臭氧联合双唑泰阴道凝胶对于中老年念珠菌性阴道炎的临床疗效观察与分析

目的:本研究旨在探讨和分析臭氧治疗联合双唑泰阴道凝胶对于中老年妇女念珠菌性阴道炎的临床治疗效果。方法:选择2014年2月至2016年2月在我院妇产科门诊治疗的100例中老年妇女念珠菌性阴道炎患者,随机分为治疗组和对照组,每组各50例。治疗组的患者接受臭氧治疗联合双唑泰阴道凝胶治疗;对照组的患者接受双唑泰阴道凝胶治疗。观察和比较两组患者的临床效果。结果:治疗组患者的总有效率明显优于对照组,差异有统计学意义(P0.05)。另外,患者的外阴瘙痒、白带变化、排尿烧灼感、腰腹疼痛等临床症状改善的时间均明显短于对照组,差异有统计学意义(P值均0.05)。结论:臭氧治疗联合双唑泰阴道凝胶对于中老年妇女念珠菌性阴道炎临床疗效显著,且症状改善时间短,值得在临床大力推广。     

高危人群阴道念珠菌带菌情况及抗真菌药物药敏分析

目的：为了解性病高危人群酵母菌的带菌情况和和对抗真菌药物的敏感性，方法：对167例特殊职业的性病高危女性人群进行了阴道分泌物涂片及培养检测，对分离出的临床菌株进行了8种常用抗真菌药物的敏感性检测。结果：性病高危女性人群中阴道念珠菌带菌率为12．1％，优势主要菌株仍以白念珠菌为主。结论：伊曲康唑、氟康唑，二性霉素B，制霉菌素，益康唑，酮康唑，咪康唑和5－氟胞啶的的药物敏感性显示，前4种均属高度敏感，后4种药物有不同程度的中度敏感与耐药。     

Efficacy of fluconazole and nystatin in the treatment of vaginal Candida species

The aim of this study was to determine and compare the efficacy of treatment with fluconazole and nystatin in Brazilian women with vaginal Candida. In a population of 932 women, vaginal cultures were performed for yeasts, whether or not the women showed signs and symptoms of vulvovaginal candidiasis. Yeasts were isolated from 12.2% of the women (114/932): 53.2% of the yeasts were Candida albicans, 27.0% C. glabrata, 13.5% C. tropicalis and 6.3% C. parapsilosis. Treatment was carried out with both drugs. The overall mean cure rates with fluconazole (87.0%) and nystatin (74.0%) were similar; among women with non-albicans, the cure rate with fluconazole was 100%, whereas that with nystatin was 44.4%. The cure rate for women with C. albicans was high with both fluconazole and nystatin; however, for those with non-albicans species the cure rate was excellent with fluconazole and very low with nystatin, differing from the majority of in vitro studies.     

Recurrent genital candidosis in women and the effect of intermittent prophylactic treatment

A study of clotrimazole for the treatment of recurrent genital candidosis unexpectedly showed that symptoms and infection can be dissociated. The aim of the study was to see if intermittent antifungal treatment would reduce symptoms in women constantly distressed by recurrent genital candidosis. Forty women seriously affected by the condition were initially given oral and local antifungal treatment. When the patients were symptom-free and the vagina was free of yeasts, they were entered into a double-blind clinical trial and were treated prophylactically for four months with either intermittent clotrimazole pessaries and cream or a placebo. The prophylactic treatment kept symptoms below a critical level but did not affect the return of the yeasts to the vagina. This dissociation between symptoms and vaginal yeasts was unexpected. Rectal yeast carriage was unaffected by prophylactic vaginal treatment. Male contacts and patients both showed a high incidence of non-specific genital infection. This association has seldom been reported. A few patients cultured yeasts from their homes but this environment was not considered a major source of reinfection. The vaginal pH did not appear to be altered by the presence of yeasts. The results of the study suggested that symptoms in women with recurrent genital candidosis were not caused by yeasts alone, and possibly the reason for recurrences might lie not in constant reinfection by yeasts, but in failure to recognise and remove a primary underlying factor, perhaps infection with other sexually transmitted agents. The question of a synergistic action between yeasts and other organisms is discussed.     

