复发性外阴阴道假丝酵母菌病患者阴道微生物的动态变化

目的 探究复发性外阴阴道假丝酵母菌病(RVVC)患者阴道菌群的动态变迁.方法 不同时间点采集RVVC患者(6例)以及正常对照女性(5例)阴道分泌物,分别对每个样本进行细菌总基因组DNA提取、16S rRNA V4区基因扩增及采用Illumina高通量测序技术对扩增的PCR产物进行测序等步骤,然后通过BIPES、TSC、GAST等程序,分析比较两组阴道菌群物种丰度和结构以及菌群动态变化.结果 正常对照女性阴道菌群以乳酸杆菌为主,其中惰性乳杆菌和卷曲乳杆菌比例相当,同时存在少量加德纳菌属、普氏菌属和其它菌属;或者以加德纳菌属、普氏菌属、奇异菌属、纤毛菌属等为主要菌属;而RVVC患者阴道菌群丰富度明显降低,以惰性乳杆菌为优势菌属,卷曲乳杆菌含量明显减少.正常对照女性阴道菌群随月经周期的变化出现波动,其中在月经期的波动最为明显,其优势菌属在月经周期中呈现相互交替或保持绝对优势的变化模式;而RVVC患者阴道菌群的波动性减弱,不随月经周期的变化而变化,且在疾病发作期和间歇期的菌群结构相似.结论 RVVC患者阴道菌群结构不随月经周期发生变化,在疾病发作期和间歇期相似.诱导卷曲乳杆菌产生或抑制惰性乳杆菌定植,从而恢复阴道菌群比例,可能可以治愈RVVC.     

Recurrent extended-spectrum beta-lactamase-producing Escherichia coli urinary tract infection due to an infected intrauterine device

The use of intrauterine devices (IUDs) have been widespread since the 1960s. In 2002, the World Health Organization estimated that approximately 160 million women worldwide use IUDs. However, IUDs are associated with short-term complications such as vaginal bleeding, pelvic discomfort, dyspareunia and pelvic infection. Herein, we report the case of a woman who had recurrent urinary tract infection (UTI) due to the use of an IUD, even after treatment. The patient developed four episodes of UTI within a seven-month period after IUD insertion. During each episode of UTI, extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli) was cultured from the patient''s midstream urine. The IUD was finally removed, and culture of the removed IUD was positive for ESBL-producing E. coli. An infected IUD as a source of recurrent UTI should be considered in women with IUD in situ who develop recurrent UTI even after treatment.     

细菌性阴道病和念珠菌性阴道炎的临床分析

目的 探讨女性下生殖道细菌性阴道病（BV）、念珠菌性阴道炎（VVC）单纯感染与混合感染之间治疗后复发率和易复发率的差别，以寻求有效的治疗和预防措施。方法 以阴道分泌物半定量法、湿片法和培养法对临床药物治疗状态进行综合分析。结果 7595例外阴阴道炎病例中单纯BV、单纯VVC和BV-VVC混合感染的患病率为56．6％（4295／7595）、30．68％（2330／7．595）和12．77％（970／7595）；复发率分别为4．07％（175／7595）、7．89％（184／7595）和48.56％（471／7595），前二者与后者间差异有显著性P〈0.01。830例复发病例中。BV、VVC单纯感染和混合感染的易复发率分别为1．7％（3／175），4，89％（9／84）和10．19％（48／471），前二者与后者间差异有显著性P〈0，05。结论 BV、VVC混合感染导致VVC复发率、易复发率明显增高；VVC合并BV是VVC复发的一个重要因素，应引起临床高度关注及有效的系统治疗。     

阴道微生物菌群与高危型人乳头瘤病毒16和18型感染的相关性研究

目的 探讨阴道微生物（vaginal microbiota, VMB）组成与人乳头瘤病毒（human papilloma virus, HPV） 16型和18型感染的关系。方法 采用基因二代测序方法测定阴道微生物16S rRNA 基因及聚合酶链反应技术（polymerase chain reaction,PCR） 进行HPV 16型、18型核酸测定。采用χ²检验及Logistic 回归分析阴道微生物菌群构成类型（community state types,CSTs）与HPV-16型和18型感染的相关性, UniFrac加权矩阵及LEfSe线性分析特定微生物菌群与HPV-16型和18型感染的相关性。结果 本研究中共发现3种阴道微生物菌群构成类型,分别是CST IV（low Lactobacillus spp.） 65.4%,CST Ⅲ（L. iners） 32.1%和CST V（L. jensenii） 2.6%,LEfSe分析显示HPV16感染者阴道微生物乳酸杆菌缺乏而厌氧菌属丰富,无乳链球菌（Streptococcus agalactiae）仅发现于HPV16感染者阴道微生物菌群中。HPV18感染者阴道微生物菌群以乳酸杆菌属（Lactobacillus）为主要丰度,而缺乏厌氧菌属。结论 阴道微生物菌群的构成及丰度与HPV16感染相关,无乳链球菌可能作为HPV16感染的标志性阴道微生物菌群,但需要进一步研究证据支持。     

Recurrent confusion and hypopituitarism.

