妇科门诊不同阴道症状就诊者阴道微生态状况调查

目的 了解妇科门诊因不同阴道症状而就诊的女性阴道微生态状况.方法 2006年3月至2007年10月,选择在北京大学第一医院妇科门诊因外阴瘙痒、阴道分泌物增多、阴道分泌物有异味等症状就诊的6982例女性,取其阴道分泌物,进行pH值、H<,2>O<,2>含量检测,并经革兰染色后在油镜下观察,进行阴道微生态(阴道菌群的密集度、多样性、优势菌、炎性反应状况等)状况评价.结果 6982例就诊者中,阴道微生态正常750例,占10.74%(750/6982);阴道微生态失调6232例,占89.26%(6232/6982);后者包括细菌性阴道病(BV)患者729例,占10.44%(729/6982);外阴阴道假丝酵母菌病(VVC)患者1527例,占21.87%(1527/6982);BV合并VVC 95例,占1.36%(95/6982);菌群异常1229例.占17.60%(1229/6982);菌群正常但阴道pH值、清洁度、乳杆菌功能异常2652例,占37.98%(2652/6982).结论 妇科门诊不同阴道症状就诊者阴道微生态可表现为正常状态,也可表现为失调状态;阴道微生态评价能够指导临床医师全面评价阴道微生态状况.     

Clinical characteristics of aerobic vaginitis and its mixed infections

OBJECTIVE: To investigate clinical characteristics of aerobic vaginitis (AV) and its mixed infections for diagnosis efficiently. METHODS: From April 2008 to December 2008, 516 patients with vaginitis treated in Tianjin Medical University General Hospital were enrolled in this study. AV, bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), trichomonal vaginitis (TV), and cytolytic vaginosis (CV) were diagnosed based on symptoms, sign and vaginal discharge examination. RESULTS: Among 516 cases, AV cases were found in 14.7% (76/516), and AV was common vaginal infection. AV mixed infections was diagnosed in 58% (44/76), including mixed with BV (45%, 20/44), mixed with VVC (30%, 13/44), and mixed with TV (25%, 11/44). Those common symptom of AV were yellow vaginal discharge (63%, 20/32), more vaginal discharge (44%, 14/32). Vaginal pH value was usually more than 4.5 (84%, 27/32). Vaginal cleanliness mainly was grade III - IV (88%, 28/32). Six cases with enterococcus faecium and 4 cases with streptococci were frequently isolated. The symptom and sign of mixed AV infection was atypical. CONCLUSIONS: Aerobic vaginitis is a common lower vaginal infection and easily mixed with other pathogens, especially with BV, VVC or TV. When patients were diagnosed with AV or other vaginal infection, it should be mentioned whether those patients have mixed vaginal infection or AV.     

Could bacterial vaginosis be due to the competitive suppression of lactobacilli by aerobic microorganisms?

Bacterial vaginosis (BV) is characterized by lack of lactobacilli and predominance of anaerobic species. Ciprofloxacin is active against a great number of aerobic bacteria. The effect of ciprofloxacin on the vaginal microbial flora was studied both in healthy subjects and in patients with BV in order to test if BV may be due to competitive suppression of lactobacilli by aerobic species. About half of the patients were relieved of their symptoms. No adverse effects on the microbial profile or colonization by lactobacilli were produced by the drug. Lactobacilli known to be able to produce hydrogen peroxide were found to be significantly more common in healthy women than in women with BV. The species most frequently related to vaginal health were Lactobacillus jensenii and Lactobacillus rogosae.     

