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。     

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。     

阴道微生态的临床研究及意义

目的:研究人群的阴道微生态状况,为阴道炎症的防治提供新思路。方法:采用整群二级抽样方式,随机抽取313例符合条件的育龄妇女进行调查及阴道微生态检测(其中阴道炎症74例),采用成组病例对照法进行分析。结果:阴道微生态失调者阴道pH值4.4,明显高于阴道微生态正常者4.0(t=6.3581,P<0.01),但并未超出阴道正常酸性环境范围;各类阴道炎症患者的阴道pH均值增高更为明显(P均<0.01),且均超出了阴道正常的酸性环境范围。微生态失调者阴道乳杆菌和H2O2(+)检出率均明显低于微生态正常者(P均<0.01),而阴道炎症者此两项指标降低更为明显(P均<0.01),且阴道炎症患者乳杆菌检出率明显低于无阴道炎症妇女(27.0%vs74.9%,P<0.01)。阴道乳杆菌检出率降低幅度越大,患常见阴道炎症的相对危险度就会越高(P均<0.01)。结论:阴道pH值升高可作为阴道微生态异常状况的预警信号;阴道乳杆菌检出率可作为阴道健康状况的监测指标或阴道炎症治疗后的康复指标。     

阴道乳杆菌对常见阴道假丝酵母菌抑制作用的体外试验研究

目的:观察阴道乳杆菌菌株在体外实验中对假丝酵母菌生长的抑制作用。方法:分离健康妇女阴道中常见的乳杆菌和外阴、阴道假丝酵母菌病(vulvovaginal candidiasis,VVC)患者阴道中的常见假丝酵母菌,采用96孔板混合生长抑制法观察处于生长对数期的乳杆菌对假丝酵母菌生长的抑制作用。结果:23例健康妇女阴道分泌物中分离出3种乳杆菌:嗜酸乳杆菌(La)、干酪乳杆菌(Lca)和卷曲乳杆菌(Lcr),15例VVC初发患者阴道分泌物中分离出3种假丝酵母菌:白色假丝酵母菌(Ca)、热带假丝酵母菌(Ct)和克柔假丝酵母菌(Ck)。各种乳杆菌均表现出对假丝酵母菌生长的抑制能力,La对各种假丝酵母菌的抑制能力均优于Lcr;与Lca相比,La对Ct的抑制更为明显;产H2O2的Lcr与不产H2O2的Lca对假丝酵母菌的抑制能力无显著差异。结论:各种乳杆菌表现出对假丝酵母菌生长的不同抑制能力,La对研究的3种假丝酵母菌的抑制能力均优于Lcr;与Lca相比,La的唯一优势体现在对Ct的抑制上;乳杆菌对假丝酵母菌的抑制可能不仅仅与产生H2O2能力有关。     

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.     

三种人工阴道成形术后阴道乳杆菌定植情况研究

目的探讨结肠代阴道、皮肤代阴道及猪小肠黏膜下层生物补片代阴道术后阴道乳杆菌定植情况。方法回顾性分析2012年7月至2014年7月在上海交通大学医学院附属第九人民医院行人工阴道成形术的患者资料,根据所用术式分为:结肠代阴道组(23例)、皮肤代阴道组(18例)、补片代阴道组(20例),分别在术后1周、1个月、6个月进行阴道分泌物乳杆菌培养检测;对照组为同期就诊的健康女性(30例)。比较各组阴道乳杆菌的检出情况。结果术后1周的阴道乳杆菌检出率,结肠代阴道组(17.39%)、皮肤代阴道组(16.67%)及补片代阴道组(20%)与对照组(60%)相比,差异均有统计学意义(P0.05);术后1个月的阴道乳杆菌检出率,结肠代阴道组(34.78%)、补片代阴道组(35.00%)与对照组相比差异均无统计学意义(P0.05),皮肤代阴道组(22.22%)与对照组相比差异有统计学意义(P0.05);术后6个月的阴道乳杆菌检出率,结肠代阴道组(47.83%)、补片代阴道组(40.00%)与对照组相比差异均无统计学意义(P0.05),皮肤代阴道组(27.78%)与对照组相比差异有统计学意义(P0.05)。结论术后1周内乳杆菌即可在人工阴道内定植;术后1、6个月时结肠代阴道和补片代阴道患者阴道内乳杆菌检出情况与健康妇女水平相近,皮肤代阴道乳杆菌检出率较低,有必要进一步研究。     