合并非特异性感染的老年性阴道炎的临床治疗效果研究

目的:本研究旨在研究采取综合治疗对合并非特异性感染的老年性阴道炎的临床治疗效果,为临床有效治疗该类疾病提供参考。方法:选择医院在2012年11月至2014年11月期间妇科收治的272例老年性阴道炎合并非特异性感染患者为本研究观察对象,随机分为试验组和对照组,各136例,分别采取综合治疗及常规治疗方法,并比较其治疗效果。结果:经过4个疗程的治疗后,两组患者临床症状均有一定程度的改善,试验组白带正常、阴道分泌物减少、外阴瘙痒减轻无灼痛及黏膜无充血水肿患者发生率分别为86.76%、94.12%、89.71%、88.24%,明显优于对照组(69.12%、77.94%、72.06%、75.00%);试验组患者p H<4.5以及阴道洁净度Ⅰ~Ⅱ度的患者例数分别为65例(95.59%)及64例(94.12%),明显优于对照组(82.35%、86.76%);经过相应治疗后,两组患者均取得一定的治疗效果。试验组总有效率为92.65%,对照组总有效率为83.82%,试验组临床治疗效果明显优于对照组。结论:采取综合措施治疗老年性阴道炎合并非特异性感染患者,临床治疗效果显著,可从根本上达到消炎、抑菌、抗感染并提高患者阴道黏膜组织抵抗力的治疗目的,值得临床广泛应用推广。     

Comparison of miconazole-coated tampons with clotrimazole vaginal tablets in the treatment of vaginal candidosis.

The effectiveness and acceptability of miconazole-coated tampons were compared with those clotrimazole vaginal tablets in the treatment of vaginal candidosis in 100 women. Both treatments were highly effective in reducing the signs and symptoms of infection; 95% of the group treated with miconazole had negative culture results for Candida species immediately after treatment compared with 86% of those treated with clotrimazole. A 17.6% recurrence rate of positive culture results was found four weeks later in the miconazole-treated group compared with that of 30% in the clotrimazole-treated group. The miconazole tampons were highly acceptable to patients. Vaginal pH values did not differ significantly between those patients with candidosis and those treated and cured. Corynebacterium vaginale (Gardnerella vaginalis) vaginitis and nonspecific genital infection were common complicating factors during follow up.     

深圳地区女性HIV合并宫颈HPV感染现状调查及临床干预的相关性研究

目的探究深圳地区女性HIV合并宫颈HPV感染的现状及临床干预效果。方法以2017年1月1日至2018年2月1日期间在广东省深圳市第三人民医院爱心门诊就诊、HIV阳性的女性作为研究对象。随机选取同期在广东省深圳市第三人民医院妇科门诊行宫颈癌筛查的HIV阴性女性作为对照,两组各选550例,对所有研究对象均行宫颈相关检测、免疫细胞和HIV病毒载量测定,统计HPV感染现状,对HPV感染率与CD4^+水平与HIV病毒RNA定量相关性进行分析。将HIV阳性合并感染HR-HPV的患者分为两组,一组采用抗HIV病毒治疗,另一组不进行任何治疗,对HIV阴性但HPV感染阳性的患者分为四组,A组采用重组人干扰素a2b乳膏+保妇康栓治疗,B组采用阴道干扰凝胶治疗,C组采用阴道保妇康栓治疗,D组不给于任何治疗,3疗程后,分别在停药后3个月、6个月、12个月对患者进行HPV定性及定量检查和LCT检测,评估疗效差别。结果 HIV阳性患者的HPV感染率、HR-HPV感染率、多重HPV感染、细胞学异常发生率和其他阴道疾病感染率显著高于HIV阴性患者,同时HIV阳性组的宫颈病变率和病变分期与HIV阴性患者组别之间存在显著的统计学差异(均P<0.05);HIV阳性合并HR-HPV感染组的CD4^+细胞数和CD4^+/CD8^+显著低于未合并HR-HPV感染组, HIV病毒载量显著高于未合并HR-HPV感染组,差异均具有统计学意义(均P<0.05);A组的好转率优于其他三组,B组和C组的好转率优于D组,均存在统计学差异(均P<0.05);在HIV阳性合并HR-HPV中采用抗病毒治疗组在术后的3个月、6个月、12个月的HR-HPV感染率、多重感染、自然转归细胞学异常均显著优于未抗HIV治疗组别,差异均具有统计学意义(均P<0.05)。结论 HIV病毒感染能够增加HR-HPV的感染机率,在此类患者的治疗上应该增加抗病毒治疗,同时在HPV感染的治疗上应该提倡联合用药的方式,对于疾病的转归具有重要意义。     