下生殖道感染患者阴道局部免疫状态的研究

目的 研究下生殖道感染患者阴道局部免疫状态及其与疾病发生的相关性.方法 应用酶联免疫吸附试验测定外阴阴道假丝酵母菌病(VVC)60例(VVC组)、细菌性阴道病(BV)60例(BV组)、滴虫性阴道炎(TV)40例(TV组)、宫颈人乳头状瘤病毒(HPV)感染60例(HPV组)、宫颈沙眼衣原体(CT)感染60例(CT组)及各组同期60例正常妇女(对照组)的阴道灌洗液辅助性T淋巴细胞(Th细胞)1、2细胞因子水平,其中Th1细胞因子以白细胞介素(IL)2表示,Th2细胞因子以IL-4、5或IL-13表示,并结合临床资料进行分析.BV、TV组患者同时测定趋化因子--IL-8.所有患者进行人防御素5(HD5)的检测.结果 (1)Th1细胞因子:WC、BV、TV、CT组与各自的对照组IL-2水平比较,差异均无统计学意义(P>0.05).HPV组IL-2水平为(96±33)×10-3 pg/L,HPV对照组为(76±36)×10-3 pg/L,两组比较,差异有统计学意义(P<0.05).(2)Th2细胞因子:VVC、CT组与各自的对照组IL-4水平比较,差异无统计学意义(P>0.05);BV组与BV对照组IL-5水平比较,差异也无统计学意义(P>0.05);TV组IL-13水平为(42±15)×10-3 pg/L,TV对照组为(30±29)×10-3pg/L,两组比较,差异有统计学意义(P<0.05);HPV组IL-4水平为(103±28)×10-3pg/L,HPV对照组为(36±22)×10-3pg/L,两组比较,差异也有统计学意义(P<0.05).(3)趋化因子:TV组IL-8水平为(5.8±2.7)pg/L,TV对照组为(2.6±2.4)pg/L,两组比较,差异有统计学意义(P<0.05);BV组与BV对照组IL-8水平比较,差异无统计学意义(P>0.05).(4)HD5:VVC、HPV、CT、BV、TV组HD5水平均高于各自对照组,差异均有统计学意义(P<0.05).结论 (1)阴道上皮的先天免疫因子HD5是下生殖道感染发病过程中的重要因子.(2)IL-13等Th2细胞因子在不同下生殖道感染发病过程中的作用较IL-2可能更为重要.(3)趋化因子IL-8在TV发病过程中可能具有重要的意义.     

Lactobacilli in the female genital tract in relation to other genital microbes and vaginal pH

BACKGROUND: The relationship between lactobacilli and other microbes and the association with vaginal pH in the female genital tract were examined. The study also included evaluation of the possibility of supplying probiotics to the genital tract by using panty liners impregnated with the probiotic strain Lactobacillus plantarum LB931. METHODS: This was a randomized, placebo-controlled, double-blind, multicenter study involving 191 healthy fertile women. Specified microbes were counted and vaginal pH was measured once a month for five consecutive months. RESULTS: Major individual variations in the genital microflora composition and the vaginal pH were found among the women. The number of lactobacilli was significantly related to vaginal pH (p<0.001) and approximately 70% of the women were permanent carriers of individual lactobacilli strains. Women with high numbers of lactobacilli were less prevalent with Group B streptococci than women with low numbers (p=0.036), and these women had a lower mean vaginal pH. The number of lactobacilli also correlated with the prevalence of yeast. LB931 could be found in 86% of the labial samples and 54% of the vaginal samples. CONCLUSIONS: High numbers of lactobacilli may contribute to a low vaginal pH and seem to have a negative influence on Group B streptococci. LB931 could be transferred from the panty liners to both the vagina and the labial fold.     

Bacterial vaginosis and the effect of intermittent prophylactic treatment with an acid lactate gel

Intermittent treatment with an acid lactate gel (Lactal, ACO, Sweden) reduced symptoms of bacterial vaginosis (BV) and promoted the reestablishment of the normal vaginal flora of lactobacilli. Forty-two women seriously affected by recurrent BV were initially given acid gel (lactate gel, pH 3.8, 5 ml) to be inserted into the vagina daily for 7 consecutive days. Thereafter they entered into a double blind clinical trial and were treated prophylactically 3 days monthly for 6 months with either lactate gel or a placebo gel. Women treated with the lactate gel were clinically improved, i.e. no signs of BV in 88% compared to 10% in the placebo group (p less than 0.001). The vaginal lactobacilli flora was reestablished in 83% of the lactate group and in 16% of the placebo group. Local intermittent application of lactate gel was found to be free of side effects and is a preferable alternative to repeated treatments with antibiotics in patients with recurrent BV.     