复发性细菌性阴道病的发病机制和治疗

细菌性阴道病(bacterial vaginosis,BV)是生育年龄妇女最常见的阴道感染.系由于阴道内产过氧化氢(H_2O_2)的乳杆菌减少,而阴道加德纳菌、各种厌氧菌、动弯杆菌及支原体等大量繁殖引起混合感染,导致阴道微生态平衡失调的临床症候群~([1～3]).     

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。     

高危型人乳头瘤病毒感染子宫颈上皮内瘤变患者阴道微生态分析

目的评价高危型人乳头瘤病毒(HR-HPV)感染子宫颈上皮内瘤变(CIN)患者的阴道微生态状况。方法将2015年2月至2016年8月在天津医科大学总医院宫颈病变中心诊治的241例HR-HPV阳性的CIN患者设为研究组,健康查体HPV阴性且宫颈细胞学无异常168例女性设为对照组,比较两组阴道微生态状况的差异。结果 241例HR-HPV阳性CIN患者中,最常见的HPV型别分别为HPV16(30.1%)、HPV52(19.5%)、HPV58(19.1%)、HPV18(10.0%)和HPV33(9.1%)。其中,细菌性阴道病(BV)、需氧菌性阴道炎(AV)、混合感染、乳杆菌异常和阴道p H值升高检出率分别为20.7%(50/241)、12.4%(30/241)、9.1%(22/241)、34.4%(83/241)和23.2%(56/241),与对照组比较,差异有统计学意义(P0.05)。外阴阴道假丝酵母菌病(VVC)和滴虫性阴道炎(TV)和WBC10个/HPF检出率分别为10.0%(24/241)、1.7%(4/241)和30.7%(74/241),与对照组比较,差异无统计学意义(P0.05)。HPV16/18阳性CIN与非HPV16/18阳性组比较,混合感染更常见(P0.05)。结论 HR-HPV阳性CIN中,最常见的阴道微生态异常为BV和AV,混合感染、乳杆菌异常及阴道白细胞增多也是重要的阴道微生态失调类型。HPV16/18阳性CIN更易合并混合感染。     

阴道微生态异常与高危型人乳头瘤病毒感染的相关性研究

目的探讨各种阴道微生态异常与高危型人乳头瘤病毒(HR-HPV)感染的相关性。方法将149例HR-HPV感染、宫颈细胞学阴性患者设为研究组;165例健康查体HPV阴性、细胞学阴性女性设为对照组,比较两组阴道微生态检查结果。结果研究组和对照组细菌性阴道病(BV)检出率分别为24.8%和9.1%(P0.001),外阴阴道假丝酵母菌病(VVC)分别为12.8%和4.8%(P0.05);需氧菌性阴道炎(AV)分别为14.1%和4.2%(P0.01);WBC10个/HPF分别为28.2%和22.4%(P0.05);p H值4.5分别为22.8%和12.1%(P0.05);乳酸杆菌减少分别为38.3%和15.2%(P0.001)。BV阴性与阳性组HR-HPV检出率分别为42.7%和71.2%(P0.001);VVC阴性与阳性组分别为45.3%和70.4%(P0.05);AV阴性与阳性组分别为44.8%和75.0%(P0.01);WBC≤10个/HPF与WBC10个/HPF组分别为45.5%和53.2%(P0.05);p H值≤4.5与p H值4.5组分别为44.2%和63.0%(P0.05);乳杆菌正常与减少组分别为39.7%和69.5%(P0.001)。结论 BV、VVC、AV、p H值4.5及乳酸杆菌减少可能与HR-HPV感染相关。     

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.     