Management of persistent vulvo vaginal candidosis due to azole-resistant Candida glabrata.

CASE REPORT--SUBJECTS--Three cases are described of long-standing vaginal candidosis due to Candida glabrata. These had failed to respond to local and systemic antifungals. In each case the infecting strain appeared resistant to a range of azole drugs in vitro. CLINICAL COURSE--Case one--This patient recovered following prolonged treatment with oral itraconazole in combination with oral and vaginal nystatin. Case two. Yeasts were eradicated from this patient following cyclical treatment with oral dydrogesterone; prolonged vaginal treatment with nystatin may have helped. Case three. This patient did not respond to a prolonged course of oral itraconazole in combination with vaginal and oral nystatin, oral medroxyprogesterone or intravaginal boric acid. Eradication of C glabrata was finally achieved by local application of 1% gentian violet. Shortly after eradication of the C glabrata infection, both Case two and Case three developed infections with other Candida species responsive to azole antifungals.     

Microscopic features of vaginal candidiasis and their relation to symptomatology

OBJECTIVES: To document the microscopic features of vaginal candidiasis and to examine the relation between yeast morphology and patient symptomatology. METHOD: The study population comprised women undergoing screening for genital infection at a department of genitourinary medicine. RESULTS/CONCLUSION: Data were collected on 267 women of whom 234 were found to have vaginal candidiasis by vaginal culture. The remaining 33 patients had microscopic features of candidiasis (spores and/or hyphae) but were culture negative. Of the culture positive women, microscopy was positive in 182 (78%). "Spores only" were identified in 65 (28%), "hyphae only" in 16 (7%), and both "spores and hyphae" in 101 (43%). 68% of culture positive women were symptomatic, the commonest symptoms being irritation alone (27%) or irritation plus vaginal discharge (25%). No association was found between yeast morphology (spores, budding/non-budding; hyphae, branching/non-branching) as identified on microscopy of vaginal secretions and symptomatology.     

Treatment of vaginal candidosis with econazole nitrate and nystatin: A comparative study

A study carried out to compare the efficacy of econazole nitrate and nystatin in the treatment of vaginal candidosis showed that a three-day course of econazole nitrate pessaries was as effective as a 14-day course of nystatin pessaries and is more acceptable to patients.     

Vaginal yeasts in the era of "over the counter" antifungals

OBJECTIVE: To establish whether there has been any rise in the prevalence of non-albicans Candida species isolated from vaginal swabs since the introduction of "over the counter" antifungal treatments. METHOD: A retrospective review looking at all positive vaginal yeast isolates collected from women attending one genitourinary medicine clinic during the 6 year period from 1993 to 1998 inclusive. All positive vaginal yeast isolates were included, regardless of whether or not the patients were symptomatic. Isolates from HIV positive women were excluded from the analysis. RESULTS: No increase in non-albicans vaginal yeast isolates was shown during the period studied. The proportion of non-albicans yeasts remained constant at approximately 5% of the total yeasts isolated. The most common non-albicans yeast isolated was C glabrata. CONCLUSION: There is no evidence from this study to suggest that the increasing use of "over the counter" antifungal treatment has selected for atypical, possibly inherently azole resistant, strains of vaginal yeasts in HIV seronegative women.     