需氧菌性阴道炎及其混合感染的临床特征分析

目的 探讨需氧菌性阴道炎(AV)及其混合感染的临床特征,为AV的临床诊治提供帮助.方法 2008年4-12月,在天津医科大学总医院选取以外阴不适、阴道分泌物异常等阴道炎症状就诊的患者516例,联合其症状、体征及相关实验室检查诊断常见阴道炎,即AV、细菌性阴道病(BV)、外阴阴道假丝酵母菌病(VVC)、滴虫阴道炎(TV),分析AV及其混合感染的临床特征.结果 516例患者中,AV 76例,占14.7%(76/516),北中混合感染44例,占58%(44/76).在44例AV混合感染中,以合并BV多见,占45%(20/44);其次为合并VVC,占30%(13/44);合并TV占25%(11/44).单纯AV患者的常见症状主要为黄绿色稀薄脓性阴道分泌物(63%,20/32),其次为阴道分泌物增多(44%,14/32);阴道pH值常>4.5(84%,27/32),清洁度主要为Ⅲ～Ⅳ度(88%,28/32);细菌培养为粪肠球菌(6例)、链球菌(4例)等需氧菌.结论 AV是常见的下生殖道感染,易合并其他病原体感染,尤以合并BV、VVC及TV多见,混合感染时症状、体征不典型.在AV诊断中,注意有无合并其他阴道感染,并在诊断其他阴道感染时,注意是否合并AV.     

内蒙古牧区育龄期健康及细菌性阴道病妇女阴道乳杆菌种的鉴定与分析

目的 对内蒙古牧区育龄期健康妇女及细菌性阴道病(BV)患者的阴道乳杆菌种进行鉴定与分析,为阴道微生态治疗提供依据.方法 2008年6至12月,选取内蒙古自治区3个牧区旗县(正镶白旗、达尔罕茂明安联合旗、百灵庙镇)育龄期蒙古族健康妇女203例、汉族健康妇女74例,蒙古族BV妇女102例,采用改良乳杆菌培养基(MRS)对阴道侧壁分泌物中乳杆菌进行分离、培养,提取细菌总DNA,进行核糖体脱氧核糖核酸(16S rDNA)基因序列鉴定,并采用四甲基联苯胺-辣根过氧化物酶-乳杆菌培养基(TMB-HRP-MRS)对乳杆菌进行产H2O2分析.结果 (1)检出率:203例蒙古族健康妇女乳杆菌检出率为76.8%(156/203),蒙古族BV妇女乳杆菌检出率为21.6%(22/102),两者比较,差异有统计学意义(P＜0.01);汉族健康妇女乳杆菌检出率为82.4%(61/74),与蒙古族健康妇女比较,差异无统计学意义(P＞0.05).(2)阴道乳杆菌鉴定:蒙古族健康妇女阴道分泌物中共检出193株乳杆菌株,共11种,蒙古族BV妇女阴道分泌物中检出22株乳杆菌株,共4种.(3)H2O2阳性乳杆菌的鉴定:对分离出乳杆菌的74例蒙古族健康妇女及22例蒙古族BV妇女进行阴道乳杆菌H2O2实验,其中蒙古族健康妇女阴道H2O2阳性乳杆菌的检出率为75.7%(56/74),蒙古族BV妇女阴道H2O2阳性乳杆菌的检出率为27.3%(6/22),两者比较,差异有统计学意义(P＜0.05).结论 内蒙古牧区育龄期健康妇女阴道乳杆菌检出率与种族无明显相关性;BV妇女的阴道乳杆菌及H2O2阳性乳杆菌检出率均较健康妇女明显降低.

Abstract：

Objective To identify and analyze the species of vaginal lactobacilli between patients with bacterial vaginosis (BV) and healthy women at childbearing age in Inner Mongolia. Methods From Jun. 2008 to Dec. 2008, 203 Mongolian healthy women, 74 Han healthy women and 102 Mongolian patients with BV from 3 pastoral areas were enrolled in this study. Isolation and culture of lactobacilli from vaginal wall were performed by modified culture medium. DNA of lactobacilli were extracted and sequenced. H2O2 were detected by TMB-HRP-MRS. Results(1)The rate of lactobacilli identification were 76.8%(156/203) in Mongolian healthy women and 21.6% (22/102) in Mongolian patients with BV, which reached statistical difference(P＜0.01).Lactobacilli identification in Han healthy women [82.4%(61/74)] did not show significant difference with that of Mongolian healthy women (P＞0.05). (2) The total of 193 strains and 11 species of Lactobacillus were detected in 203 Mongolian healthy women. Meanwhile,22 strains and 4 species of Lactobacillus were found in 102 Mongolian BV cases.(3)The rate of H2O2 generating Lactobacilli was 27.3% (6/22) in Mongolian BV patients and 75.7% (56/74)in Mongolian healthy women, which showed statistical difference(P＜0.05). Conclusions The rate of Lactobacillus was not related with the race of women in pastoral area in Inner Mongolian. The amount of lactobacilli and H2O2 generating Lactobacilli in the vagina of BV patients was remarkably lower than those of healthy women at childbearing age.     

