昆明小鼠白色念珠菌性阴道炎模型构建条件的摸索

目的 探索构建经济实用的白色念珠菌性阴道炎动物模型的最佳成模条件.方法 采用SPF级昆明雌性小鼠,经不同剂量的苯甲酸雌二醇(E2)处理后,小鼠阴道内注入含不同菌量白色念珠菌悬液造模.造模后动态观察小鼠的一般情况及外阴阴道症状,阴道灌洗液菌丝生成情况及菌落计数,并观察白色念珠菌性子宫积液情况及组织病理学情况.结果 随着接种菌量及E2量的增加,阴道炎感染率随之增加,但白色念珠菌性子宫积液率亦增加.J3E2组(接种菌量为5×104个/只,皮下注射E20.025 mg/只),第2天始即出现高水平的菌落数,CFU≥104/ml,第4天菌丝检出率可达80%,并可持续至实验结束,与接种菌量≤5×104个/只及皮下注射E2≤0.025 mg/只的各组菌落数比较差异均有统计学意义(P＜0.01或0.05),与接种菌量≥5×104个/只及皮下注射E2≥0.025 mg/只的各组菌落数比较,差异均无统计学意义;且子宫积液率为33.33%,明显低于接种菌量≥5×104及皮下注射E2≥0.025mg/只的各组.感染成功小鼠阴道组织切片PAS染色阴道浅层组织及腔内见大量孢子及菌丝.结论 J3E2组为昆明小鼠白色念珠菌性阴道炎模型最佳成模条件.     

急性白色念珠菌性阴道炎的护理体会

白色念珠菌为条件致病菌 ,多因长期使用抗生素、穿化纤紧身内裤、肥胖等使细菌繁殖而引起感染 ,患者常感外阴奇痒痛苦难忍 ,给工作和生活带来不便。近 3年来 ,作者对急性白色念珠菌性阴道炎患者进行了护理 ,疗效显著 ,现总结如下。1　临床资料我院 1999年 7月～ 2 0 0 2年 7月治疗急性白色念珠菌性阴道炎患者 6 5例 ,年龄 17～ 39岁。2　护理2 1　入院后的护理2 1 1　心理护理 :急性白色念珠菌性阴道炎急性发作期外阴奇痒 ,给患者带来诸多生活上的不便 ,有些农村妇女大多受传统观念的影响 ,有害羞心理 ,不愿接受治疗。鉴于这种情况 ,作为…     

氟康唑联合妇科净治疗白色念珠菌性阴道炎的临床观察

阴道炎是妇科的常见病,此病种类很多,其中白色念珠菌性阴道炎较为多见,常因用药不规律或夫妻双方相互感染而反复发作。我院2001年6月～2002年6月使用氟康唑和妇科净栓剂及妇科净粉配制成洗剂联合,治疗白色念珠菌性阴道炎,取得了良好的效果,报告如下。     

海洋溶菌酶治疗白色念珠菌性阴道炎临床分析

念珠菌性阴道炎即霉菌性阴道炎,是由念珠菌感染所引起的阴道炎症,是最常见的妇女外阴阴道炎症之一。念珠菌性阴道炎中80%￣95%是由白色念珠菌感染所引起,因治疗不彻底而导致反复发作,严重影响妇女身心健康[1]。     

念珠菌性阴道炎的治疗

19世纪中期是最早有关于女性生殖道念珠菌感染的记录,念珠菌性阴道炎并不是一种很罕见的阴道炎。曾经人们错误的将这种阴道炎叫做霉菌性阴道炎。半数以上的阴道念珠菌感染都是由于白色念珠菌所导致的,剩下的都其他念珠菌和拟酵母菌所引发的。大约有1成的非孕妇女的阴道中存在这种病菌,而孕妇中存在这种病菌的人群数量是非孕妇女的3-4倍,这种病菌没有很明显的病症。发病的诱因有很多,妊娠、长期使用抗生素、糖尿病、服用避孕药或长期穿着紧身化纤内衣等等。患者临床表现为阴部瘙痒、白带粘稠成凝乳状。     

孕妇念珠菌性阴道炎的诊治

以往统称的霉菌性阴道炎是一种常见妇科疾病，主要为白色念珠菌。在农村感染率较高，特别是孕妇易发病，妊娠是霉菌性阴道炎的高发因素。     

康妇特栓治疗念珠菌性阴道炎280例疗效观察

念珠菌性阴道炎是妇科常见病，目前治疗此病的药物很多，以局部治疗为主，疗效不稳定或疗程长，难以根治。康妇特栓为新一代广谱抗真菌药物，笔者通过对280例临床观察，现介绍疗效如下。     