Three women in late middle age had recurrent episodes of confusion which could not be explained solely on the basis of an associated infection. All three patients had latent hypopituitarism diagnosed on final presentation. Each patient had a previous history of a severe postpartum haemorrhage followed by two further pregnancies. Experienced clinicians had not made a diagnosis of confusional episodes due to hypopituitary encephalopathy because the history was not immediately available in the confused patient, and the significance of deficient axillary and pubic hair was not given due emphasis.     

低剂量结合雌激素软膏治疗绝经妇女泌尿系反复感染的临床观察

目的 探讨低剂量结合雌激素软膏治疗绝经妇女反复泌尿系感染的疗效和安全性.方法 选择绝经后反复泌尿系感染患者56例,其中36例为治疗组,20例为绝经后对照组;另选18例育龄期妇女作为尿道细胞的成熟值育龄对照组.治疗组为症状发作时口服抗生素并同时使用结合雌激素软膏行阴道治疗,绝经后对照组仅用抗生素对症治疗.观察用药后泌尿系感染症状发作次数的变化、了解治疗前后医疗费用的情况,并对三组分别进行尿道细胞涂片检查,计算尿道细胞的成熟值;治疗组观察用药前后子宫内膜厚度和血雌二醇(E2)水平及其他不良反应.结果 56例患者、18例育龄期妇女全部接受随访,观察6个月后与绝经后对照组比较,治疗组泌尿系感染发作次数、医疗费用明显下降[(1.71±1.24)次,(89.74±24.70)元vs(3.54±1.43)次,(294.86±309.73)元],组间比较有显著性差异(P＜0.001).治疗组用药后尿道细胞成熟值由(7.8±2.3)分上升至(36.3±17.5)分,有显著性差异(P＜0.001),与绝经后对照组的(7.2±2.2)分比较亦有显著性差异,但仍低于育龄对照组的尿道细胞成熟值[(94.8±4.7)分],组间比较有显著性差异(P＜0.01);治疗组用药前后血E 2、子宫内膜厚度无改变(P＞0.05).结论 阴道使用低剂量结合雌激素软膏治疗绝经后反复泌尿系感染有明显疗效,且不良反应轻微,可节省医疗费用,是一种较好的治疗方法.     

子宫肌瘤腹腔镜手术186例分析

目的:探讨腹腔镜下及腹腔镜辅助下经阴道或腹部"迷你"切口等微创术式在子宫肌瘤切除术中的适应证、术中术后并发症、术后恢复等方面的区别。方法:回顾分析我院2005年4月至2007年8月间腹腔镜下子宫肌瘤切除术154例,腹腔镜辅助下经阴道子宫肌瘤切除术13例,腹腔镜辅助下腹部"迷你"切口子宫肌瘤切除术19例。结果:腹腔镜组中术后病率5例,平均手术时间(47.3±25.2)min,平均术中出血(84.3±34.6)ml。辅助下经阴道组术后病率4例,平均手术时间(78.6±42.9)min,平均术中出血(131.4±52.6)ml。辅助迷你组术后病率1例,平均手术时间(72.4±47.5)min,平均术中出血(130.6±58.7)m1。结论:三种术式相比,因其手术入路不同、适应证略有不同,腹腔镜手术术中出血少、术后恢复快、术后病率低。     