Long, uniform Lactobacilli (Döderlein's Bacteria): a new risk factor for postoperative infection after first-trimester abortion

Objective: The production of hydrogen peroxide (H₂O₂) from different strains of lactobacilli in the vagina has been proposed to play one of the most important protective roles in the vaginal defense system. New data have, however, suggested that Döderlein''s bacteria, with the morphological appearance of long lactobacilli, have a low production of H₂O₂ . The purpose of the present study was to correlate the morphology of lactobacilli with the incidence of infection following legal abortion.Methods: Seven hundred sixty-nine women with lactobacilli but without Chlamydia trachomatis or bacterial vaginosis in their vaginal wet smears who were to undergo legal abortions were divided into 6 different groups according to the morphological appearance of the lactobacilli. The postoperative infection rates in these different groups were compared. A phenotypic classification of some of the lactobacilli was performed.Results: The presence of Döderlein''s bacteria compared with a mixed flora of lactobacilli increased the risk of postoperative infection 3 times [relative risk (RR) = 3.0; 95% confidence interval (CI), 1.5-6.3]. After a logistic regression analysis, the only independent risk factors were the presence of Döderlein''s bacteria and earlier gestational age.Conclusions: We found that the lactobacilli regarded as commensal organisms and “normal, healthy lactobacilli” in the vagina were present in only 18% of these women and that their presence might be hazardous. Therefore, we must reconsider our concept of the “normal” lactobacilli in the vaginal wet smears of healthy women.     

Leukocyte esterase activity in vaginal fluid of pregnant and non-pregnant women with vaginitis/vaginosis and in controls

OBJECTIVES: To determine the leukocyte esterase (LE) activity in vaginal lavage fluid of women with acute and recurrent vulvovaginal candidosis (VVC and RVVC respectively), bacterial vaginosis (BV), and in pregnant and non-pregnant women without evidence of the three conditions. Also to compare the result of LE tests in women consulting at different weeks in the cycle and trimesters of pregnancy. The LE activity was correlated to vaginal pH, number of inflammatory cells in stained vaginal smears, type of predominating vaginal bacteria and presence of yeast morphotypes. METHODS: One hundred and thirteen women with a history of RVVC, i.e. with at least four attacks of the condition during the previous year and who had consulted with an assumed new attack of the condition, were studied. Furthermore, we studied 16 women with VVC, 15 women with BV, and 27 women attending for control of cytological abnormalities, who all presented without evidence of either vaginitis or vaginosis. Finally, 73 pregnant women were investigated. The LE activity in vaginal fluid during different weeks in the cycle of 53 of the women was measured. RESULTS: In the non-pregnant women, an increased LE activity was found in 96, 88, 73 and 56% of those with RVVC, VVC and BV and in the non-VVC/BV cases, respectively. In 73% of pregnant women in the second trimester, and 76% of those in the third, the LE test was positive. In all groups of non-pregnant women tested, the LE activity correlated with the number of leukocytes in vaginal smears, but it did not in those who were pregnant. There was no correlation between LE activity and week in cycle. The vaginal pH showed no correlation to LE activity in any of the groups studied. CONCLUSIONS: The use of commercial LE dipsticks has a limited value in the differential diagnosis of RVVC, VVC and BV. There is no correlation between the LE activity in vaginal secretion on one hand and vaginal pH, week in the menstrual cycle and trimester in pregnancy on the other. Women with BV often have signs of inflammation as evidenced by a positive LE test and inflammatory cells in genital smears.     