念珠菌性阴道炎患者的健康教育

念珠菌性阴道炎是常见的妇女阴道炎症之一,因易复发,已成为临床上医患双方均感到棘手的问题.我院通过专职护士对念珠菌性阴道炎患者进行有目地的、系统化的健康教育,使患者对该病的病因、治疗和预防有了进一不步的了解和认识,提高了患者的自我防护能力,有效地降低了复发率。     

南方沿海地区念珠菌性阴道炎感染分析

目的探讨近两年南方高热高湿沿海地区念珠菌性阴道炎群体在不同季节、年龄、月经周期的发病情况以及治疗后稳定趋势状况。方法对妇科门诊就诊的8 099例阴道炎患者进行念珠菌检测,采用生理盐水涂片法和革兰染色及念珠菌培养。结果南方高热高湿沿海地区念珠菌性阴道炎发病率为24.694%（2000/8 099）;育龄妇女患病率高于其他年龄段,差异有统计学意义（χ2=58.81,P〈0.01）;夏、秋比冬、春季节患病率高,差异有统计学意义（χ2=32.39,P〈0.01）;月经后1周患病率高于其它时期,差异有统计学意义（χ2=4.67,P〈0.05）;治疗后,阳性率随末次用药时间的延长而逐渐下降（趋势χ2=47.78,P〈0.01）。结论南方高热高湿沿海地区念珠菌性阴道炎的感染率有所上升;与生育年龄呈正相关;夏、秋季节念珠菌性阴道炎的感染率高;月经后1周,念珠菌的阳性率最高,应重点预防。复查应选停药5 d后,因其结果趋于稳定     

Susceptibility to Vaginal Candidiasis under Different Conditions in Mice

In order to study the susceptibility of murine vaginal mucosa to Candida albicans under different conditions, vaginal lavage fluid and vaginal tissue of mice were observed and compared between murine models with normal immune system （estrogen-treated mice） and immunosuppressed murine model, and between primary infection model of vaginal candidiasis and secondary infection one. The average level of colony forming unit （CFU） from the immuosuppressed group was higher than that from estrogen-treated group at each time point and the peak time was delayed. The differences between the two groups were statistically significant （P〈0.05） from the fourth day after inoculation. A significant difference existed in the average level of CFU between the control group and the estrogen-treated group （P〈0.05）, and between the control group and the immuosuppressed group （P〈0.01）. It was concluded that the vaginal mucosa from the immunosuppressed mice is more susceptible to Candida albicans and no difference is found in susceptibility between mice with primary infection and secondary infection.     

Local Expression of Vaginal Th1 and Th2 Cytokines in Murine Vaginal Candidiasis under Different Immunity Conditions

To investigate the expression of vaginal Th1 and Th2 cytokines in rats with experimental vaginal candidiasis under different immune conditions, ICR murine vaginal candidiasis model was established and immno-suppressed murine models of vaginal cadidiasis were established in estrogen-treated mice. Non-estrogen-treated mice were used as controls. The mRNA level of Th1 （IL-2）/Th2 （IL-4, IL-10, TGF-β1） cytokines in murine vaginal tissues was determined by RT-PCR. The cykotine in local tissues was increased to different extent under normal immune condition. IL-2 mRNA was increased during early stage of infection, while IL-10 was increased transiently during late stage of infection. TGF-β1 production was found to be increased persistently. At same time, the expression of IL-2 mRNA was suppressed in immno-suppressed group, and the level of IL-4, IL-10, and TGF-β1 were higher than the normal immunity group to different degree during infection. The high level of IL-2 mRNA during early stage of infection was associated with clearance of mucosal Candidia albicans （C. albicans）, and its expression suppressed leading to decreased clearance of mucosal C. albican in immuno-suppression. The over-expression of IL-4 and IL-10 could significantly enhance the susceptibility to C. albicans infection in mice.     

