妇女阴道微生态状态研究

目的:研究中小学女教师群体阴道微生态状态及年龄、绝经与否、避孕方式对阴道pH和阴道乳杆菌分布的影响.方法:对1000名贵阳市中小学女教师,采用问卷调查、病史询问、妇科检查及阴道微生态检查方法,将被检者进行分组比较.结果:①阴道微生态异常率较高(67.20%);②在30～60岁年龄段,随着年龄的增长,阴道平均pH值升高,阴道乳杆菌检出率下降;③与未绝经者相比,绝经者阴道平均pH值升高,阴道乳杆菌检出率下降;④使用避孕套者细菌性阴道病的检出率明显低于其他避孕方式;⑤患细菌性阴道病者,阴道pH值升高,乳杆菌检出率降低.结论:女性阴道微生态变化受年龄、绝经、避孕方式及细菌性阴道病的影响.     

女性阴道混合感染246例临床分析

目的通过微生态的检查,全面评估女性阴道混合感染的微生态状况,为临床诊断治疗提供良好的依据。方法 2009年11月至2010年2月,选择在北京大学第一医院妇科门诊就诊的246例阴道炎患者,观察患者的症状、体征及阴道分泌物pH值,经革兰染色后,在油镜下观察,进行阴道微生态(阴道菌群、乳杆菌分级、需氧菌和炎性反应等)状况评分。结果 246例患者中,单一感染143例(58.1%),混合感染103例(41.9%),细菌性阴道病(BV)+需氧菌阴道炎(A V)者57例(55.3%);外阴阴道假丝酵母菌病(VVC)+A V者25例(24.3%);滴虫阴道炎(TV)+AV者15例(14.6%);VVC+BV+AV者5例(4.9%),AV+单纯疱疹病毒(HSV)感染者1例(1.0%)。混合感染患者发生阴道灼痛(86.4%,89/103)增加,清洁度Ⅲ度(40.8%,42/103)、pH值偏高(pH值5.0者,20.4%,21/103),乳杆菌减少(乳杆菌Ⅲ者,64.1%,66/103)等,与单一感染患者比较,差异均有统计学意义(P0.05)。结论阴道混合感染的发生率很高,微生态检查是诊断中非常重要的手段。     

2 066例妇女阴道微生态失调构成情况分析

目的：了解妇科门诊妇女阴道微生态平衡失调者白带异常检出率、构成比和年龄分布情况。方法：收集2009年11月—2010年1月在中南大学湘雅二医院妇科门诊就诊的有明显症状妇女的阴道分泌物,采用革兰染色及阴道pH试纸方法检测,同时以问卷方式采集受试者基本资料,并进行相应的统计学处理。结果：4 025例患者中有2 066例白带检测异常,总检出率为51.33%,其中外阴阴道假丝酵母菌病占28.99%,细菌性阴道病占8.57%,滴虫性阴道病为2.03%,混合性阴道炎为0.48%,未定义及未分类的阴道微生态失调为59.92%。阴道微生态失调妇女各年龄构成中＜21岁组为2.4%,21～岁组为32.7%,31～岁组为38.2%,41～岁组为21.7%,＞50岁组为5.0%。各种阴道微生态失调的中位数年龄中除混合性阴道炎位于21～30岁,其他均位于31～40岁。结论：阴道微生态平衡失调中外阴阴道假丝酵母菌病构成比明显高于细菌性阴道病、滴虫性阴道炎及混合性阴道炎。外阴阴道假丝酵母菌病、细菌性阴道病、滴虫性阴道炎及混合性阴道炎均好发于生育期年龄女性。除上述阴道炎症外,尚有大部分阴道微生态失调需要定义。     

889例妇科门诊阴道不适患者阴道微生态状况的分析

目的:了解因阴道不适而就诊于妇科门诊患者的阴道微生态状况,以验证我院阴道炎诊治方案的正确性。方法:2010年11月至2011年4月在西安交通大学第一附属医院妇科门诊因"阴道分泌物增多、外阴瘙痒、分泌物有异味"等症状就诊的女性患者共889例,取其阴道分泌物并分析其阴道微生态状况(致病菌、阴道菌群的密集度、多样性、优势菌、功能状态等)。结果:889例患者中阴道微生态正常者占6.86%(61/889);阴道微生态失调者占93.14%(828/889),其中能够明确致病菌诊断者343例(38.58%),不能被传统检测方法诊断,但已存在微生态失调者485例(54.56%)。结论:因阴道不适症状就诊的患者的阴道微生态既可表现为正常,也可表现为失调状态。阴道微生态评价体系能够全面评价阴道微生态现状,指导临床医生诊治及预后评估,形成新的阴道炎治疗理念。     