健康妇女和外阴阴道假丝酵母菌病患者阴道乳杆菌对阴道假丝酵母菌抑制作用的实验研究

目的:探讨正常健康和外阴阴道假丝酵母菌病(VVC)妇女阴道分泌物中分离的乳杆菌对假丝酵母菌生长的抑制。方法:健康正常(正常组)和VVC初发(VVC组)妇女各30名,通过定量采集阴道分泌物培养乳杆菌,观察阴道乳杆菌数量及菌种分布情况,并将获得的乳杆菌及VVC患者阴道分泌物中假丝酵母菌分离纯化及鉴定后,采用牛津杯法观察乳杆菌对假丝酵母菌生长的抑制作用,同时比较VVC组和正常组乳杆菌产H2O2能力的差异。结果:①乳杆菌检出率及菌种分布组间无统计学差异(P>0.05);②VVC组阴道乳杆菌数量的平均对数值与正常组相比显著减少(P<0.01);③阴道内乳杆菌BV试剂盒检测为阴性者,正常组显著高于VVC组(P<0.01);④正常组阴道分离的乳杆菌与VVC组比较,对白色和热带假丝酵母菌的生长抑制有统计学差异(P<0.05),对克柔假丝酵母菌的抑制无统计学差异(P>0.05);正常组分离的嗜酸乳杆菌与VVC组的比较,对白色和热带假丝酵母菌的生长抑制均有统计学差异(P<0.01,P<0.05),对克柔假丝酵母菌的生长抑制无统计学差异(P>0.05);但是正常组和VVC组分离的詹氏乳杆菌对上述3种假丝酵母菌的生长抑制均无统计学差异(P>0.05)。结论:①正常妇女与VVC患者阴道内乳杆菌检出率、菌种分布相似,均以嗜酸、詹氏乳杆菌为优势菌种;②VVC患者阴道乳杆菌的数量显著减少;③VVC组产生H2O2的能力下降,可能与VVC发生相关;④正常状态下阴道乳杆菌对假丝酵母菌抑制作用优于VVC感染状态,其中以嗜酸乳杆菌的抑菌作用最为明显。     

Complexity of vaginal microflora as analyzed by PCR denaturing gradient gel electrophoresis in a patient with recurrent bacterial vaginosis

OBJECTIVE: Gardnerella vaginalis has long been the most common pathogen associated with bacterial vaginosis (BV). We aimed to test our hypothesis that symptoms and signs of BV do not necessarily indicate colonization by this organism, and often will not respond to standard metronidazole or clindamycin treatment. METHODS: Using a relatively new molecular tool, PCR denaturing gradient gel electrophoresis (DGGE), the vaginal microflora of a woman with recalcitrant signs and symptoms of BV was investigated over a 6-week timeframe. RESULTS: The vagina was colonized by pathogenic enterobacteriaceae, staphylococci and Candida albicans. The detection of the yeast by PCR-DGGE is particularly novel and enhances the ability of this tool to examine the true nature of the vaginal microflora. The patient had not responded to antifungal treatment, antibiotic therapy targeted at anaerobic Gram-negative pathogens such as Gardnerella, nor daily oral probiotic intake of Lactobacillus rhamnosus GG. The failure to find the GG strain in the vagina indicated it did not reach the site, and the low counts of lactobacilli demonstrated that therapy with this probiotic did not appear to influence the vaginal flora. CONCLUSIONS: BV is not well understood in terms of its causative organisms, and further studies appear warranted using non-culture, molecular methods. Only when the identities of infecting organisms are confirmed can effective therapy be devized. Such therapy may include the use of probiotic lactobacilli, but only using strains which confer a benefit on the vagina of pre- and postmenopausal women.     

下生殖道感染与子宫颈细胞学异常的相关性研究

Objective?To study the association between abnormal cervical cytology and bacterial vaginosis (BV), vulvovaginal candidiasis(VVC), trichomonas vaginitis(TV), high-risk human papillomavirus(HR-HPV) infection in women attending cervical cancer screening. Methods?The study recruited 3 300 women aged 21 to 64 years of age who participated in cervical cancer screening. Demographic information was collected. Cervical exfoliated cell specimens were collected for liquid-based cytological diagnosis and HR-HPV detection. Reproductive tract secretions specimens were collected for molecular vaginitis diagnostics from women who were diagnosed with negative for intraepithelial lesion or malignancy(NILM) and all HR-HPV positive or ≥atypical squamous cells of undetermined significance(ASC-US). The Logistic multivariate model was used to analyze the risk factors of abnormal cervical cytology. Results?645 women were included in the study, including 408 NILM, 182 ASC-US, 23 low-grade squamous intraepithelial lesion (LSIL), and 32 high-grade squamous intraepithelial lesions (HSIL). The positive rate of HR-HPV (14.7%, 39.0%, 78.3% and 87.5%) increased with the severity of cytology (P<0.001). The prevalence of BV in different cytological diagnosis (34.1%, 49.5%, 60.9% and 43.8%) were significantly different (P<0.001), and the prevalence of BV in ASC-US were significantly higher than that in women with NILM (P<0.05). The prevalence of VVC in different cytological diagnosis (14.2%, 4.9%, 8.7% and 3.1%) was significantly different (P<0.01), and the ASC-US group was significantly lower than the NILM group (P<0.001). There was also a significant difference in the distribution of the prevalence of TV (2.5%, 9.3%, 4.3%, and 6.3%, P<0.01). The prevalence of TV in women with abnormal cytology was higher than that in women with normal cytology(P<0.05). The Logistic analysis showed that HR-HPV infection, BV, TV, VVC, lower level of education, and postmenopause were related to abnormal cervical cytology. Conclusion?HR-HPV infection is the determinant of abnormal cervical cytology. BV, TV, VVC, lower level of education, postmenopause, etc. may associate with abnormal cervical cytology.     