妊娠晚期阴道微生态与早产的相关性研究

目的研究妊娠晚期阴道微生态与早产的相关性。方法选取2017年1月至2018年6月海淀区妇幼保健院进行产前检查的144例孕妇作为研究对象。孕周范围28周~34周+6天,诊断先兆早产或早产临产者104人,根据分娩孕周,有早产孕妇40人和足月孕妇64人。从足月孕妇64人中随机选取40人,作为足月组。早产孕妇40人作为早产组。无先兆早产症状的孕妇40人,有一人孕35+周早产胎膜早破后早产分娩,其余39人均足月分娩,此39人为对照组。所有入组孕妇均行阴道微生态检查,比较3组孕妇一般情况、母儿结局及微生态结果。结果①早产组阴道优势菌群为革兰阳性杆菌的比例,正常阴道菌群密集度的比例,正常阴道菌群多样性的比例明显低于足月组和对照组,差异有统计学意义(P<0.05)。②早产组细菌性阴道病、外阴阴道假丝酵母菌病、需氧菌阴道炎及微生态失调的发生率明显高于足月组和对照组,差异有统计学意义(P<0.05)。③三组的宫腔感染率、产褥感染率及新生儿感染率无统计学差异。结论妊娠晚期阴道微生态失调易导致早产。     

盆底肌训练联合阴道给药雌三醇对围绝经期全子宫切除术后盆底功能障碍影响研究

目的探讨盆底肌训练联合阴道给药雌三醇对围绝经期全子宫切除术后盆底功能障碍的影响。方法选取2017年6月至2018年11月佛山市禅城区中心医院接收的67例行全子宫切除术后出现盆底功能障碍的围绝经期患者作为研究对象。随机分为观察组和对照组,对照组患者给予常规护理,观察组患者在常规护理基础上,给予盆底肌训练联合阴道给药雌三醇。比较两组患者治疗前、治疗6个月后盆底肌张力、膀胱功能改善情况,评价两组患者治疗6个月后性生活满意度,并对术后两组患者阴道分泌物清洁度、pH值阳性率、细菌性阴道炎发生率等进行对比。结果治疗前,两组患者阴道静息压(VRP)、阴道收缩压(VSP)、阴道收缩持续时间(PT)、残余尿量、膀胱颈移动度(BNP)相当,差异无统计学意义(P>0.05);观察组患者治疗6个月后VRP、VSP、PT、残余尿量、BNP较治疗前明显改善,差异具有统计学意义(P<0.05);观察组患者以上指标改善程度明显优于对照组患者,差异具有统计学意义(P<0.05);观察组患者治疗后阴道分泌物清洁度、pH值阳性率、细菌性阴道炎发生率(20.59%、20.59%、17.65%)明显低于对照组患者(9.09%、6.06%、6.06%),差异具有统计学意义(P<0.05);观察组患者治疗后性生活满意度91.17%明显高于对照组患者满意度66.66%,差异具有统计学意义(P<0.05)。结论盆底肌训练联合阴道给药雌三醇对于行全子宫切除术后出现盆底功能障碍的围绝经期妇女具有较好疗效,能显著促进盆底肌力及膀胱功能恢复,改善阴道微生态环境。     

妊娠晚期B族链球菌筛查阳性孕妇的阴道微生态研究

目的了解妊娠晚期B族链球菌(group B streptococcus,GBS)筛查阳性孕妇的阴道微生态情况。方法选取2019年1月至2019年7月在北京市海淀区妇幼保健院诊治的妊娠晚期GBS筛查阳性100例孕妇作为研究对象。将这100例孕妇作为试验组,选取同时期妊娠晚期GBS筛查阴性的100例孕妇作为对照组。两组孕妇均行阴道微生态检查,比较两组孕妇的微生态结果及母儿结局。试验组根据是否合并微生态失调分为甲、乙两组,甲组合并微生态失调共62人,乙组微生态正常共38人。比较两组的新生儿窒息率,宫腔感染+产褥感染的发生率以及新生儿感染率。结果试验组微生态失调发生率高于对照组,差异具有统计学意义(P<0.05)。试验组宫腔感染+产褥感染发生率及新生儿感染率高于对照组,差异具有统计学意义(P<0.05)。甲组的宫腔感染+产褥感染发生率明显高于乙组,差异具有统计学意义(P<0.05)。结论GBS感染与阴道微生态相关,对GBS阳性且合并微生态失调者,改善其阴道微生态环境,可能改善围产结局。     