需氧菌性阴道炎的临床及微生态特征分析

目的:探讨妇科门诊需氧菌性阴道炎(aerobic vaginitis,AV)的临床及微生态特征。方法:回顾性分析4019例妇科门诊不同症状就诊者阴道微生态评价检测指标(菌群密集度、多样性、优势菌、病原体、AV评分、Nugent评分及五项菌群功能及炎症反应指标)及诊断结果。结果:4019例被检查者中AV占3.11%(125/4019)。AV患者中单纯AV占24.00%(30/125),AV混合感染占76.00%(95/125),其中AV合并外阴阴道假丝酵母菌病(VVC)占44.80%(56/125),AV合并滴虫阴道炎(TV)占27.20%(34/125),AV合并细菌性阴道病(BV)占2.40%(3/125),AV合并TV、VVC占0.80%(1/125),AV合并BV、TV占0.80%(1/125)。125例AV患者阴道乳杆菌功能均异常伴阴道炎症反应,其中优势菌群异常占84.80%(106/125)。结论:AV为常见阴道感染,易合并其他感染,尤以合并VVC及TV多见。微生态特征为需氧菌增多,乳杆菌功能异常或优势菌群被替代伴明显阴道炎症反应。因此,应用阴道微生态评价系统诊断AV时,注意微生态状况及有无合并其他类型阴道感染。     

子宫内膜息肉患者阴道微生态指标分析及对预后的影响

目的 探讨子宫内膜息肉患者阴道微生态指标分析及对预后的影响。方法 选择子宫内膜息肉患者为研究组,选择同期健康体检者为对照组,每组80例,均进行阴道微生态指标检查,比较两组检查结果。研究组根据阴道微生态指标检查结果分为正常组和失衡组,均接受手术治疗,随访1年观察预后效果。结果 研究组阴道微生态失衡发生率、阴道感染率均高于对照组（P<0.05）;研究组阴道微生态正常率低于对照组（P<0.05）;研究组pH、乳杆菌分级指标优于对照组（P<0.05）;研究组菌群密集度、菌群多样性及炎性反应指标与对照组比较,差异无统计学意义（P>0.05）;失衡组不良反应发生率均高于正常组（P<0.05）。结论 阴道微生态指标分析可以更好地了解子宫内膜息肉患者阴道健康状况,重点关注阴道pH、乳杆菌有明显异常的患者,可以及早进行干预,从而预防子宫内膜息肉发生和复发,值得临床推广与应用。     

妇科门诊患者阴道微生态特征及其与人乳头瘤病毒感染的相关性分析

目的 探讨妇科门诊患者阴道微生态特征及其与人乳头瘤病毒（HPV）感染的相关性。方法 选取2019年1月至2020年12月于首都医科大学附属北京妇产医院妇科门诊就诊行阴道微生态及HPV检查的患者30 205例，对其检查结果进行分析。结果 （1）30 205例患者中，阴道菌群正常者64.4%（19 460/30 205）；菌群抑制2.0%（605/30 205）；单纯性阴道炎21.7%（6543/30 205），以外阴阴道假丝酵母菌病（VVC）和需氧性阴道炎（AV）为主（分别占单纯性阴道炎的48.2%和46.9%）；混合性阴道炎11.9%（3597/30 205），其中AV+细菌性阴道炎（BV）占混合性阴道炎的62.5%。（2）阴道微生态正常的比例随着年龄的增长而降低，单纯性阴道炎及混合性阴道炎的比例随着年龄的增长而增加（均P<0.001）。（3）在阴道微生态指标中，pH值异常、菌群密集度异常、乳杆菌减少及白细胞酯酶计数异常均与HPV感染增加相关（均P<0.001）。（4）单纯性VVC、AV以及混合性阴道炎与HPV感染增加相关（均P<0.05）。结论 阴道微生态异常与HP...     

