达克宁联合伊曲康唑治疗复发性外阴阴道假丝酵母茵病48例临床研究

目的：探讨达克宁联合伊曲康唑治疗复发性外阴阴道假丝酵母茵病的合理、有效的治疗方案。方法i根据阴道分泌物真菌培养＋药敏结果选择个体化强化＋巩固治疗方案；每月1个疗程，口服＋阴道用药强化治疗。口服用药：伊曲康唑0．2g1次／d，连用5d或氟康唑150mgl次或150mg，1次／3d，连用2次后150mr：／周；阴道配伍用药：制霉菌素阴道栓每晚40万单位，连用7d或克霉唑阴道栓每晚0．1g，连用7d或达克宁栓200mg。结果：①48例RVVC以白色假丝酵母菌感染为主占85．41％；②治疗有效率93．75％，停药后远期治愈率分别是89．58％，87．5％，83．34％。结论：RVVV主要病原茵是白色假丝酵母茵，选择口服＋阴道放药的巩固治疗是治愈RVVC的有效措施。     

Study of Candida Albicans Vaginitis Model in Kunming Mice

The model of vaginal candidiasis in Kunming mice was constructed in order to search for the optima construction conditions and provide an economic animal model of Candida albicans (C. albicans) vaginitis. Estrogen benzoate (E2) was given to mice at different concentrations ranging from 0.0 to 0.05 mg/mouse (4 levels) beginning 72 h prior to vaginal inoculation, then mice were in- oculated intravaginally with various concentrations of stationary-phase C. albicans blastoconidia (ATCC90028) (5 levels) in 20 μL of phosphate-buffered saline (PBS) in each E2 level. General state, scores of genital pathology, the hyphae and vaginal fungal burden (CFU) in vaginal lavage fluid, the hydrops rate of uterus and vaginal tissues for pathological section in mice were observed and ob- tained at day 2, 4, 7, 14 and 21 after inoculation. The results showed the infection rate in mice was related to the dosage of E2 and concentration of C. albicans blastoconidia. Additionally there was better cross-effect between the two treated factors. The infection rate was about 80% on the day 4, and could reach 100% on the day 7 until the end of experiment after inoculated intravaginally in groups of E2I3, E2 0.025 mg/mouse injected hypodermically and inoculated intravaginally with 5×104 C. albicans blastoconidia, and large amount of hyphae and blastoconidia could be observe in superfi- cial layer tissue and canal of vaginal by PAS. From the results in our experiment it was concluded that E2I3 was the optima construction condition in kunming mice.     

复发性念珠菌外阴阴道炎发病的相关因素及不同的治疗方法

目的 探讨复发性念珠菌外阴阴道炎发病的相关因素并观察微生态制剂对其治疗效果的影响.方法 将复发性念珠菌性外阴阴道炎576例通过问卷调查、化验检查得出：滥用抗生素、合并其他病原菌感染、经常阴道冲洗各占发病因素30%、25%和19.1%;同时对其中226例随机分为对照组（单独抗真菌治疗）与治疗组（抗真菌治疗联合微生态制剂）.治疗前、后1周、1个月、2个月进行临床、真菌学疗效分析.结果 经抗真菌治疗后,临床、真菌学疗效较好.治疗后2个月,治疗组有效率明显高于对照组（x^2=16.61,P＜0.01）,复发率低.结论 联合微生态制剂治疗复发性念珠菌性外阴阴道炎效果良好.     

外阴阴道假丝酵母菌病患者阴道人类防御素分泌及发病相关因素的研究

目的 通过对外阴阴道假丝酵母菌病(VVC)患者与健康妇女的比较,对VVC发病的相关因素进行分析,并研究VVC患者的阴道局部免疫状态.方法 应用病例对照研究方法,对VVC患者(VVC组,60例)及无VVC妇女(正常对照组,60例)进行比较,研究对象均填写调查表,取阴道分泌物进行阴道分泌物常规检查、pH值检测及细菌培养,用酶联免疫吸附试验对阴道冲洗液进行相关细胞因子[白细胞介素2、白细胞介素4、人类防御素5、人类β防御素(HBD)1、HBD2等]含量的检测分析.结果 (1)两组妇女的学历、对妇科感染的了解程度、妇科炎症病史、卫生习惯、性生活情况、药物应用情况比较,差异均无统计学意义(P>0.05);正常对照组慢性宫颈炎的发生率(43%,26/60)高于VVC组(22%,13/60),两组比较,差异有统计学意义(P<0.05).(2)正常对照组与VVC组妇女阴道pH值比较,差异无统计学意义(P>0.05).(3)VVC组妇女阴道分泌物检出假丝酵母菌43例,检出率为72%(43/60).(4)VVC组妇女阴道冲洗液中,人类防御素5、HBDI、HBD2含量[分别为(0.94±0.44)mg/L、(3.1±0.4)μg/L、(10±6)μg/L]明显高于正常对照组[分别为(0.61±0.27)mg/L、(2.7±0.4)μg/L、(7±3)μg/L],分别比较,差异均有统计学意义(P<0.05).结论 VVC是女性常见的外阴阴道炎症,在育龄期妇女VVC的发生与学历、对妇科感染的了解程度、妇科炎症病史、卫生习惯、性生活情况、药物应用情况无明显相关性.人类防御素的作用可能与VVC的发病密切相关.     

