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.     

细菌性阴道病阴道乳酸杆菌的生态学特征

细菌性阴道病（ｂａｃｔｅｒｉａｌｖａｇｉｎｏｓｉｓ，ＢＶ）系阴道内菌群生理生态内环境改变所致，尤与阴道内乳酸杆菌（ｌａｃｔｉｃａｃｉｄｂａｃｉｌ－ｌｕｓ，ＬＡＢ）与加特纳杆菌（Ｇａｒｔｎｅｒ＇ｓｂａｃｉｌ－ｌａｓ，ＧＢ）或混合性厌氧菌群失调有关。阴道...     

细菌性阴道病患者阴道分泌物革兰染色的涂片特征

细菌性阴道病患者阴道分泌物革兰染色的涂片特征刘小平樊尚荣李世荣李耀霞细菌性阴道病（ｂａｃｔｅｒｉａｌｖａｇｉｎｏｓｉｓ，ＢＶ）系由多种微生物（主要为厌氧菌）所致的无阴道粘膜炎症表现的临床综合征。本病首先由Ｇａｒｄｎｅｒ等［１］描述，主要临床特征为白带...     

定君生治疗复发性细菌性阴道病的临床观察

细菌性阴道病（BV）占外阴阴道炎症的40％～50％。通常采用阴道冲洗及口服或局部放置抗生素治疗，近期疗效良好，远期复发率高。我院妇科门诊自2003年6月开始使用定君生（乳杆菌活菌胶囊）治疗复发性BV。随访表明，此法疗效好，复发率低。     

乳杆菌活菌胶囊治疗细菌性阴道病的疗效观察

细菌性阴道病(bacterial vaginosis，BV)占外阴、阴道感染的40％～50％，如不及时治疗可引起子宫出血、盆腔炎、输卵管炎、不孕、早产、产褥期感染等妇产科并发症，以前治疗通常用抗生素药物，如甲硝唑、克林霉素等。我院自2003年12月以来试用乳杆菌活菌胶囊(商品名定君生。内蒙古双奇药业股份有限公司产)治疗细菌性阴道病，获得了良好的临床疗效，现报道如下。     

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.     

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。     

妊娠合并细菌性阴道病

细菌性阴道病 (ＢＶ)系阴道菌群紊乱 ,既以高浓度的阴道加德纳杆菌、各种厌氧菌及人型支原体替代了正常、健康的阴道乳酸杆菌而引起的一种临床疾病。虽然符合这一疾病诊断标准的妇女中 5 0 %是没有症状的 ,但ＢＶ是引起异常阴道分泌物和阴道炎的最常见的原因。据报道[1 ] 妇女中ＢＶ的发病率为 10 %～ 41% ,妊娠期ＢＶ检出率远高于阴道滴虫及念珠菌感染者 ,并且新的证据[2 ,3 ] 表明ＢＶ与自然流产、早产、胎膜早破、羊膜绒毛膜炎、羊水感染、产后子宫内膜炎和剖宫产后切口感染等相关 ,在这些研究中风险指数 (ＲＲ)从 1 1到 7 3,具有显著性…     

细菌性阴道病的诊断与治疗

细菌性阴道病的诊断与治疗中山医科大学孙逸仙纪念医院（５１０１２０）冯华英邝健全细菌性阴道病（ｂａｃｔｅｒｉａｌｖａｇｉｎｏｓｉｓ，ＢＶ）是由阴道加德纳菌（Ｇａｒｄｎｅｒｅｌａ）与某些厌氧菌混合感染引起的，曾称非特异性阴道炎（ｎｏｎｓｐｅｃｉｆｉｃｖａ...     

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.     

乳酸杆菌治疗妊娠合并细菌性阴道病临床观察

目的观察乳酸杆菌活菌制剂对妊娠期合并细菌性阴道病的治疗作用，评价其疗效。方法107例妊娠合并细菌性阴道病的患者随机分为两组，分别应用乳酸杆菌活菌胶囊及甲硝唑栓阴道上药，每晚1次，连续用药10天，停药3天回院复查。结果乳酸杆菌活菌胶囊能迅速缓解临床症状，实验室检查转阴有效率高，总有效率85．1％，甲硝唑栓有效率81．4％，两者相比差异无显著性。结论乳酸杆菌活菌胶囊是目前安全、有效、无毒副作用的治疗妊娠期细菌性阴道病的药物。     