细菌性阴道病患者与健康妇女阴道乳杆菌生态学特征的比较

目的:观察健康妇女与细菌性阴道病患者阴道内乳杆菌属内各种乳杆菌在阴道中分布的差异。方法:利用微生态学研究方法,调查45例健康妇女和40例细菌性阴道病患者阴道乳杆菌的分布,鉴定阴道内乳杆菌,比较阴道乳杆菌产生过氧化氢的能力。结果:健康妇女阴道内乳杆菌检出率和平均活菌数量对数值明显高于细菌性阴道病患者(P<0.01),健康妇女阴道内优势乳杆菌是嗜酸乳杆菌(35%,7·68±1.41)、德氏乳杆菌(7·5%,8.06±0.83)和乳酸乳杆菌(7·5%,8.07±1·51),其大多数产生H2O2能力较强;健康妇女阴道内产H2O2乳杆菌的分离率明显高于细菌性阴道病患者(P<0.01)。结论:H2O2阳性的乳杆菌是健康妇女阴道乳杆菌的重要成员,在防治细菌性阴道病发生中起重要作用。     

阴道微生态检测与高危型HPV感染的710例临床报告分析

目的探讨阴道微环境与高危型HPV(HR-HPV)感染是否有关。方法选择2016年8月至2017年8月在北京展览路医院妇科就诊的同时行HPV感染检查和阴道微生态检测710例作为研究对象,对其HRHPV感染及阴道微生态检测结果进行回顾分析。结果 HR-HPV感染阳性者139例,HR-HPV感染率19.78%,其中合并有细菌性阴道病(BV)占58.27%(81/139)、滴虫性阴道炎(TV)占12.23%(17/139)、外阴阴道假丝酵母菌病(VVC)占6.47%(9/139)、过氧化氢缺乏者占17.27%(24/139),白细胞酯酶阳性占1.44%(2/139)。与阴道微生态正常者相比,BV患者的HR-HPV感染率差异有统计学意义(P0.05),TV、VVC患者及另二种阴道微生态失调状态者的HR-HPV感染率差异无统计学意义(P0.05)。结论 BV与HR-HPV感染有关,TV、VVC及阴道微生态失调者与HR-HPV感染无关。     

23 181例初诊的妇科门诊妇女阴道微生态分析

目的分析妇科门诊初诊妇女中阴道炎人群和非阴道炎人群的阴道微生态状况。方法 2018年12月至2020年12月就诊于首都医科大学附属北京妇产医院妇科门诊并完成阴道微生态检测的妇女共计30 265例, 排除反复就诊者后, 按照初诊是否有阴道炎症状体征将23 181例初诊妇女分为有阴道炎症状体征组(6 697例)及无阴道炎症状体征组(16 484例), 并对两组阴道微生态状况进行对比分析。结果 (1)23 181例初诊妇女中阴道炎总检出率为34.87%(8 083/23 181), 其中有阴道炎症状体征组阴道炎检出率为46.10%(3 087/6 697), 无阴道炎症状体征组阴道炎检出率为30.31%(4 996/16 484), 近1/3无阴道炎症状体征的妇科门诊妇女存在阴道炎。(2)单纯性阴道炎类型中, 有阴道炎症状体征组中外阴阴道假丝酵母菌病(VVC)最多(16.01%, 1 072/6 697)、需氧菌性阴道炎(AV)其次(12.83%, 859/6 697), 与无阴道炎症状体征组比较, 差异均有统计学意义(P均<0.001);而细菌性阴道病(BV)、滴虫阴道炎(TV)两组...     

800例女性阴道菌群分布调查及影响因素的研究

目的:探讨女性阴道的菌群分布及其影响因素。方法:对成都地区800例妇女的阴道分泌物进行细菌培养、测定pH值和检查白带清洁度。结果:正常女性阴道内乳酸杆菌培养阳性率为59.8%,其余几种主要的菌群及其培养阳性率分别为棒状杆菌(29.0%),凝固酶阴性葡萄球菌(20.6%),加德纳氏菌(18.1%),粪肠道球菌(18.4%),大肠埃希菌(8.9%)。50岁以下各组女性的阴道菌群检出率无统计学差异(P>0.05);50岁以上各组妇女的乳酸杆菌显著降低(40.0%vs60.4%,P<0.05)。以pH≤4.5划分阴道正常和异常酸性环境,异常组乳酸杆菌的检出率明显少于正常组(34.4%vs66.2%,P<0.001),其他菌群检出率显著上升(P<0.02),加德纳氏菌的增加最为显著(35.6%vs13.7%,P<0.001)。白带清洁度异常组乳酸杆菌的检出率显著少于正常组(42.9%vs70.9%,P<0.001),加德纳氏菌检出率显著增加(36.4%vs7.2%,P<0.001),其余菌群检出率无统计学差异(P>0.05)。慢性宫颈炎组与正常组相比,菌群分布差异无显著性(P>0.05)。结论:女性阴道内有多种菌群存在,优势菌为乳酸杆菌。阴道pH值升高、绝经期、白带清洁度异常会抑制乳酸杆菌生长,破坏阴道菌群的平衡,从而增加条件致病菌繁殖和阴道炎症发生的机会。     