利用DNA指纹图谱技术对健康女性阴道菌群多样性的分析

目的:利用DNA指纹图谱技术——变性梯度凝胶电泳(denaturing gradient gel electrophoresis,DGGE)分析我国育龄期及绝经期健康女性阴道菌群多样性,为了解各种下生殖道感染疾病状态下的微生态环境奠定基础,为研制适合恢复中国女性正常阴道微生态环境的微生态制剂提供依据。方法:选取2009年10月至2010年1月在北京大学第一医院妇产科门诊常规体检的健康女性(其中育龄期30例、绝经后30例)为研究对象。采集阴道分泌物,提取细菌总DNA,采用通用引物对细菌16S rDNA基因的V3区进行扩增,将PCR产物进行变性梯度凝胶电泳,通过对DGGE特征条带切胶回收并进行克隆测序,利用GenBank中的Blast与已知序列比对,鉴定细菌菌种,分析不同生理状态下阴道菌群的多样性。结果:(1)我国育龄期健康女性阴道常见菌种为:卷曲乳杆菌(Lactobacilluscrispatus)、惰性乳杆菌(Lactobacillus iners)和加氏乳杆菌(Lactobacillus gasseri),其中惰性乳杆菌是以往通过传统培养方法尚未认识到的阴道优势菌种。(2)绝经期健康女性阴道菌种与育龄期不同且复杂,常见菌种有:惰性乳杆菌、卷曲乳杆菌、大肠杆菌(Escherichia coli)、无乳链球菌(Streptococcus agalactiae)、解没食子酸链球菌(Streptococcusgallolyticus)、韦荣球菌属(Veillonella sp.)、中间链球菌(Streptococcus intermedius)、咽颊炎链球菌(Streptococcus angi-nosus)、普雷沃氏菌属(Prevotella sp.)、气球菌(Anaerococcus lactolyticus)和脆弱拟杆菌(Bacteroides fragilis)。结论:通过DGGE分析发现我国育龄期健康女性阴道常见优势菌种为:卷曲乳杆菌、惰性乳杆菌、加氏乳杆菌;绝经期健康女性阴道常见优势菌种为:惰性乳杆菌、卷曲乳杆菌、大肠杆菌、链球菌属、普雷沃菌属、脆弱拟杆菌以及产乳酸的韦荣球菌、气球菌属,并首次发现在不同生理状态下惰性乳杆菌均是阴道优势菌种之一。     

Frequency of asymptomatic shedding of herpes simplex virus in women with genital herpes

Twenty-seven women with recurrent genital herpes simplex virus infection underwent daily home culturing to detect asymptomatic genital herpes simplex virus shedding. Asymptomatic herpes simplex virus shedding was documented on 1% of the days on which cultures were obtained. Asymptomatic shedding from the vulva was as frequent as asymptomatic cervicovaginal shedding, and 45% of asymptomatic episodes were identified only by positive results from vulvar cultures. All women who obtained samples on more than 100 days and 80% of women who obtained samples on more than 50 days had documented asymptomatic viral shedding, compared with only 6% of those who obtained samples for fewer than 25 days. Asymptomatic shedding was not related to contraceptive use or menstrual cycle. These data suggest that all women with recurrent genital herpes simplex virus infection should be instructed about the possible risk, albeit infrequent, of asymptomatically shedding virus from the genital tract.     

经闭孔无张力阴道补片在女性前盆底重建中的应用

目的探讨经闭孔无张力阴道补片前盆底重建术治疗中、重度以及术后复发的阴道前壁脱垂的疗效及安全性。方法对36例3~4度以及术后复发的阴道前壁脱垂患者进行经闭孔无张力阴道聚丙烯补片前盆底重建术。对伴有压力性尿失禁(SUI)或潜在SUI的患者同时进行经闭孔尿道中段无张力阴道吊带术(TOT)。通过比较手术前后POP-Q分度法分级判断手术疗效,同时统计和分析并发症的发生情况。结果经闭孔无张力阴道聚丙烯补片前盆底重建的平均手术时间52 m in;术中平均出血量55 mL;术后平均住院时间3.5 d;无手术并发症发生。所有患者的阴道前壁脱垂得到纠正。随访2~24个月,未出现复发,有效率100%。尿失禁症状分级均显著改善,有效率100%。阴道聚丙烯补片修补术后侵蚀发生率5.56%。结论经闭孔无张力阴道聚丙烯补片前盆底重建术是治疗中、重度以及术后复发阴道前壁脱垂的微创手术方法;伴有SUI或潜在SUI的患者需同时进行TOT。该术式安全可行,短期疗效好;但术后有补片侵蚀的发生;长期疗效尚有待进一步观察。     

A retrospective analysis of isolates from patients with vaginitis in a private Greek obstetric/gynecological hospital (2003-2006).