A study of the prevalence of hydrogen peroxide generating Lactobacilli in bacterial vaginosis: the determination of H2O2 concentrations generated, in vitro , by isolated strains and the levels found in vaginal secretions of women with and without infection.

The concentration of hydrogen peroxide in the vaginal secretions of normal women were compared with levels found in women infected with bacterial vaginosis (BV). The mean concentration found in 90 normal samples was 0.171 microg per ml, whereas in women with BV, the mean level was 0.04 microg per ml (P < 0.001). In vitro culture experiments using TMB agar showed that in normal women, 75% of Lactobacillus strains produced H2O2 and 25% did not, whereas in women 'infected' with BV. 14% of the isolates produced H2O2 and 86% did not (P < 0.001). Quantitative culture tests showed that both anaerobic and facultative strains of Lactobacilli isolated from normal women generated significantly higher levels of H2O2 than strains cultured from women with BV. Anaerobic strains isolated from normal women produced a mean level of 6.8 microg per ml, compared with the mean level of 1.4 microg per ml from women with BV. Facultative strains from normal women produced mean levels of 18.3 microg per ml compared with 2.4 microg per ml produced by strains from BV-infected women, which had been incubated under the same conditions (P < 0.001). There results indicate that Lactobacilli which produce H2O2 probably have a significant role in protecting the vaginal ecosystem from BV infection.     

The in vitro activity of vaginal Lactobacillus with probiotic properties against Candida

Lactobacilli, the predominant vaginal microorganisms in healthy premenopausal women, control other members of the vaginal microflora and thus protect against bacterial vaginosis and urinary tract infections. It has been claimed that some lactobacilli are also protective against Candida vaginitis. Little is known, however, about the mechanisms by which these lactobacilli can control vaginal populations of Candida and prevent vaginitis. To address this question, vaginal Lactobacillus strains with known antagonistic properties against bacteria were tested for their cell surface properties, adhesion to vaginal cell lines in vitro and antagonistic activities against Candida. A small proportion of the lactobacilli tested adhered strongly to cultured vaginal epithelial cells and inhibited growth of Candida albicans but not of C. pseudotropicalis. This anticandidal activity was in some Lactobacillus strains related to hydrogen peroxide (H2O2) production, but catalase treatment did not suppress this activity in other Lactobacillus strains, suggesting alternative mechanism(s). Moreover, tested vaginal Candida strains were resistant to relatively high concentrations of H2O2 that markedly exceeded those produced by even the most active Lactobacillus strains.     

Hydrogen peroxide producing lactobacilli in women with vaginal infections

OBJECTIVE: Hydrogen peroxide producing lactobacilli are isolated from the vaginas of a majority of healthy reproductive age women. Their toxic and inhibitory effect against the overgrowth of pathogens in the vagina is documented by in vitro studies. Clinical studies concerning the role of hydrogen peroxide producing lactobacilli in vaginal infections are controversial. STUDY DESIGN: The aim of this study was to isolate lactobacilli from women with major vaginal infections: bacterial vaginosis (BV), vulvovaginal candidiasis (VVC) and trichomoniasis (TV), and from women with normal flora (NF), to test their ability to produce hydrogen peroxide, to quantitate lactobacilli and to evaluate factors related to the colonization of vagina with hydrogen peroxide producing lactobacilli. The study group comprised 108 women: 27 with VVC, 26 with BV, 20 with TV and 35 with NF. Data was analysed with Fisher exact test, chi2-test, and ANOVA. RESULTS: Lactobacilli were isolated from 81.5% of women with VVC, 58% of women with BV (p=0019), 55% of women with TV (p=0.015) and from 86% of women with NF. The majority of isolates of lactobacilli from women with VVC, TV and NF produced hydrogen peroxide (77%, 63.5% and 80%, respectively), compared with women with BV where only 26.5% of isolates produced hydrogen peroxide (p=0.01). Quantitative analysis showed that in an overwhelming majority of women colonized with lactobacilli, their count was >10(7) CFU/ml. Upon evaluation of behavioural and demographic characteristics, we found that smokers had a lower incidence of isolation of hydrogen peroxide producing lactobacilli (p=0.018). Our results showed that women with BV lack lactobacilli, especially hydrogen peroxide producing ones. Women with TV had a lower rate of lactobacilli. In women with VVC, there was neither significant difference in the isolation of lactobacilli, nor in their ability to produce hydrogen peroxide, compared to women with NF. CONCLUSION: Our results point out that hydrogen peroxide producing lactobacilli could protect against the development of BV, but not against VVC and TV.     

