妊娠期外阴阴道假丝酵母菌病症状与妊娠结局分析

目的：研究妊娠期外阴阴道假丝酵母菌病(VVC)症状与妊娠结局的关系。方法选取我院收集的136例妊娠>35 w患者阴道分泌物假丝酵母菌涂片阳性诊断VVC,其中有症状者60例作为观察组,无症状者76例作为对照组。观察两组妊娠结局及不良妊娠结局情况。结果观察组胎膜早破、产褥感染和剖宫产率与对照组比较差异有统计学意义(<0.05);而胎儿窘迫和新生儿感染率比较差异无统计学意义(>0.05)。结论妊娠期有症状VVC可致胎膜早破、剖宫产率等不良妊娠结局增高,早期诊断和治疗十分必要。     

雌激素影响外阴阴道假丝酵母菌病的发生发展

白假丝酵母菌是外阴阴道假丝酵母菌病的主要条件致病菌,高水平的雌激素与外阴阴道假丝酵母菌病的高发病率密切相关。雌激素对菌体和宿主均有影响。雌激素通过结合白假丝酵母菌的雌激素结合蛋白增加1型菌丝壁蛋白、分泌型天冬氨酸蛋白酶和磷脂酶的表达,促进形态转换和热休克蛋白90的表达,从而增强白假丝酵母菌对宿主组织的粘附、入侵和环境适应力。同时雌激素通过与宿主的雌激素受体结合影响阴道的pH,抑制阴道上皮细胞和吞噬细胞介导的先天性抗假丝酵母菌免疫以及T细胞和B细胞介导的获得性抗假丝酵母菌免疫。雌激素是建立外阴阴道假丝酵母菌病动物模型的关键因素。此文章总结了在外阴阴道假丝酵母菌病的发生发展中雌激素对假丝酵母菌和宿主产生的影响。     

外阴阴道假丝酵母菌病与阴道局部免疫的研究进展

阴道假丝酵母菌病感染后,阴道上皮局部介导的先天免疫在抗假丝酵母菌病中开始发挥重要作用,局部Th1与Th2细胞及其细胞因子形成局部免疫网络相互调控、彼此抑制,调节免疫应答引起阴道上皮局部免疫改变,决定了机体对致病菌的易感性。本文就VVC与Th1/Th2介导的阴道局部免疫相关研究进行阐述。     

臭氧治疗外阴阴道假丝酵母菌病的临床观察

目的观察臭氧对外阴阴道假丝酵母菌病（VVC）的治疗效果。方法将102例VVC患者随机分为观察组（51例）和对照组（51例）,观察组接受臭氧治疗,对照组接受达克宁硝酸咪康唑栓治疗。两组于治疗后第3天进行临床和真菌学疗效分析。结果治疗结束后第3天,观察组治愈42例（82．3％）、显效6例（11．8％）、有效3例（5．3％）,总有效率为100％;对照组治愈28例（55．0％）、显效12例（23．5％）、有效6例（11．8％）、总有效率为90．3％。两组治愈率差异有统计学意义（P〈0．01）。结论臭氧治疗外阴阴道假丝酵母菌病效果显著,不良反应发生率低。     

克霉唑栓联合乳酸菌阴道胶囊在治疗复发性外阴阴道假丝酵母菌病中的应用与疗效

目的：分析研究临床在面对复发性外阴阴道假丝酵母菌病患者时,给予其实施克霉唑栓、乳酸菌阴道胶囊联合治疗后的临床效果。方法择取我院妇科在近期内接诊的103例复发性外阴阴道假丝酵母菌病患者,并按照治疗方式的不同将患者分为A组(51例单一实施克霉唑栓治疗)、B组(52例实施克霉唑栓、乳酸菌阴道胶囊)。结果经过治疗后,B组患者的治疗有效率为94.23%,明显高于A组患者(P<0.05);治疗后随访结果显示,B组患者的复发率明显低于A组患者(P<0.05)。结论临床在面对复发性外阴阴道假丝酵母菌病患者时,给予其实施克霉唑栓、乳酸菌阴道胶囊联合治疗后临床效果佳,值得临床推广应用。     

抗真菌药联合转移因子治疗复发性外阴阴道假丝酵母菌病的疗效观察

目的 观察抗真菌药联合转移因子治疗复发性外阴阴道假丝酵母菌病的疗效.方法 将160例确诊为复发性外阴阴道假丝酵母菌病的患者随机分为两组,治疗组80例,给予抗真菌药联合转移因子治疗,对照组80例,单纯给予抗真菌药物治疗.观察两组停药后1w、1个月、3个月、6个月的情况.结果 治疗6个月后停药,两组治愈率无明显差异(P＞005);停药1个月、3个月、6个月后治疗组的复发率明显低于对照组(P＜0.05).结论 抗真菌药联合转移因子治疗复发性外阴阴道假丝酵母菌病,疗效显著,复发率低,值得推广使用.     