BACKGROUND: Vaginitis is a common cause of complaints in women in various parts of the world. Through our literature search, we identified noteworthy differences in the etiology of vaginitis based on the geographic location. This study was conducted to describe microbial etiology in a population of symptomatic women with vaginitis in Greece. MATERIAL/METHODS: Data for pathogens isolated from cultures of vaginal fluid specimens or identified with microscopy testing of such specimens of women with symptomatic vaginitis who were examined at "Lito" Private Obstetric/Gynecological Hospital, Athens, Greece, during the period 1/2003-12/2006 were analyzed retrospectively. RESULTS: During this period, 1632 women were examined. The mean age of the patients was 28 years, ranging from 18 to 57 years. Three hundred and eighty five from 1632 cultures/tests contributed no pathogen, whereas 1247/1632 cultures/tests were positive. Of the isolates, in which twelve species were identified, 504 (40.4%) were Gardnerella vaginalis, 530 (42.5%) Candida spp, and 101 (8.1%) Trichomonas vaginalis. Less usual isolates were Escherichia coli, Streptococcus agalactiae, Enterococcus spp., Streptococcus viridans, Staphylococcus epidermidis, Peptostreptococcus spp., and Staphylococcus saprophyticus. CONCLUSIONS: The authors believe that this study adds to the relevant literature of information regarding the pathogens implicated in patients with symptomatic vaginitis by reporting data from a cohort of patients in Greece. Ninety-one percent of the isolated and identified pathogens from vaginal cultures of symptomatic Greek women included Candida albicans, Gardnerella vaginalis, and Trichomonas vaginalis, with the first two species representing the great majority.     

外阴阴道假丝酵母菌病患者阴道局部甘露糖结合凝集素mRNA水平的测定

目的:初步探讨甘露糖结合凝集素(MBL)在外阴阴道念珠菌病(VVC)和复发性外阴阴道念珠菌病(RVVC)发病过程中的免疫机制。方法:选取2006年1月~2007年7月健康体检的女性、VVC患者、RVVC患者各20例,采集阴道灌洗液,半定量RT-PCR测定MBL-mRNA表达情况。结果:阴道局部MBL-mRNA的表达VVC患者显著高于正常人群,而RVVC患者显著低于正常人群。结论:VVC患者阴道局部MBL-mRNA高表达说明MBL参与了局部免疫反应,其在免疫防御中发挥了重要作用,而阴道局部MBL-mRNA的低表达可能和RVVC反复发作不易治疗有关,提示有必要对MBL水平低下者进行MBL临床治疗的研究。     

外阴阴道假丝酵母菌病患者阴道局部甘露糖结合凝集素mRNA水平的测定

目的：初步探讨甘露糖结合凝集素（MBL）在外阴阴道念珠菌病（VVC）和复发性外阴阴道念珠菌病（RVVC）发病过程中的免疫机制。方法：选取2006年1月～2007年7月健康体检的女性、VVC患者、RVVC患者各20例，采集阴道灌洗液，半定量RT-PCR测定MBL-mRNA表达情况。结果：阴道局部MBL-mRNA的表达VVC患者显著高于正常人群，而RVVC患者显著低于正常人群。结论：VVC患者阴道局部MBL-mRNA高表达说明MBL参与了局部免疫反应，其在免疫防御中发挥了重要作用，而阴道局部MBL-mRNA的低表达可能和RVVC反复发作不易治疗有关，提示有必要对MBL水平低下者进行MBL临床治疗的研究。     

剖宫产后妊娠经阴分娩可行性分析

目的研究探讨割宫产后再次妊娠经阴分娩的可行性。方法对120例剖宫产后再次妊娠孕妇经阴分娩情况进行观察。结果120例孕妇阴道试产,试产成功86例,成功率71．6％。结论只要选择适当的孕妇,剖宫产后再次妊娠大部分可经阴道分娩,剖宫产史不应该作为再次妊娠剖宫产的手术指征。     

Ultrasound findings in amenorrhoeic women with vaginal bleeding

OBJECTIVE OF STUDY: To document sonographically identifiable causes of vaginal bleeding in secondarily amenorrhoeic women of child bearing age. METHODS: A retrospective study of ultrasonographic findings among 102 secondarily amenorrhoeic women of childbearing age with vaginal bleeding was carried out. Ultrasound scan was carried using Siemens Sonoline SL1 equipment with 3.5MHz and 5.0MHz transducers RESULTS: 75(73.2%) patients had pregnancy-related conditions, 14(13.7%) had normal, non-pregnant uteri while the remaining 13 (12.8%) had other gynaecological conditions namely pelvic inflammatory disease (PID), uterine fibroids and ovarian masses. Though pregnancy-related conditions are the major causes of vaginal bleeding in amenorrhoeic women of childbearing age, PID, fibroids and ovarian masses are possible findings. CONCLUSION: Ultrasound examination is vital in the elucidation of vaginal bleeding in amenorrhoeic women. Pregnancy related conditions are not the only significant cause of amenorrhoea complicated by vaginal bleeding.     