32 046名妇科门诊女性阴道微生态分布情况分析

Objective?To analyze the distribution and characteristics of female vaginal micro-ecology in gynecological clinic. Methods?From January 2015 to February 2020, 32 046 female outpatients were selected to conduct a retrospective analysis of the results of vaginal micro-ecology. Results?The vaginal micro-ecology of 2 790 patients(8.71%) was normal; however,the other 29 256 patients (91.29%) were abnormal, which including simple vaginitis in 7 417 cases(7 417/32 046, 23.14%) and the mixed vaginitis in 3 085 cases (3 085/32 046, 9.63%). The bacterial vaginosis (BV) occupied for 9.29%(2 976/32 046),which is the most common type among the simple vaginitis. The vulvovaginal candidiasis (VVC) occupied for 8.93%(2 863/32 046). Mixed vaginitis is given priority to BV and AV infection (2 016/32 046, 6.29%),followed by BV and VVC(649/32 046,2.03%). Vaginitis is closely related to age,the difference is statistically significant (P＝0.00). Conclusion?Vaginal evaluation system has outstanding advantages in the diagnosis of vaginitis, and can improve the diagnosis rate of mixed vaginitis.     

常用抗假丝酵母菌药物对阴道常见乳杆菌生长影响的研究

目的:探讨治疗外阴阴道假丝酵母菌病(VVC)的药物对阴道常见乳杆菌生长的影响。方法:VVC患者随机分为3组,分别应用咪康唑(咪康唑组)、伊曲康唑(伊曲康唑组)、制霉菌素栓(制霉菌素组)进行治疗,治疗前、后分别进行乳杆菌Nugent评分,治疗后观察患者症状缓解时间、阴道pH值、乳杆菌数量及H2O2阳性乳杆菌的检出率等。结果:患者症状缓解时间、总有效率3组间差异无统计学意义(P>0.05)。3组乳杆菌Nugent评分均较治疗前有所降低,且伊曲康唑组乳杆菌Nugent评分显著高于咪康唑组和制霉菌素组,差异有统计学意义(P<0.05)。咪康唑组、伊曲康唑组、制霉菌素组中H2O2阳性的乳杆菌分别占30.0%、60.0%和25.0%,差异有统计学意义(P<0.05),伊曲康唑组H2O2阳性的乳杆菌的检出率显著高于其余2组,差异有统计学意义(P<0.05)。结论:伊曲康唑治疗VVC疗效确切,对阴道乳杆菌生长的影响较小,有助于维护阴道正常菌群,是一种治疗VVC较理想的抗真菌药物。     

5236例健康妇女阴道微生态状况的分析

目的:了解无阴道感染女性阴道微生态情况。方法:选取2006年3月7日至2007年12月18日在我院妇科门诊就诊无阴道炎症妇女5236例,取阴道分泌物,进行阴道微生态评价。结果:菌群正常占68.7%,菌群密集度多在++～+++,占97.7%;菌群多样性多在++～+++,占94.6%;优势菌以乳杆菌为主,占99.9%,其中乳杆菌功能正常占73.6%;2.58%的真菌定植;pH<4.5占72.1%。无阴道感染妇女中仍存在异常菌群1637例,占31.3%,主要包括菌群异常[主要为革兰阳性小杆菌(58.0%)、革兰阳性球菌(23.5%)]、菌群抑制、菌群增殖过度。结论:临床评价阴道微生态能指导临床评价感染及治疗后的阴道微生态状况。     

萎缩性阴道炎的临床观察及阴道需氧菌菌群研究

收集萎缩性阴道炎病人50例、绝经前健康妇女20例和绝经后阴道萎缩妇女20例,进行临床观察和阴道需氧菌培养.萎缩性阴道炎妇女的症状以阴道瘙痒疼痛多见,阴道pH值明显高于绝经前妇女(P＜0.05),共分离出65株细菌,分离率由高到低依次是大肠埃希氏菌(26%)、表皮葡萄球菌(18%)、粪链球菌(14%)和绿色链球菌(12%);大肠埃希氏菌的分离率明显高于绝经前对照组,其余各菌群与另外两组比较无明显差别.大肠埃希氏菌在萎缩性阴道炎发病中可能起一定作用.     