妊娠期女性生殖道感染病原菌分布、耐药性分析及对妊娠结局的影响

目的:分析妊娠期女性生殖道感染病原菌分布、耐药性分析及对妊娠结局的影响.方法:选取我院于2018年5月至2019年5月收治的408例进行孕期检查孕妇的临床资料,结合患者病原菌采集、检验、年龄、文化程度、分娩史、流产史、生殖系统感染史、糖尿病史、血红蛋白、体质量指数、血清白蛋白等相关资料,分析妊娠期女性感染率及生殖道感染病原菌分布、耐药情况,采用logistic回归模型分析妊娠期女性生殖道感染的危险因素,根据感染结果分为感染组、未感染组,感染组根据感染病原菌药敏分析结果急进行治疗干预,愿意进行药物治疗者分为治疗组,因对药有顾虑而未采取药物治疗者分为未治疗组,比较感染组与未感染组及治疗组与未治疗组妊娠结局.结果:408例妊娠期女性中有129例出现生殖道感染,感染率为31.62％;共检出173例病原菌,其中真菌感染占69.94％,衣原体占11.56％,支原体占7.51％,其他病原菌占10.99％.129例生殖道感染患者白色念珠菌感染对咪康唑、酮康唑耐药性较高,但所有感染患者均对两性霉素-B与5-氟哌嘧啶较为敏感.经logistic回归模型显示:患者文化程度高中以下、有分娩史、有流产史、有糖尿病史为妊娠期女性生殖道感染发生的独立危险因素(P<0.05).感染者患者不良妊娠结局发生率显著高于未感染者(P<0.05).给予药物治疗的感染者不良妊娠结局发生率均显著高于正常者与给予药物治疗者(P<0.05).结论:根据妊娠期女性生殖道感染病原菌分布以及影响妊娠期女性生殖道感染的独立危险因素并及时根据药敏分析给予药物治疗可降低发生妊娠期女性生殖道感染机率及不良妊娠结局发生率.     

纳米银抗菌凝胶联合氟康唑治疗外阴阴道假丝酵母菌疗效观察

目的：探讨纳米银抗菌凝胶联合氟康唑治疗外阴阴道假丝酵母菌病疗效。方法选择门诊确诊的外阴阴道假丝酵母菌患者58例随机分为治疗组和对照组,治疗组氟康唑单次口服150mg,纳米银抗菌凝胶连用6d。对照组纳米银抗菌凝胶连用6d,对比疗效。结果两组停药后7d总有效率为93.3%和82.1%,两组在下次月经干净后总有效率为93.3%和78.6%。结论纳米银抗菌凝胶联合氟康唑治疗外阴阴道假丝酵母菌具有较好的疗效。     

86例外阴阴道假丝酵母菌病的临床疗效分析

目的讨论氟康唑联合克霉唑治疗白假丝酵母菌性阴道炎的效果。方法随机抽取来我院就诊的白假丝酵母菌性阴道炎的女性患者86例,随机分为研究组与常规组,每组各43例。针对常规给予苏打水溶液外阴清洗后置入克霉唑栓治疗;针对研究组给予在常规组治疗的基础上口服氟康唑胶囊治疗;两组用药均1次/d,以7d为一个疗程,进行4个疗程的观察。结果研究组总有效率为95.35％明显高于常规组的74.42％。所有数据均符合统计学差异（P＜0.05）。结论氟康唑联合克霉唑对于白假丝酵母菌性阴道炎的治疗效果好,值得推广。     

可宝净栓联合伊曲康唑治疗复发性外阴阴道假丝酵母菌病的临床观察

目的观察可宝净栓及伊曲康唑联合治疗复发性外阴阴道假丝酵母菌病的疗效及复发情况。方法选择2003～2004年我院妇科门诊确诊为复发性外阴阴道假丝酵母菌病的患者110例,随机分成3组,A组40例给予可宝净栓阴道上药,日一次,每次1片,连用18d,月经期不间断。B组40例给予可宝净栓阴道上药,用法同A组,同时口服抗真菌药物斯皮仁诺200mg,口服,每日一次,共三次。C组,30例,单纯给予斯皮仁诺200mg口服,每日一次,共3次。用药后1个月复诊,以后随访达半年,观察治疗效果,及有无复发。结果联合用药组疗效最好,且复发率最低。结论可宝净栓联合伊曲康唑治疗RVVC疗效显著,且可明显降低VVC复发率。     