The diagnosis of bacterial vaginosis and vaginal flora changes

In a population of 956 women, attending for contraceptive advice, 131 (13.7%) were found to have BV acording to Amsel’s criteria. Clue cells were detected in 200 (20.9%) women, a positive amine (’sniff’) test in 191 (20.0%), a vaginal pH≥4.7 in 243 (25.4%) and a ”characteristic” vaginal discharge in 104 (10.9%) women. Sensitivity, specificity, positive and negative predictive values in relation to BV were calculated for each of these four criteria. The detection of clue cells, an increased pH and a positive sniff test showed excellent sensitivity (86–100%) values, but had a less satisfactory positive predictive value (52–68%). Vaginal discharge was found to be a poor predictor of BV. The vaginal flora in women with clue cells, increased vaginal pH or a positive sniff test was very similar to that of the women with BV, every after excluding concomitant cases of BV and the three respective criteria. Thus, a positive amine test, which is easily performed, strongly suggests BV and a vaginal flora predominated by Gardnerella vagi- nalis, Mycoplasma hominis, Mobiluncus species and anaerobic species on one hand, and lack of lactobacilli on the other. When there is a clinical suspicion of BV, the sniff test is positive and differential diagnoses are excluded, one can safely treat a woman for bacterial vaginosis. Received: 9 May 2000 / Accepted: 26 July 2000     

Psychological and biological markers of stress and bacterial vaginosis in pregnant women

OBJECTIVES: To determine whether stress is associated with risk of bacterial vaginosis (BV) in pregnant women. DESIGN: Prospective cohort study. SETTING: The prenatal care clinics at the University of North Carolina. The residents' clinic sees mostly government-insured and uninsured women, and the physicians' clinic sees mostly those with private health insurance. POPULATION: A total of 897 women gave samples for BV analysis. Study participants were 22% African-American, 68% white; 24% unmarried and 44% nulliparous. More than half had completed college. METHODS: Women completed two questionnaires and two interviews reporting stress and psychological aspects of their lives. Measurement scales included the Sarason life events questionnaire, the Cohen perceived stress scale, Spielberger state-trait anxiety, the John Henryism coping style and the Medical Outcomes Study social support inventory. Two stress hormones, corticotrophin-releasing hormone and cortisol, were also measured. MAIN OUTCOME MEASURES: BV at 15-19 and 24-29 weeks of gestation was diagnosed by Gram's stain. RESULTS: Women in the highest quartile of stress measures, particularly state anxiety (OR=2.0, 95% CI 1.2-3.3), perceived stress (OR=2.4, 95% CI 1.5-3.9) and total life events (OR=2.0, 95% CI 1.3-3.2), had the highest risk of BV. Adjustment for confounders, especially age, race, and income, reduced these associations (state anxiety: OR=1.3, 95% CI 0.7-2.4; perceived stress: OR=1.4, 95% CI 0.8-2.5; total life events: OR=1.3, 95% CI 0.7-2.4). No clear pattern of association was seen between stress hormones and BV. CONCLUSIONS: Few associations between stress and BV were seen after adjustment for confounders.     

Pharmacokinetics of metronidazole in pregnant patients with bacterial vaginosis

Objective.?The present study was undertaken to investigate the pharmacokinetics of metronidazole in pregnant patients with bacterial vaginosis.

Methods.?Twenty patients received metronidazole (Flagyl®, Pfizer, 235 East 42nd Street, NY, NY 10017) oral dose 500?mg twice a day for 3 consecutive days. Pharmacokinetic analyses of metronidazole were performed after a single oral dose on the morning of day 4.

Results.?Although absolute estimates of metronidazole total body exposure were highest in women during early term pregnancy, weight-corrected estimates of exposure maximum plasma drug concentration (C_max) and the area under the plasma concentration-versus-time curve (AUC_0-12), along with apparent oral clearance and distribution volume, were not significantly different between women at early, middle, and late stages of pregnancy and were in the range of reported values for nonpregnant patients receiving a similar dose.

Conclusions.?The pharmacokinetic profile of metronidazole did not change at the different time points assessed during pregnancy.     

Fetal fibronectin and bacterial vaginosis are associated with preterm birth in women who are symptomatic for preterm labor

OBJECTIVE: The purpose of this study was to codify the relationship between bacterial vaginosis/fetal fibronectin and preterm labor/birth. STUDY DESIGN: In this prospective study, 185 women who were symptomatic for preterm labor were assessed for bacterial vaginosis and fetal fibronectin. RESULTS: These women comprised 4 groups: group A (n=23 women; +bacterial vaginosis/+fetal fibronectin); group B (n=31 women; -bacterial vaginosis/+fetal fibronectin); group C (n=47 women; +bacterial vaginosis/-fetal fibronectin); and group D (n=84 women; -bacterial vaginosis/-fetal fibronectin). The time interval from gestational age at testing until delivery was significantly shorter for groups A and B versus groups C and D (P < or =.05 and P <.001, respectively). Similarly, delivery at <32 weeks of gestation was increased in group B (26%) compared with groups A (9%), C (2%), and D (5%; P <.009; odds ratio, 165.90; 95% CI, 30.02, 916.08). CONCLUSION: Women who are symptomatic for preterm labor should be considered for fetal fibronectin and bacterial vaginosis testing.