妊娠期HIV感染者的分娩方式和母婴结局分析

目的:探究妊娠期人类免疫缺陷病毒(HIV)感染者的分娩方式对母婴结局的影响。方法:回顾性研究2012年1月至2016年6月我院收治的87名孕产妇作为研究对象,根据分娩方式分为阴道产组和剖宫产组,其中阴道产组53名孕妇,生产54名新生儿;剖宫产组34名孕妇,生产34名新生儿,对比分析两组HIV感染孕产妇的一般资料、产程时间、产后出血量、先兆子宫破裂及分娩结果,并对结果进行分析研究。结果:两组HIV感染孕产妇一般资料无显著性差异,剖宫产组在产程时间、先兆子宫破裂、新生儿感染率方面均优于阴道产组,且差异具有统计学意义(P<0.05),但是在孕妇产后并发症(产褥感染、产后出血量)和新生儿窒息率不及阴道产组,且差异具有统计学意义(P<0.05)。结论:不同分娩方式对孕产妇和新生儿的影响不同,剖宫产可大大降低新生儿感染HIV病毒的几率。     

阴道冲洗行为对阴道内菌群分布的影响分析

目的:探讨阴道冲洗行为与细菌性阴道炎和性传播疾病的关系。方法:选取100名生育年龄的妇女,其中有0~2个性伴侣的女性75名,有3个或3个以上性伴侣女性25名,让她们使用冲洗产品进行阴道冲洗,并分三个阶段进行观察。第一阶段定为时间是4周的冲洗阶段,第二阶段定为时间是10周的停止冲洗阶段,第三个阶段定为时间是4周的自主选择阶段,让观察者自主选择继续冲洗还是停止冲洗。在最初的14周中,每个观察者每周去医院进行2次阴道样本采集,从第15周开始每个观察者每周来医院进行1次阴道样本采集,分别观察三个阶段低性伴侣女性细菌性阴道炎的患病情况和多性伴侣女性的性传播疾病的患病情况。结果:在第一阶段和第二阶段期间,细菌性阴道炎的平均评分为(2.11±0.52)分和(1.89±0.23)分,无统计学差异(P0.05)。第三个阶段共有156个样本选择继续冲洗,244个样本选择停止冲洗。继续冲洗者的细菌性阴道炎评分显著高于停止冲洗者(P0.05)。继续冲洗样本的阴道炎菌群检出数显著多于停止冲洗样本(P0.05)。结论:过度的阴道冲洗并不能有效地阻止感染的发生,当停止阴道冲洗时,乳酸内环境恢复,感染明显下降。故合理进行阴道冲洗,积极控制感染,帮助建立乳酸内环境,才是治疗和预防疾病的关键。     

抗HPV生物蛋白敷料治疗HPV高危感染合并宫颈CINⅠ的临床观察

目的:探讨抗HPV生物蛋白敷料治疗HPV高危感染合并宫颈CINⅠ的疗效。方法:选取2012年2月至2015年11月期间在我院门诊就诊患者,选取146例HPV高危感染合并宫颈CINⅠ患者,随机分为研究组和对照组,研究组84例,采用抗HPV生物蛋白敷料阴道上药,每次1支,隔日1次,10次为1个疗程,连用3个疗程。对照组62例,未使用药物,仅做观察。结果:在第4个月复查宫颈脱落细胞学检查和HPV检测,研究组总有效率为80.95%,对照组总有效率为46.67%,两组比较,差异有统计学意义(P0.05)。研究组宫颈脱落细胞学检查转阴率为80.77%,对照组转阴率为31.58%,两组比较,差异有统计学意义(P0.05)。结论:抗HPV生物蛋白敷料治疗HPV高危感染合并宫颈CINⅠ可能有效,未发现不良反应。     