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。     

Improving appropriate use of antifungal medications: the role of an over-the-counter vaginal pH self-test device

OBJECTIVES: To determine whether patients can understand and use the vaginal pH device in the diagnosis of vaginitis. To compare whether vaginal pH readings determined by patients and healthcare providers are similar. To determine whether vaginal pH can reduce inappropriate over-the-counter (OTC) antifungal medication use and improve the correct diagnosis of vaginitis. METHODS: One hundred and fifty-one women indicated their belief about the cause of their vaginal infection, read the instructions of the vaginal pH device package insert, used the device and interpreted the findings. The patient interpretations were compared with results obtained by healthcare providers, blinded to patient findings. RESULTS: Over 96% of patients stated that they could easily read the instructions, use the vaginal pH device and interpret the readings. They obtained the same readings as healthcare professionals (Kappa = 0.9). Restricting the use of OTC antifungal medications to those individuals with vaginitis symptoms and vaginal pH < or = 4.5 significantly reduced inappropriate use by approximately 50%, Fisher's exact test, p-value = 0.018. Conversely, seeking healthcare provider assessment with vaginal pH > 4.5, leads to correct diagnosis of vaginitis. CONCLUSIONS: The vaginal pH device can be used as an OTC diagnostic tool by consumers when a vaginal infection is suspected. Vaginal pH readings would direct patients whether to purchase an antifungal medication or seek professional diagnosis from a healthcare provider. Understanding and use of this vaginal pH device could reduce inappropriate use of OTC antifungal medications by approximately 50% and improve the correct diagnosis of vaginitis.     

Vaginitis, cervicitis, and cervical length in pregnancy.

OBJECTIVE: We sought to determine the possible association among vaginitis, cervicitis, and cervical length in pregnancy. STUDY DESIGN: Primigravid volunteers, between 20 and 36 weeks' gestation (n = 210), were examined. Vaginitis was diagnosed by pH determination and wet mount smear, cervicitis was diagnosed by cervicography, and cervical length was diagnosed by vaginal ultrasonographic measurement. Patients with both vaginitis and cervicitis (n = 70) were compared with those without any trace of infection (n = 23). The remainder (n = 117) had variable degrees of infection and were excluded. RESULTS: The mean gestational age was 28.3 weeks. No significant association was found among vaginitis, cervicitis, and cervical length. In the infection group (n = 70), however, a significant association between an elevated vaginal pH (>5) and a shortened cervical length (r = 0.29) was noted. CONCLUSION: No significant association exists among vaginitis, cervicitis, and cervical length, but in patients with clinical signs of infection, an elevated pH appears to be associated with a decreased cervical length.     

Virulence factors of Escherichia coli isolated from female reproductive tract infections and neonatal sepsis

OBJECTIVE: The presence of enterobacteria such as Escherichia coli in the vagina of normal women is not synonymous with infection. However, vaginal E. coli may also cause symptomatic infections. We examined bacterial virulence properties that may promote symptomatic female reproductive tract infections (RTI) and neonatal sepsis. METHODS: E. coli isolated as the causative agent from cases of vaginitis (n = 50), tubo-ovarian abscess (n = 45) and neonatal sepsis (n = 45) was examined for selected phenotypic and genetic virulence properties. Results were compared with the frequency of the same properties among fecal E. coli not associated with disease. RESULTS: A significantly greater proportion of infection E. coli exhibited D-mannose resistant hemagglutination compared with fecal E. coli (p < 0.01). This adherence phenotype was associated with the presence of P fimbriae (pap) genes which were also significantly more prevalent among isolates from all three infection sites (p < 0.01). The majority of pap+ isolates contained the papG3 allele (Class II) regardless of infection type. Increased frequency of Type IC genes among vaginitis and abscess isolates was also noted. No significant differences in frequency of other bacterial adherence genes, fim, sfa, uca (gaf or dra were observed. E. coli associated with vaginitis was significantly more likely to be hemolytic (Hly+) than were fecal isolates (p < 0.05). The Hly+ phenotype was also more prevalent among tubo-ovarian abscess and neonatal sepsis isolates (p < 0.08). CONCLUSIONS: E. coli isolated from female RTI and neonatal sepses possess unique properties that may enhance their virulence. These properties are similar to those associated with other E. coli extra-intestinal infections, indicating that strategies such as vaccination or bacterial interference that may be developed against urinary tract infections (UTI) and other E. coli extra-intestinal infections may also prevent selected female RTI.