Hydrogen peroxide-producing Lactobacillus species in healthy women and in women with bacterial vaginosis

We compare the prevalence of H2O2--producing Lactobacillus species in women with or without bacterial vaginosis. H2O2--producing facultative Lactobacillus species were found in the vaginas of 37 (92.5%) of 40 normal women and 3 (4.1%) of 72 women with BV. Anaerobic Lactobacillus species (which do not produce H2O2) were isolated from 12 (16.6%) of 72 women with BV and 1 (2.5%) of 40 normal women. The production of H2O2 by Lactobacillus species may represent a nonspecific antimicrobial defence mechanism of the normal vaginal ecosystem.     

223例健康育龄妇女阴道内乳酸杆菌菌群的鉴定

目的检测健康育龄妇女阴道内乳酸杆菌的主要菌群种类及其产生过氧化氢的能力。方法采集223例健康育龄妇女阴道侧壁的分泌物,经过乳酸杆菌选择性培养基（Rogosa）与肉汤培养基（MRS）分离培养后,提取细菌染色体DNA,PCR扩增细菌的16SrRNA基因,测定16SrRNA核苷酸序列,然后与基因库（GenBank）中的数据进行比对,确定细菌的种类。并对乳酸杆菌产生过氧化氢的情况进行分析。结果从223例健康育龄妇女阴道中分离到8种乳酸杆菌种属,较常见的种属为卷曲乳杆菌（53．7％）,詹氏乳杆菌（27．9％）与格氏乳杆菌（10．3％）。其他少见的细菌类型包括阴道乳杆菌（2．2％）,L．coleohominis（1．5％）,约氏乳杆菌（1．5％）,嗜酸乳杆菌（1．5％）及发酵乳杆菌（1．5％）;大多数乳酸杆菌均能产生过氧化氢,其中卷曲乳杆菌和詹氏乳杆菌产生过氧化氢的能力较强。结论卷曲乳杆菌、詹氏乳杆菌和格氏乳杆菌是健康育龄妇女阴道内乳酸杆菌的主要种属。卷曲乳杆菌和詹氏乳杆菌有较强的产生过氧化氢的能力。     

The relationship of hydrogen peroxide-producing lactobacilli to bacterial vaginosis and genital microflora in pregnant women.

Lactobacilli provide an important microbial defense against genital colonization by pathogens. The role of hydrogen peroxide (H2O2) in the control of genital microflora was explored in a cross-sectional study of 275 women in the second trimester of pregnancy. Vaginal cultures were obtained for detection of H2O2-positive and H2O2-negative lactobacilli and other members of the genital microflora. Compared with women with H2O2-negative lactobacilli, women colonized by H2O2-positive lactobacilli were less likely to have bacterial vaginosis, symptomatic candidiasis, and vaginal colonization by Gardnerella vaginalis, Bacteroides, Peptostreptococcus, Mycoplasma hominis, Ureaplasma urealyticum, and viridans streptococci (P less than or equal to .05 for each comparison). In addition to the above organisms, women without vaginal lactobacilli were more likely than those women with H2O2-positive lactobacilli to have Chlamydia trachomatis, and less likely to be colonized by Enterococcus or coagulase-negative staphylococci (P less than .05 for each comparison). Vaginal colonization by group B streptococci or Escherichia coli was not related to the presence of H2O2-positive lactobacilli. These data suggest that the presence of H2O2-positive lactobacilli in the vagina is inversely correlated with infection by some genital pathogens in pregnant women.