白念珠菌阴道炎鼠模型构建的研究

目的:不同条件下构建小鼠白念珠菌性阴道炎模型,为白念珠菌性阴道炎发病机制和防治研究提供平台。方法:(1)用同龄小鼠建立雌激素化,免疫抑制和正常对照鼠模型,观察不同时间点各模型小鼠阴道灌洗液真菌载量及阴道组织病理学变化。(2)再对雌激素化组中已自愈的小鼠进行再感染,观察再感染小鼠与初次感染同龄小鼠的真菌载量及阴道组织病理学的变化。结果:雌激素化组、免疫抑制组小鼠自第2天起阴道灌洗液真菌载量水平较高并持续至观察期末,与正常对照组比较前者P<0.05,后者P<0.01,而且从第4天起免疫抑制组明显高于雌激素化组(P<0.05);初发、复发组均高于正常对照组(P<0.05),初发与复发组之间差异无显著性(P>0.05)。阴道组织病理显示雌激素化、免疫抑制及复发感染小鼠在接种后第2天开始至21天,阴道黏膜可见芽生孢子或菌丝侵入,伴有较多的炎性细胞浸润。结论:几种条件下白念珠菌性阴道炎鼠模型构建是成功的,为念珠菌性阴道炎发病机制及防治的研究提供了较理想的平台。     

Safety and efficacy evaluations for vaginal and rectal use of BufferGel in the macaque model

BACKGROUND: The nonhuman primate model allows for safety and efficacy testing of topical microbicide products. GOAL: The goal of this study was to evaluate the safety and efficacy of vaginal and rectal applications of BufferGel (ReProtect, Inc.). STUDY DESIGN: The safety of repeated product applications was evaluated by microflora, pH, vaginal colposcopy, and rectal lavage. To test efficacy in preventing chlamydia, infection was documented by culture and nucleic acid amplification tests. RESULTS: Repeated vaginal or rectal applications of BufferGel were not associated with significant changes in microflora. BufferGel use had a transient acidifying effect on vaginal and rectal pH. Colposcopic observations remained relatively normal in all test animals. A slightly increased incidence of epithelial desquamation was noted after rectal product use compared with the control group. BufferGel did not prevent cervical or rectal chlamydial infection. CONCLUSION: BufferGel has an acceptable safety profile after repeated vaginal and rectal use, but does not prevent chlamydial infection in the macaque models.     

HPV感染对宫颈炎患者阴道微生态的影响

目的:研究人乳头瘤病毒(HPV)感染对宫颈炎患者阴道微生态的影响。方法:回顾性分析我院2013年11月至2015年11月94例宫颈炎患者临床资料,根据患者HPV感染情况分为HPV阳性组41例,HPV阴性组54例,再选取同时期在我院接受体检的50例健康人临床资料,并设置为对照组,比较三组阴道微生态环境变化情况。结果:HPV阳性组患者阴道乳酸杆菌异常率87.80%较HPV阴性组44.44%及对照组2%显著较高(P<0.05);HPV阳性组菌群密度Ⅱ~Ⅲ级、菌群多样性Ⅱ~Ⅲ级、pH值≤4.5的概率较HPV阴性组和对照组显著较低(P<0.05);HPV阳性组微生态失调率较HPV阴性组和对照组显著较高(P<0.05);HPV阳性组惰性乳酸杆菌、卷曲乳酸杆菌、加氏乳酸杆菌、詹氏乳酸杆菌分布率较HPV阴性组和对照组均显著较低(P<0.05)。结论:HPV感染的宫颈炎患者阴道微生态失调,阴道乳酸杆菌水平显著降低,HPV感染会造成阴道病原体繁殖,增加女性生殖道感染和宫颈上皮细胞异常增生的风险。