Co-occurence of indol-producing bacterial strains in the vagina of women infected with Chlamydia trachomatis

OBJECTIVES: The aim of this study was to determine if cervicitis, caused by Chlamydia trachomatis (C. trachomatis), has an influence on the frequency of occurrence of selected aerobic and anaerobic bacterial strains, connected with etiology of aerobic vaginitis (AV) and bacterial vaginosis (BV). Indole-producing bacteria have received particular attention due to their possibly inductive role in chronic cervicitis caused by C. trachomatis. MATERIAL AND METHODS: The swabs from vagina and cervical canal have been obtained from 122 women (aged 18-40). The presence of C. trachomatis antigen had been detected and diagnosed with the help of direct immunofluorescence, BV with Amesl and Nugent criteria, whereas the AV with Donders criteria. The identification of the bacterial strains isolated from vagina has been performed according to classical microbiological diagnostics. RESULTS: Disruption of vaginal microflora (4-10 in Nugent score) was determined in 11,5% of observed women. AV was diagnosed in 4.5% women with chlamydial cervicitis, BV was diagnosed in 10.9% and 5.45% of these women, on the basis of Amsel and Nugent criteria respectively. CONCLUSIONS: Indole-producing bacterial strains connected with BV and AV (Peptostreptococcus anaerobius, Propionibacterium acnes, Escherichia coli) have been isolated significantly more often from vagina of women infected with C trachomatis (p = 0.0405, chi2 = 4.20) and these findings confirm co-importance of indole-producing bacterial strains in cervicitis caused by C trachomatis .     

基于门诊患者阴道微生态与HPV感染的相关性研究

目的: 分析以外阴阴道瘙痒、干涩、疼痛和（或）分泌物异常为主诉就诊患者的阴道微生态及宫颈人乳头瘤病毒（human papilloma virus,HPV）分布特点,探讨阴道微生态失调与HPV感染的关系。方法: 选取2019年2月1日—2019年12月31日,因外阴阴道瘙痒、干涩、疼痛和（或）分泌物异常就诊于天津中医药大学第二附属医院妇科门诊的483例患者为研究对象,同时进行阴道微生态检测和宫颈HPV检测,对检测结果进行分析。结果: 483例患者中,阴道微生态正常者仅有4例,占0.8%,微生态失调者479例,占99.2%,其中有明确致病菌的微生态失调（即阴道感染）者350例（73.1%）,无明确致病菌的微生态失调者129例（26.9%）;在350例阴道感染患者中,单一感染287例（82.0%）,混合感染63例（18.0%）。外阴阴道假丝酵母菌病（vulvovaginal candidiasis,VVC）单一感染（38.7%,111/287）及含VVC的混合感染（79.4%,50/63）发生率最高。阴道感染者中乳杆菌减少者、H₂O₂含量减少者占比高于无明确致病菌的阴道微生态失调者,差异有统计学意义（P<0.05）。在483例患者中,HPV感染162例,感染率为33.5%,而阴道感染患者的HPV感染率（37.1%,130/350）明显高于无明确致病菌的阴道微生态失调患者（24.0%,31/129）,其中滴虫性阴道炎（trichomonal vaginitis,TV）、细菌性阴道病（bacterial vaginosis,BV）、需氧菌性阴道炎（aerobic vaginitis,AV）、VVC、BV中间型患者HPV感染率分别为73.3%（11/15）、52.9%（72/136）、34.5%（10/29）、29.2%（47/161）和 27.4%（20/73）。多因素回归分析结果显示,TV、BV与HPV感染正相关（OR分别为5.325和3.298,均P<0.05）。结论: 外阴阴道瘙痒、干涩、疼痛和（或）分泌物异常的患者常存在阴道微生态失调,而且容易合并HPV感染,当发生阴道感染时（特别是TV及BV）,HPV感染的风险显著增加。     

Relationship of vaginal bacteria and inflammation with conception and early pregnancy loss following in-vitro fertilization