灭滴灵阴道用药对细菌性阴道病晚孕妇女不良妊娠结局的预防效果

目的：探讨灭滴灵治疗细菌性阴道病对不良妊娠结局是否有改善作用。方法：在产科门诊对用阴道分泌物涂片革兰氏染色Ｎｕｇｅｎｔ诊断标准孕２８－３２周妇女进行细菌性阴道病筛查，对检出的患者随机分为二组；观察组５２例，未给予治疗；治疗组５０例，采用灭滴灵阴道用药治疗，必要时再次治疗。     

Prevalence and species distribution of microorganisms isolated among non-pregnant women affected by vulvovaginal candidiasis: A retrospective study over a 20 year-period

BackgroundVulvovaginal candidiasis (VVC) is the second most common infection of the genital tract affecting millions of women worldwide. Data concerning the distribution and antifungal resistance of Candida species responsible of VVC vary among countries and population studied. Objectives: The aim of this work was to determine the prevalence, species distribution and antifungal susceptibility patterns of Candida species among symptomatic women over a 20-year period.MethodsA total of 5,820 unique samples were retrospectively identified. Out of them, 1,046 (18%) were diagnosed with VVC.ResultsWomen between 18 and 30 years had the highest prevalence rate of VVC (21%). Women aged less than 18 years and greater than 51 years had the highest prevalence rates of vaginal bacterial infections. Thirty-five (3.3%) women presented recurrent VVC. The most common yeast isolated was C. albicans, followed by C. glabrata, C. krusei, and C. parapsilosis. Non-Candida albicans species (NAC) were more significantly isolated among women aged 51 or above, than in women included in other groups (p < 0.01). Resistance to fluconazole and amphotericin B was infrequent in C. albicans strains. Resistance to fluconazole and amphotericin B was infrequent in C. albicans strains. NAC species presented higher resistance rates against fluconazole (30%) and voriconazole (25%). C. krusei and C. glabrata isolates showed lower MICs than most of the strains against amphotericin B (1 mg/L) and flucytosine (1 mg/L).ConclusionsOur findings indicated that continued surveillance on Candida species distribution and non-susceptibility rates to antifungals should be routinely reported to help the selection of the most appropriate drug, to avoid the emergence of resistant strains, and to improve the patient's outcomes.     

Escherichia coli enhances the virulence factors of Candida albicans,the cause of vulvovaginal candidiasis,in a dual bacterial/fungal biofilm

Co-infection with other microorganisms can promote the Candida albicans to be invasive. In this study, Escherichia coli and C. albicans were co-isolated from the women with candidiasis symptoms. The in vitro effects of E. coli on C. albicans hypha development, biofilm formation, antibiotic susceptibility, dispersion from the biofilm, expression of Als3, Hwp1, and Tup1 genes, and pathogenesis in Galleria mellonella were investigated. Electron microscopic images revealed that hypha induction was markedly increased in the bacteria-fungi co-culture. Biofilm formation was increased 2.2 fold in the presence of E. coli. The minimum inhibitory concentration of nystatin against Candida was increased from (μg mL^?1) 25 to 50 in the dual biofilm. Candida dissemination was increased up to 2.7 fold from the mixed fungi/bacteria biofilm. The expression of ALS3 and HWP1 genes was increased (5.9 and 2.0 fold, respectively) while the TUP1 gene expression was decreased (0.4 fold) when C. albicans was incubated with E. coli. The simultaneous injection of C. albicans and E. coli to the insect larvae increased Galleria mortality up to 40%. This study demonstrated the effects of E. coli to promote fungi virulence factors, which suggest polymicrobial interaction should be considered during treatment of fungal infections.     

Epidemiology,risk factors and antimicrobial profile of Vulvovaginal Candidiasis (VVC): A study among women in the central region of Saudi Arabia

BackgroundCandida spp. is a fungal resident of the normal microbiota of gastrointestinal tract, reproductive mucosa and oral cavity. Hence, a majority of the healthy population may be prone to the most common fungal infection such as candidiasis that can be caused by any species of Candida. In women, vaginitis or vulvovaginal candidiasis (VVC) forms a significant part of urogenital infections with a high recurrence rate thus posing a public health issue worldwide.ObjectivesThe aim of this study was to determine the prevalence of VVC, its possible risk factors and the antifungal susceptibility of the species isolated from women attending a hospital in the central region of Saudi Arabia.MethodsSamples of high vaginal swabs (HVS) were obtained from 208 women aged 15–64 years with signs and symptoms of VVC. The samples were cultured on Sabouraud agar plates (SDA) and incubated at 30 °C for 10 days. Candida spp. were initially identified using morphologic characteristics, wet mount, germ tube test and finally confirmed with Vitek 2.ResultsAmong the samples, 34% were culture positive. Out of the positive samples, 68% were Candida albicans, followed by C. tropicalis (27%) and C. glabrata (2.7%). Majority of the C. albicans (16%) were observed in women between ages of 21–30 years. All the isolates were sensitive to the antifungals tested. Also, the presence of Candida spp. did not correlate to risk factors such as pregnancy, diabetes and use of antibiotics.ConclusionsPrevalence of vulvovaginal candidiasis was observed in the central region of Saudi Arabia with the predominant organism as Candida albicans.     