外阴阴道念珠菌病的特点及药敏实验分析

目的总结外阴阴道念珠菌病的特点及观察其对真菌药物的药敏反应。方法我科对4年来妇科门诊就诊的患者进行外阴阴道念珠菌病发病情况调查,总结此病发病特点并进行药敏实验。结果共检出850例患者患有此病,其中310例为单纯型,540例为复杂型。各型患者的外阴瘙痒、外阴灼痛、阴道充血、白带增多评分后人数比较差异显著（P〈0．01）。药敏实验发现,白色念珠菌对制霉菌素最敏感,对克霉唑、氟康唑、伊曲康唑等药物也比较敏感。结论外阴阴道念珠菌病的主要致病菌为白色念珠菌,此菌对制霉菌素、克霉唑等药物敏感,治疗时可供参考。     

耳念珠菌不同条件下生长特性及体内毒性

目的 探讨耳念珠菌在不同条件下的生长特性、代谢特点及体内毒性特征。方法 以白色念珠菌为参照,测定并比较耳念珠菌与白色念珠菌在常规培养条件、不同pH值和不同盐含量下的生长情况;利用微量生化反应管测定两种念珠菌糖醇发酵情况;以四周龄裸鼠为实验动物,用随机数字表法分为3组,耳念珠菌感染组、白色念珠菌感染组和生理盐水对照组,5只/组。耳念珠菌感染组和白色念珠菌感染组取0.3 mL已调至5×109 cfu/mL菌液,对裸鼠进行灌胃处理,建立胃肠道感染模型,对照组用等量生理盐水灌胃,取肝脏、肾脏、肠、粪便和血液等标本,通过真菌培养和组织病理学变化分析耳念珠菌的体内分布和毒性特征。结果 耳念珠菌的对数生长期约为8~24 h,约在24 h后进入生长稳定期,最适生长的pH值范围为5~7,生长模式与白色念珠菌相同;耳念珠菌在浓度为5%和10%的NaCl培养基中生长情况优于白色念珠菌,能发酵葡萄糖、蔗糖、海藻糖和山梨醇;从裸鼠的粪便、血液、肝脏和肾脏组织中分离出耳念珠菌,肝脏载菌量最多为5.7 log10 cfu/g,其可造成肝组织和肠组织病理学改变,但病变程度比白色念珠菌弱。结论 耳念珠菌在弱酸或中性条件下最适宜生长,具有高耐盐性,在免疫抑制状态下感染机体后,存在突破肠屏障入血及随血流播散并导致组织病变的可能。     

定君生联合凯妮汀治疗复发性外阴阴道念珠菌病临床观察

目的研究联合运用定君生和凯妮汀对复发性外阴阴道念珠菌病的临床治疗效果及治疗后复发情况。方法复发性外阴阴道念珠菌病患者97例,随机分为治疗组和对照组,分别给予定君生（0．25g／d）联合凯妮汀（500mg/3d）,及凯妮汀（500mg/3d）单用治疗。结果单用凯妮汀能有效降低患者症状积分,治愈率为54．2％,复发率达到30．1％;定君生联合凯妮汀显著降低患者症状积分,并且治愈率达到85．7％,且复发率仅为4．8％。结论定君生和凯妮汀联用能显著提高对复发性外阴阴道念珠菌病的治愈率,且显著降低复发率,是一种有效的治疗方法。     

The Effect of Itraconazole on the Vaginal Candidiasis under Different Immunity Conditions in Mice

To study the effect of itraconazole on the vaginal candidiasis caused by Candida under different immunity conditions, the fungal vaginitis model was established in female ICR mice by in- travaginal inoculation of suspension of C. albicans after the animal had been pretreated with estradiol or dexamethasone. Mice were divided at random into different groups and then treated with itracona- zole or IFN-γ given by gastrogavage. The burden of the fungus in the vaginal lavage fluids in the mice of the different groups was measured dynamically at different time points after the beginning of the drug treatment. The difference in the effect of itraconazole on the vaginal candidiasis between normal immune system group (group A) and control group (group D) was statistically significant (P<0.01). The difference in the efficacy of itraconazole among immunosuppressed group (group E), immuno-regulated group (group F) and the control group (group G) was statistically significant (P<0.01). But on the 5th, 6th, 7th, 9th, 11th day after the inoculation the average level of colony forming unit (CFU) of groups A, E and F showed no statistically significant difference (P>0.05). It is concluded that the efficacy of itraconazole in the treatment of the vaginal candidiasis under different immunity conditions (groups A, E and F) in mice were all good, but there was no difference in the anti-fungal effect of itraconazole among the three groups.     