OBJECTIVE: The aim of this study was investigate the impact of vaginal flora and vaginal inflammation on conception and early pregnancy loss following in-vitro fertilization (IVF). METHODS: We enrolled 91 women who were undergoing IVF. At embryo transfer (ET), all of the women had quantitative vaginal culture, ET catheter-tip culture, and vaginal Gram stain scored for bacterial vaginosis and quantitated for polymorphonuclear leukocytes (PMNs). Conception and early pregnancy loss were compared with culture and Gram stain results. Statistical analyses included the Chi-square test, Fisher's exact test and the Mann-Whitney U-test. RESULTS: The overall live birth rate (LBR) was 30% (27/91), and the rate of early pregnancy loss was 34% (14/41). In women with bacterial vaginosis, intermediate flora and normal flora, the conception rates were 30% (3/10), 39% (12/31) and 52% (26/50), respectively (p = 0.06 for trend). Early pregnancy loss occurred in 33% (1/3), 42% (5/12) and 31% (8/26) of women, respectively (p = 0.06, comparing intermediate and normal flora). The vaginal log concentration of hydrogen peroxide-producing lactobacilli was 7.3 +/- 1.7 in women with a live birth (n = 27) and 4.9 +/- 2.5 in those with early pregnancy loss (n = 14) (p = 0.1). CONCLUSIONS: IVF patients with bacterial vaginosis and with a decreased vaginal log concentration of hydrogen peroxide-producing lactobacilli may have decreased conception rates and increased rates of early pregnancy loss. A larger prospective treatment trial designed to evaluate the impact on IVF outcomes of optimizing the vaginal flora prior to IVF may be warranted.     

未足月胎膜早破患者阴道菌群微生态的分析

目的了解未足月胎膜早破患者阴道微生态的状况,探讨未足月胎膜早破(preterm premature rupture of membranes, PPROM)孕妇阴道微生态评价的临床意义。 方法选取2013年1月至2013年12月在伊犁州友谊医院常规进行产前检查,孕28～36^＋6周PPROM孕妇150例为PPROM组,同孕周正常孕妇150例为对照组,采集两组患者阴道分泌物,革兰染色涂片后进行阴道微生态学评价;计数资料比较采用t检验,计量资料比较采用χ²检验。 结果PPROM组阴道优势菌以革兰阳性球菌为主(34.67%,52/150),与对照组(12.00%,18/150)比较,χ²＝21.54,P<0.01,差异有统计学意义;对照组以革兰阳性杆菌为主(67.33%,101/150),与PPROM组(31.33%,47/150)比较,χ²＝38.89,P<0.01。PPROM组正常菌群密集度(Ⅱ级和Ⅲ级)的比例(63.33%,95/150),与对照组(88.00%,132/150)比较,χ²＝17.28,P<0.01,差异有统计学意义;PPROM组正常菌群多样性(Ⅱ级和Ⅲ级)(60.00%,95/150),与对照组(90.67%,136/150)比较,χ²＝37.96,P<0.01。PPROM组孕妇的细菌性阴道病(BV)、外阴阴道假丝酵母菌病(VVC)、BV＋VVC及菌群失调者的发生率分别为(21.33%,32/150)、(24.00%,36/150)、(13.33%,20/150)、(32.00%,48/150)对照组分别为(10.67%,16/150)、(10.67%,16/150)、(1.33%,2/150)、(20.67%,31/150),两组比较χ²值分别为6.33、9.27、27.33和4.95,P值分别为＝0.01、<0.01、<0.01和<0.05,差异均有统计学意义。PPROM组中无症状者有33.81%,处于微生态失调状态。 结论未足月胎膜早破孕妇阴道微生态改变表现为微生态失调比例升高。     