白假丝酵母菌对人阴道上皮细胞TLR4mRNA表达的影响

目的探讨白假丝酵母菌对人阴道上皮细胞Toll样受体4（Toll-like receptor4，TLR4）mRNA表达的影响。方法用白假丝酵母菌热灭活孢子刺激体外培养的人阴道上皮细胞12h和24h，应用实时定量逆转录聚合酶链反应（QRT-PCR）检测细胞TLR4mRNA的表达水平。结果正常人阴道上皮组织和体外培养人阴道上皮细胞均表达TLR4mRNA。白假丝酵母菌热灭活孢子刺激12h，上皮细胞中TLR4 mRNA表达明显高于对照组和刺激24h组P〈0．05，刺激24h组与对照组比较，无明显差异P=0．50。结论人阴道上皮细胞构成性表达少量TLR4，白假丝酵母菌刺激12h时人阴道上皮细胞表达TLR4 mRNA增加，推测TLR4可能在人阴道上皮细胞识别白假丝酵母菌和启动防御感染的早期起一定作用。     

外阴阴道假丝酵母菌病患者阴道局部甘露糖结合凝集素mRNA水平的测定

目的：初步探讨甘露糖结合凝集素（MBL）在外阴阴道念珠菌病（VVC）和复发性外阴阴道念珠菌病（RVVC）发病过程中的免疫机制。方法：选取2006年1月～2007年7月健康体检的女性、VVC患者、RVVC患者各20例，采集阴道灌洗液，半定量RT-PCR测定MBL-mRNA表达情况。结果：阴道局部MBL-mRNA的表达VVC患者显著高于正常人群，而RVVC患者显著低于正常人群。结论：VVC患者阴道局部MBL-mRNA高表达说明MBL参与了局部免疫反应，其在免疫防御中发挥了重要作用，而阴道局部MBL-mRNA的低表达可能和RVVC反复发作不易治疗有关，提示有必要对MBL水平低下者进行MBL临床治疗的研究。     

完带汤化裁联合西药治疗复发性外阴阴道假丝酵母菌病的Meta分析

目的 系统评价完带汤化裁联合西药治疗复发性外阴阴道假丝酵母菌病（recurrent vulvovaginal candidiasis,RVVC）的有效性和安全性。方法 检索CNKI、Sinomed、WanFang、VIP、PubMed、Embase、Cochrane Library等数据库,筛选完带汤化裁联合西药治疗RVVC的临床随机对照研究,用RevMan5.3软件进行数据分析。结果 共纳入10个研究,病例1075例。Meta分析结果显示：完带汤化裁联合西药治疗RVVC有效率高于单纯西药,且可降低复发率,改善阴道微生态,两组比较有统计学差异。结论 完带汤化裁联合西药治疗RVVC具有良好效果。     

硝酸舍他康唑栓治疗外阴阴道假丝酵母菌病28例

［摘要］目的评价硝酸舍他康唑栓治疗外阴阴道假丝酵母菌病的疗效及安全性。方法采用随机双盲对照试验。治疗组及对照组各30例,分别外用硝酸舍他康唑栓300 mg和克霉唑栓500 mg,用药1或2次。停药后（7±1） d及28～35 d时进行观察。结果治疗组28例、对照组30例纳入分析,治疗组和对照组停药后（7±1） d临床有效率分别为89.29%,86.67%（P＞0.05）;用药结束后28～35 d时的临床有效率分别为81.48%,66.67%（P＞0.05）;均未发生与药物相关的不良反应。结论硝酸舍他康唑栓治疗外阴阴道假丝酵母菌病有效,安全。     

复发性外阴阴道念珠菌病患者念珠菌菌种鉴定及药敏分析

目的 检测复发性外阴阴道念珠菌病患者念珠菌菌种分布及耐药状况,为临床治疗方案制订提供依据。方法120例患者依据病史分为复发性外阴阴道念珠菌病患者（RVVC）60例（病例组）,偶发外阴阴道念珠菌病者（VVC）60例（对照组）。病例组及对照组分别进行真菌培养、菌种鉴定及药物敏感试验。结果在120株念珠茵中白念珠茵占80．83％,非白念珠茵占19．17％。RVVC组中自念珠茵占73．33％;VVC组中为白念珠茵占88．33％,RVVC组白念珠菌所占比例明显低于VVC组,差异有统计学意义（氏0,05）。60株RVVC念珠菌对两性霉素B、氟康唑和伊曲康唑的敏感率分别为100．00％、93．33％、95．00％。结论白念珠茵仍是VVC、RVVC的主要致病菌,RVVC分离菌株对咪唑类抗真菌药物仍有较高的敏感率。     

Prevalence and phenotypic evaluation of Candida dubliniensis in pregnant women with vulvovaginal candidosis in a university hospital in Ankara

Candida dubliniensis is very similar to Candida albicans in terms of genotypic and phenotypic characteristics. As the hormonal milieu of the vagina during pregnancy, characterised by a lack of maternal cell-mediated immunity, enhances Candida colonisation and serves as a risk factor for symptomatic expression, investigation into the isolation of C. dubliniensis in vaginal discharges of pregnant women with vulvovaginal candidosis was made. A total of 77 Candida isolates obtained from 60 patients positive for vulvovaginal candidosis collected from 218 pregnant women were investigated for C. dubliniensis subsistence. In total 41 Candida species phenotypically identified as C. albicans on the basis of a positive germ tube test and carbohydrate assimilation tests were screened for the presence of C. dubliniensis. Phenotypic tests for differentiation of C. dubliniensis from C. albicans, such as growth at 42 and 45 degrees C on Sabouraud dextrose agar, appearance on CHROMagar and colony morphology on Cornmeal-Tween-80 agar and Staib agar were carried out. Only one strain (2.43%) was phenotypically identified as C. dubliniensis. According to our study, a combination of at least five phenotypic methods is necessary for an exact diagnosis of C. dubliniensis. Large-scale studies of pregnant women are required to discover the aetiological importance of this yeast.