性份数[n(%)] 样本份数(N) 阳性份数[n(%)] 样本份数(N) 阳性份数[n(%)] 尿液 6601 642(9.73) 7194 2394(33.28) 3234 188(5.81) 5281 242(4.58) 宫颈拭子 3914 241(6.16) 3859 2384(61.78) 880 30(3.41) 3444 73(2.12) 尿道拭子 224 22(9.82) 218 55(25.23) 132 13(9.85) 207 23(11.11) P值 ＜0.001 ＜0.001 0.002 ＜0.001 CT、UU、MG、NG：同表 1
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表 3 男性患者不同类型标本4种病原体阳性率比较
标本类型 CT UU MG NG 样本份数(N) 阳性份数[n(%)] 样本份数(N) 阳性份数[n(%)] 样本份数(N) 阳性份数[n(%)] 样本份数(N) 阳性份数[n(%)] 尿液 5269 539(10.23) 5687 1569(27.59) 2626 175(6.66) 4135 218(5.27) 尿道拭子 205 21(10.24) 197 43(21.83) 125 12(9.60) 186 23(12.37) P值 0.826 0.075 0.203 ＜0.001 CT、UU、MG、NG：同表 1
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表 4 女性患者不同类型标本4种病原体阳性率比较
标本类型 CT UU MG NG 样本份数(N) 阳性份数[n(%)] 样本份数(N) 阳性份数[n(%)] 样本份数(N) 阳性份数[n(%)] 样本份数(N) 阳性份数[n(%)] 尿液 1332 103(7.73) 1507 825(54.74) 608 13(2.14) 1146 24(2.09) 宫颈拭子 3914 241(6.16) 3859 2384(61.78) 880 30(3.41) 3444 73(2.12) 尿道拭子# 19 1(5.26) 21 12(57.14) 7 1(14.29) 21 0(0) P值* 0.022 ＜0.001 0.150 0.959 CT、UU、MG、NG：同表 1；#女性尿道拭子标本极少，未参与比较；*尿液标本与宫颈拭子标本间的比较
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表 5 同一患者不同类型标本中4种病原体阳性率比较
标本类型 CT UU MG NG 例数(N) 阳性例数[n(%)] 例数(N) 阳性例数[n(%)] 例数(N) 阳性例数[n(%)] 例数(N) 阳性例数[n(%)] 男性 尿液 31 1(3.23) 32 3(9.38) 20 4(20.00) 22 2(9.09) 尿道拭子 31 1(3.23) 32 4(12.50) 20 3(15.00) 22 2(9.09) 女性 尿液 72 11(15.28) 85 45(52.94) 50 3(6.00) 57 3(5.26) 宫颈拭子 72 10(13.89) 85 43(50.59) 50 4(8.00) 57 4(7.02) CT、UU、MG、NG：同表 1
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