快速青春发育期女性外阴阴道感染特征分析

目的:探讨9~13岁快速青春发育期女性外阴阴道感染特征。方法:回顾性分析390例2015年7月至2018年6月在四川大学华西第二医院就诊的9~13岁快速青春发育期女性外阴阴道感染状况,并按年龄分为9岁、10岁、11岁、12岁、13岁5个年龄组。采用χ^2检验分析其假丝酵母菌外阴阴道病(VVC)总发生率、细菌性阴道病(BV)发生率、炎症反应率、优势菌异常率,及不同年龄组上述四者的差异。结果:研究对象中BV发生率、VVC总发生率、炎症反应率、优势菌异常率分别为:37.95%、19.24%、16.15%、8.21%,BV发生率显著高于VVC总发生率,差异有统计学意义(P<0.05)。VVC中白假丝酵母菌和非白假丝酵母菌阳性检出率分别为:15.39%、3.85%,两者比较差异有统计学意义(P<0.05)。5组间经两两比较,发现不同年龄组BV发生率和炎症反应率差异无统计学意义(P>0.05);9岁组VVC总发生率(7.56%)显著低于其他年龄段组(分别为20.75%、29.51%、25.42%、24.44%),差异有统计学意义(P<0.05);10岁组优势菌异常率(12.26%)显著高于13岁组(4.44%),差异有统计学意义(P<0.05)。乳杆菌数量1+/油镜随年龄增长呈下降趋势,而乳杆菌3+~4+/油镜随年龄增长呈上升趋势。结论:快速青春发育期女性外阴阴道感染好发BV和VVC,且BV比VVC更易感,而VVC中以白假丝酵母菌感染为主;9岁女性VVC总发生率最低;10岁女性优势菌异常率高于13岁,波动尚无规律。乳杆菌数量随年龄增长呈规律性增加。     

产后妇女阴道菌群状况及其影响因素分析

目的 探讨产后6～8周妇女的阴道菌群状况及其相关的影响因素.方法 选取2007年6-10月7家医院产后6～8周来院复查的560例产后妇女作为研究对象,对其进行相关因素的问卷调查,并行阴道分泌物涂片的Nugent评分及阴道菌群检查.结果 (1)阴道分泌物涂片Nugent评分结果及菌群比率:Nugent评分结果为菌群正常的产后妇女有48例(8.6%,48/560),评分结果为菌群临界的产后妇女有337例(60.2%,337/560),评分结果为细菌性阴道病(BV)的产后妇女有175例(31.2%,175/560).560例产后妇女中有74例阴道内检出乳杆菌(13.2%,74/560);560例产后妇女中有322例检出加德纳菌和类杆菌(57.5%,322/560),有214例检出染色不定弯曲小杆菌(38.2%,214/560).(2)分娩方式及会阴侧切对产后妇女阴道菌群状况的影响:①阴道分娩266例,其中Nugent评分结果为阴道菌群正常25例(9.4%,25/266),菌群临界为148例(55.6%,148/266),诊断BV 93例(35.0%,93/266).②剖宫产分娩294例,其中Nugent评分结果阴道菌群正常23例(7.8%,23/294),菌群临界189例(64.3%,189/294),诊断BV 82例(27.9%,82/294).阴道分娩与剖宫产分娩者的BV发生率比较,差异无统计学意义(P=0.204).③会阴侧切233例,其中阴道菌群正常22例(9.4%,22/233),菌群临界状态135例(57.9%,135/233),诊断BV 76例(32.6%,76/233).④无会阴侧切327例,其中Nugent评分结果阴道菌群正常26例(8.O%,26/327),菌群临界202例(61.8%,202/327),诊断BV 99例(30.3%,99/327).有会阴侧切与无会阴侧切者的BV发生率比较,差异无统计学意义(P=0.790).(3)孕期阴道炎症及孕期性生活对阴道菌群状况的影响:①孕期有阴道炎症46例,其中Nugent评分结果阴道菌群正常5例(10.9%,5/46),菌群临界26例(56.5%,26/46),诊断BV 15例(32.6%,15/46).②无阴道炎症514例,其中Nugent评分结果阴道菌群正常43例(8.4%,43/514),菌群临界311例(60.5%,311/514),诊断BY 160例(31.1%,160/514).有阴道炎症与无阴道炎症者的BV发生率比较,差异无统计学意义(P=0.962).③孕期无性生活的284例中诊断BV 78例(27.5%,78/284);偶尔有性牛活的270例中诊断BV 96例(35.6%,96/270);经常有性生活的6例中诊断BV 1例(1/6).3者分别比较,差异均无统计学意义(P=0.185).(4)喂养方式对阴道菌群状况的影响:母乳喂养的216例中诊断BV 67例(31.0%,67/216);人工喂养的89例中诊断BV 35例(39.3%,35/89);混合喂养的255例中诊断BV 73例(28.6%,73/255),3者分别比较,差异无统计学意义(P:0.573).结论 产后妇女阴道乳杆菌明显减少,菌群比率明显失调.阴道分娩、会阴侧切、阴道炎症、孕期性生活及喂养方式对产后妇女的BV发病无显著影响.产后妇女的BV发生率较高.