妊娠期妇女阴道念珠菌对克霉唑、咪康唑、制霉菌素的敏感性研究

目的研究妊娠期妇女阴道念珠菌对克霉唑、咪康唑、制霉菌素的敏感性，为妊娠期念珠菌性外阴阴道炎（VVC）的治疗提供理论依据。方法选取来自628人次妊娠期妇女的阴道念珠菌，参考美国国家临床实验标准化委员会的抗真菌药物敏感实验标准，以微量平板法检测不同菌株对克霉唑、咪康唑和制霉菌素的药物敏感性。结果妊娠期VVC发生率为19．3％，感染的念珠菌存在明显的菌种多样性，白色念珠菌最为多见。对于白色念珠菌，咪康唑的24h最小抑菌浓度（MIC）明显低于制霉菌素（P〈0．01）；不同孕期3种药物的48h MIC差异均无统计学意义（P〉0．05）；对于非白色念珠菌，咪康唑的24、48h MIC明显低于制霉菌素和克霉唑（P〈0．01），晚孕期克霉唑和制霉菌素的24、48h MIC与早孕期和（或）中孕期差异有统计学意义（P〈0．05）。结论妊娠期阴道白色念珠菌对抗念珠菌药物相对敏感，不同孕期治疗原则大体一致。妊娠期非白色念珠菌性阴道炎的治疗相对困难，普通克霉唑制剂不宜使用，早、中孕期治疗可选制霉菌素制剂，晚孕期可选咪康唑制剂。     

阴道分泌物念珠菌感染检测方法对比分析

目的 分析常规镜检、荧光PCR核酸扩增法和真菌显色培养法在阴道分泌物真菌检测结果的相关性.方法 选取2014-2016年于该院就诊的疑似阴道炎患者,收集镜检阴道分泌物真菌阳性和阴性标本各500例,用荧光PCR核酸扩增法鉴定念珠菌类型,并将100份荧光PCR核酸扩增法检测结果阳性标本进行真菌微生物培养,验证分型结果的正确率.结果 荧光PCR核酸扩增法和常规镜检一致性检验Kappa值为0.632,二者一致性差.500例患者阴道分泌物常规镜检阳性标本,荧光PCR核酸扩增法测得白色念珠菌感染382例(76.4％),光滑假丝酵母菌感染73例(14.6％),热带假丝酵母菌感染10例(2.0％),白色念珠菌合并光滑假丝酵母菌感染3例(0.6％),其他真菌感染32例(6.4％).500例患者阴道分泌物常规镜检阴性标本,荧光PCR核酸扩增法鉴定阳性共152例,其中白色念珠菌130例,光滑假丝酵母菌16例,热带假丝酵母菌6例.荧光PCR核酸扩增法与CHROMAgar快速显色法检测结果比较,差异无统计学意义(x2 =0.131,P=0.936).结论 对于有临床表现而镜检阴性的患者,建议行荧光PCR核酸扩增快速分型鉴定或真菌培养鉴定.     

Comparison of the Effects of Three Different Anti-fungus Drugs on Candida Albicans of Murine Vaginal Mucosa

To compare the therapeutic effects of three different anti-fungal drugs (i.e., terbinafine, fluconazole and intraconazole) in the treatment of experimental vaginitis caused by Candida albicans (C. albicans) in mice, the fungal vaginitis model was established in female ICR mice by intravaginal inoculation of suspension of C. albicans after the animal had been pretreated with estradiol. Mice were divided at random into different groups and then respectively treated with terbinafine, flucona- zole and intraconazole given by gastrogavage. The burden of the fungus in the vaginal lavage fluids in the mice of the different groups was measured dynamically at different time points after the begin- ning of the drug treatment. The fungal burdens in the vaginal lavage fluids taken at different time points from the mice treated with terbinafine were significantly higher than those taken at corre- sponding time points from mice treated with fluconazole or itraconazole (P<0.01). The fungal bur- dens in the vaginal lavage fluids taken from mice 1 week after the beginning of the treatment with terbinafine remained at a relatively high level. A dramatic drop in the fungal burden was noted in the vaginal lavage fluids taken on the 2nd day of the treatment from mice treated with itraconazole or flu- conazole group and the fungal burden on the 3rd day of the treatment in these mice were at a very low level, suggesting that fluconazole or itraconazole were highly effective for the treatment. How- ever, the difference in the therapeutic effect between the two drugs was not significant (P>0.05). Itraconazole or fluconazole, but not terbinafine, is very effective for the treatment of fungal vaginitis caused by C. albicans in mice.