染色体多态性与ART妊娠结局的临床分析

目的分析染色体多态性对生育功能的影响,探讨其与ART妊娠结局的关系。方法回顾性调查分析珠海市妇幼保健院2009年至2010年生殖中心行IVF-ET共1607例患者的染色体核型及其临床资料,研究其ART妊娠情况。结果 1607例生殖异常患者中,检出染色体正常核型1563例(97.3%),ART妊娠877例,妊娠率为56.1%,流产113例,流产率为12.9%;检出染色体多态性核型37例(2.3%),ART临床妊娠20例,妊娠率为54.1%,流产2例,流产率为10.0%。结论染色体正常组与染色体多态性组ART的妊娠率及流产率的差异无显著性统计学意义,染色体多态性患者不影响ART妊娠结局。     

Quantitative system for diagnosis of vulvovaginal candidiasis

IntroductionVaginal infections are one of the most common reason for gynecological consultations. Many of them are the result of overgrowth of resident microorganisms. The clinical symptoms of vulvovaginal candidiasis are nonspecific and an accurate diagnosis is a problem that often leads to inadequate treatment or delays in treatment. The lack of an exact and practical diagnostic method is a common cause of misdiagnosis.AimTo create a complex, quantitative method for the diagnosis of vulvovaginal candidiasis which to enables differentiation from vaginal fungal colonization.Material and methodsA total of 2306 vaginal samples were examined. Clinical, microbiological, epidemiological methods and statistical models are used.Results and discussionThe proposed score system is a specific, sensitive and inexpensive method to routinely diagnose vulvovaginal candidiasis. Statistical processing of the obtained data shows the impact of the individual components on which the method is based: the presence of vaginal discharge, pruritus, direct microscopy and assessment of the fungal growth. The data analysis reveals good sensitivity (71%) and high specificity (98%) of the method. This allows accurate interpretation of the result of the clinical and microbiological examination of each patient.ConclusionThe system for diagnosing vulvovaginal candidiasis is complex and based on quantitative indicators. The method can be used to differentiate vulvovaginal candidiasis from vaginal fungal colonization (the cut-off value is 5.5 points) and to more accurately interpret a Candida positive result from quantitative real-time PCR in asymptomatic patients or in women with mixed vaginal infection.     

复发性外阴阴道假丝酵母菌病局部病因调查及治疗

目的调查复发性外阴阴道假丝酵母菌病(RVVC)的局部病因及探讨其合理有效的治疗方案。方法选择158例确诊为RVVC的患者,常规行肛周分泌物及性伴侣龟头分泌物真菌培养,另50例非阴道病患者同时行肛周分泌物真菌培养作为对照。158例研究病例随机分3组,A组:口服易启康(依曲康唑)0.1g,每天2次,连服7d为一疗程。B组:口服易启康 克霉唑栓0.15g阴道上药每天1次,共10d为一疗程。C组:在B组基础上再进行维持治疗,克霉唑栓0.15g阴道上药,每隔3d 1次,共3次。3组均每次月经干净后3d开始重复治疗,连续6个疗程。性伴侣龟头分泌物真菌培养阳性者同时口服抗真菌药物治疗。治疗完成后第4、8、12、24周分别进行临床及真菌观察评定疗效。结果158例患者肛周分泌物真菌培养阳性率100%(158/158);50例非阴道病患者肛周分泌物真菌培养阳性率8%(4/50),两者差异有统计学意义(P<0.05)。158例性伴侣中有18例有包皮过长或龟头炎,这18例性伴侣其龟头分泌物真菌培养阳性率100%(18/18),另140例性伴侣无龟头炎或包皮过长者,其龟头分泌物真菌培养阳性率为1.43%(2/140),两者差异有统计学意义(P<0.05)。3组治疗4周后有效率差异无统计学意义(P>0.05);治疗8周后A组有效率显著低于B、C组,差异有统计学意义(P<0.01);24周后A组复发率显著高于B、C组,差异有统计学意义(P<0.01)。结论消化道真菌感染可能是RVVC反复发作的病因之一;性伴侣有包皮过长或龟头炎时需同时治疗;小剂量、长时间口服易启康及口服加阴道用药治疗RVVC近期4周内均有较好疗效,但联合用药远期疗效优于单纯口服用药。