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解析
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（收稿日期：2016⁃01⁃26） （本文编辑：尚淑贤）
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
邵丽丽 展小飞 齐蔓莉 王惠平 王树椿 刘全忠 300052 天津医科大学总医院皮肤科 天津性传播疾病研究所（邵丽丽、齐蔓莉、王惠平、王树椿、 刘全忠）；重庆三峡中心医院皮肤性病科（展小飞） 通信作者：刘全忠，Email：liuquanzhong@medmail.com.cn
年来，有研究者用米诺环素替代多西环素治疗生殖道沙眼衣 62.88%（581 例）］，差 异 有 统 计 学 意 义（配 对 χ2 值 分 别 为
【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
中华皮肤科杂志 2016 年 12 月第 49 卷第 12 期 Chin J Dermatol, December 2016, Vol. 49, No. 12
885
issn.1672⁃0709.2005.02.011.
Wang XD, Xia ZH, Shen H, et al. Clinical analysis of 18 cases of mycosis fungoides［J］. Chin J Dermatovenereol Integr Tradit West Med, 2005, 4（2）: 92⁃94. DOI: 10.3969/j.issn.1672⁃0709.2005.02. 011 ［5］ Bosseila M, Sayed SK, El ⁃ Din SSS, et al. Evaluation of angio ⁃ genesis in early mycosis fungoides patients: dermoscopic and immunohistochemical study［J］. Dermatology, 2015, 231（1）: 82 ⁃ 86. DOI: 10.1159/000382124. ［6］ Lallas A, Apalla Z, Lefaki I, et al. Dermoscopy of early stage
生殖道沙眼衣原体感染是一种以沙眼衣原体为致病菌
二、结果
的泌尿生殖道系统感染。尽管其概念和诊断已发生变化，但
1. 不同标准治愈率比较：根据临床判愈标准，924 例患
20 年来推荐采用阿奇霉素和多西环素的治疗方案始终没 者中治愈 784 例，治愈率 84.85%，显著高于第 1、2、3 次病原
变，许多临床医生也对该治疗方案的确切疗效有所怀疑。近 学判愈率［治愈率分别为 69.16%（639 例）、63.53%（587 例）、
【关键词】 沙眼衣原体；生殖道感染；米诺环素；疗效评估 基金项目：国家自然科学基金（31500157）
Evaluation of efficacy of minocycline for the treatment of Chlamydia trachomatis urogenital infection by using clinical and pathogenic standards 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
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. 【Key words】 Chlamydia trachomatis; Reproductive tract infections; Minocycline; Efficacy evaluation Fund program: National Natural Science Foundation of China（31500157）
DOI：10.3760/cma.j.issn.0412⁃4030.2016.12.013
【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。
mycosis fungoidBaidu Nhomakorabeas［J］. J Eur Acad Dermatol Venereol, 2013, 27 （5）: 617⁃621. DOI: 10.1111/j.1468⁃3083.2012.04499.x. ［7］ Li W, Dai H, Li Z, et al. Reflectance confocal microscopy for the characterization of mycosis fungoides and correlation with histology: a pilot study［J］. Skin Res Technol, 2013, 19（3）: 352⁃ 355. DOI: 10.1111/srt.12049.
万方数据
886
中华皮肤科杂志 2016 年 12 月第 49 卷第 12 期 Chin J Dermatol, December 2016, Vol. 49, No. 12
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
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
邵丽丽 展小飞 齐蔓莉 王惠平 王树椿 刘全忠 300052 天津医科大学总医院皮肤科 天津性传播疾病研究所（邵丽丽、齐蔓莉、王惠平、王树椿、 刘全忠）；重庆三峡中心医院皮肤性病科（展小飞） 通信作者：刘全忠，Email：liuquanzhong@medmail.com.cn
年来，有研究者用米诺环素替代多西环素治疗生殖道沙眼衣 62.88%（581 例）］，差 异 有 统 计 学 意 义（配 对 χ2 值 分 别 为
【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
中华皮肤科杂志 2016 年 12 月第 49 卷第 12 期 Chin J Dermatol, December 2016, Vol. 49, No. 12
885
issn.1672⁃0709.2005.02.011.
Wang XD, Xia ZH, Shen H, et al. Clinical analysis of 18 cases of mycosis fungoides［J］. Chin J Dermatovenereol Integr Tradit West Med, 2005, 4（2）: 92⁃94. DOI: 10.3969/j.issn.1672⁃0709.2005.02. 011 ［5］ Bosseila M, Sayed SK, El ⁃ Din SSS, et al. Evaluation of angio ⁃ genesis in early mycosis fungoides patients: dermoscopic and immunohistochemical study［J］. Dermatology, 2015, 231（1）: 82 ⁃ 86. DOI: 10.1159/000382124. ［6］ Lallas A, Apalla Z, Lefaki I, et al. Dermoscopy of early stage
生殖道沙眼衣原体感染是一种以沙眼衣原体为致病菌
二、结果
的泌尿生殖道系统感染。尽管其概念和诊断已发生变化，但
1. 不同标准治愈率比较：根据临床判愈标准，924 例患
20 年来推荐采用阿奇霉素和多西环素的治疗方案始终没 者中治愈 784 例，治愈率 84.85%，显著高于第 1、2、3 次病原
变，许多临床医生也对该治疗方案的确切疗效有所怀疑。近 学判愈率［治愈率分别为 69.16%（639 例）、63.53%（587 例）、
【关键词】 沙眼衣原体；生殖道感染；米诺环素；疗效评估 基金项目：国家自然科学基金（31500157）
Evaluation of efficacy of minocycline for the treatment of Chlamydia trachomatis urogenital infection by using clinical and pathogenic standards 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
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. 【Key words】 Chlamydia trachomatis; Reproductive tract infections; Minocycline; Efficacy evaluation Fund program: National Natural Science Foundation of China（31500157）
DOI：10.3760/cma.j.issn.0412⁃4030.2016.12.013
【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。
mycosis fungoidBaidu Nhomakorabeas［J］. J Eur Acad Dermatol Venereol, 2013, 27 （5）: 617⁃621. DOI: 10.1111/j.1468⁃3083.2012.04499.x. ［7］ Li W, Dai H, Li Z, et al. Reflectance confocal microscopy for the characterization of mycosis fungoides and correlation with histology: a pilot study［J］. Skin Res Technol, 2013, 19（3）: 352⁃ 355. DOI: 10.1111/srt.12049.
万方数据
886
中华皮肤科杂志 2016 年 12 月第 49 卷第 12 期 Chin J Dermatol, December 2016, Vol. 49, No. 12
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