瘢痕子宫再次妊娠经阴分娩的可能性分析

目的探讨瘢痕子宫再次妊娠实施经阴分娩的可能性与科学性。方法选择瘢痕子宫妊娠产妇500例进行分娩分析,产前对产妇行详细检查,了解前次剖宫产手术情况,严格产时监护、心理护理及产时镇痛处理,共有268例患者选择经阴分娩。结果144例成功行经阴分娩,124例试产失败者均行剖宫产术。结论瘢痕子宫的足月妊娠在一定的科学条件下实施阴道分娩是可行的。     

雌激素治疗绝经后妇女反复血尿的临床观察

目的探讨雌激素治疗绝经妇女无痛性反复血尿的效果及可行性。方法将 46例反复血尿的绝经后妇女分成两组 ,即雌激素治疗组 ,治疗组使用结合雌激素 (商品名倍美安片剂 ) ,对照组使用止血药及抗炎对症药物 ,疗程为 6个月。用药前分别行清洁中段尿常规检查 ,尿细菌培养 ,B超检查 ,排除泌尿系统肿瘤 ,损伤结石等因素而致的血尿 ,同时对阴道细胞成熟值及阴道健康情况进行评估 ,并测定血清中雌二醇水平、肝、肾功能及血酯 ,做尿三杯试验。结果治疗组 30例除 1例失访外 ,其余均完成治疗。用药后治疗组血尿发生率 (1/ 2 9) ,明显低于对照组 (13/ 16 ) ,差异有极显著性 (P <0 0 0 1)。治疗组阴道乳酸杆菌检出率达 10 0 % ,对照组无乳酸杆菌出现。治疗阴道健康评分 (13 4± 2 5 )分。阴道细胞成熟值 (74 6± 14 1) ,分别明显高于综合治疗组 (5 2± 4 3;10 8± 8 3) ,差异有显著性 (P <0 0 5 )。结论使用性激素补充治疗能有效治疗绝经后反复血尿效果好 ,且不易复发     

人型支原体感染与阴道菌丛改变关系的研究

目的　探讨细菌性阴道炎和非细菌性阴道炎患者阴道人型支原体（Ｍｈ） 与阴道菌丛改变的关系。方法１２３（１２．３％ ）例妇女Ｍｈ 培养阳性，８７３ 例Ｍｈ 培养阴性为对照组。阴道炎Ｍｈ 培养阳性组中５０ 例有细菌性阴道炎，对照组中８１ 例妇女检出细菌性阴道炎。用Ｌｏｇｉｓｔｉｃ 回归分析。结果　Ｍｈ 阳性组较对照组阴道有明显鱼腥臭味，氨试验阳性，阴道ｐＨ＞ ４．７，并出现线索细胞；Ｍｈ 阳性组阴道菌丛改变较大。结论　表明Ｍｈ 感染与生殖器症状与及阴道菌丛改变有关联。     

Recurrent vaginal candidiasis. Importance of an intestinal reservoir.

To test the hypothesis that all cases of vaginal candidiasis are associated with a "reservoir" of this organism in the bowel, paired specimens of feces and vaginal material were cultured for Candida albicans simultaneously. Ninety-eight young women who complained of recurrent vaginitis were selected in sequence. The results showed that if C albicans was cultured from the vagina, it was always found in the stool. Conversely, if it was not isolated from the stool, it was never found in the vagina. These data are presented as an explanation for the recurrent nature of Candida vaginitis, and thus a cure of vaginitis would not be possible without prior eradication of C albicans from the gut. The gut-reservoir concept may well apply to other forms of candidiasis.     

复发性外阴阴道念珠菌病的危险因素及治疗研究

为探讨复发性外阴阴道念珠菌病 (RVVC)发病的危险因素及其治疗方法 ,采用念珠菌直接镜检和培养的方法将 15 6例患者中阳性者分为 RVVC组和外阴阴道念珠菌病 (VVC)组 ,阴性者为对照组 ,分析各种危险因素在三组之间的差异。并对克霉唑乳酸配方阴道栓和制霉菌素治疗 RVVC的疗效进行观察。结果表明 :使用抗生素、阴道冲洗、口服避孕药、妊娠是 RVVC的危险因素 ,克霉唑乳酸配方阴道栓可有效预防 RVVC的复发