外阴阴道假丝酵母菌病的免疫防御机制研究进展

外阴阴道假丝酵母菌病是妇产科常见病,但其发病机制仍然不明。多数学者认为阴道上皮细胞的先天性抗假丝酵母菌活性及局部免疫在抗假丝酵母菌感染中发挥着重要作用。细胞免疫、体液免疫的保护作用仍有争议。机体抗假丝酵母菌的防御机制较为复杂,可能多种免疫因素共同参与了防御活动。     

Doppelblind-Vergleichsstudie mit Ciclopiroxolamin- und Miconazol-Vaginalcreme bei uilvovaginaler Candidose

Zusammenfassung: Die Wirksamkeit und Vertraglichkeit von Ciclopiroxolamin- und Miconazol-Vaginalcreme wurde in einer Doppelblind-Vergleichsstudie an 39 Patientinnen mit vulvovaginalen Candidosen geprüft. Es wurde zunächst 6 Tage lang täglich 1 mal behandelt. Nach 1 Tag Pause erfolgte eine mykologische und klinische Befundaufnahme, an welche sich eine weitere 6-tägige Behandlungsperiode und abschließende Befunderhebung anschloß. Beide Präparate bewirkten eine gute Rückbildung der vulvovaginalen Symptome, mit einem leichten Unterschied zugunsten von Ciclopiroxolamin. Die Rückbildung war nach 6 Tagen für beide Präparate signifikant (p < 0,001). Besonders fiel die Wirkung von Ciclopiroxolamin auf den Vaginalfluor im Vergleich zu Miconazol auf. Das Negativwerden der Nativpräparate verlief sehr zufriedenstellend, eine geringere Negativrate ergab sich bei der kulturellen Untersuchung. Mit Ciclopiroxolamin wurde ein globaler Behandlungserfolg (sehr gut und gut) bei 91,3 % und mit Miconazol bei 87,5 % der Fälle erzielt. Beide Präparate waren sehr gut verträglich und ohne Nebenwirkungen. Die Autoren halten Ciclopiroxolamin für ein empfehlenswertes Lokaltherapeutikum für vulvovaginale Candida-Infektionen. Summary: A double-blind study was performed on 39 female patients with vulvovaginal Candida infections, to evaluate the efficacy and tolerance of ciclopiroxolamine vaginal cream, in comparison to miconazole. The preparations were applied once a day, for a period of 6 days. After an interval of 1 day for the first evaluation of therapeutic results, the treatment was carried on for another 6 days. The final evaluation was performed one day after the end of the treatment. As to the effect on vulvovaginal symptoms (itching, burning, erythema, swelling) both preparations showed good results, with a small difference in favour of ciclopiroxolamine. Already after 6 days of treatment a statistically significant relief of these symptoms at the p < 0.001 level for both medications was registered. The effect of ciclopiroxolamine on leucorrhea was also very evident in comparison to miconazole. The mycological negativity index of both groups was satisfactory in the smear examination and sufficient in the cultures. According to clinical evaluation as well as patients' opinion, the global results were very satisfactory (very good and good) in 91.3 % of the cases in the ciclopiroxolamine-group and 87.5 % in the miconazole-group. Tolerance of both preparations was very good and no important side-effects were observed. The authors conclude that ciclopiroxolamine, due to its good efficacy and tolerance, is a reliable option for the treatment of vulvovaginal Candida infections.     

白念珠菌性阴道炎动物模型的构建

目的 构建白念珠菌性阴道炎的小鼠模型。方法 采用ICR雌性小鼠,预先给其皮下注射苯甲酸雌二醇以造成小鼠的假发情,再给予小鼠阴道内注射约5×10⁴个白念珠菌稳态芽生孢子,动态观察其阴道分泌物生成及镜检情况;并进行阴道灌洗液的真菌载量分析以及阴道组织病理观察。结果 与未雌激素化的小鼠比较,雌激素化小鼠阴道灌洗液的真菌载量分析显示自第2天开始可分离出高水平的计数结果并直到接种后21d;阴道组织病理结果发现自第4天至实验结束均可见到阴道粘膜浅层有菌丝生长,并有炎性细胞浸润。结论 此动物模型可以作为一个研究念珠菌性阴道炎发病机制的手段。     

门诊治疗妊娠期外阴阴道假丝酵母菌病的护理干预

目的评价对妊娠期外阴阴道假丝酵母菌病进行护理干预的效果。方法对89例妊娠期外阴阴道假丝酵母菌病症状严重或反复发作的患者实施综合性护理干预措施。结果 95.5%患者治愈,无复发;4.5%患者症状好转;所有患者均未发生先兆流产及早产现象。结论综合性护理干预措施能有效提高妊娠期外阴阴道假丝酵母菌病的治愈率,并降低复发率。     

闭孔动脉跨区供血的长型股薄肌肌皮瓣即时重建癌切除后的女阴阴道缺损

目的探讨女阴阴道癌扩大根治术后即时进行修复再造的方法。方法应用闭孔动脉跨区供血的股薄肌肌皮瓣对女阴阴道癌切除后的缺损进行即时的修复与重建。肌皮瓣的肌肉组织可充填癌切除后的组织缺损,皮肤组织则可修复创面和再造阴道。术中还可对癌切后的创面直接进行放射治疗。结果临床应用4例,其中1例术中进行放疗。全部转移的肌皮瓣均100%成活,切口甲级愈合,再造的外阴及阴道无挛缩,外观酷似正常,性功能如常。结论闭孔动脉跨区供血的长型股薄肌肌皮瓣,不仅具有与传统股薄肌肌皮瓣相同的修复机能,而且由于其蒂部在耻骨闭孔处,故转移弧度更广,更适合会阴癌切除后的修复再造,也不影响术前、术中和术后进行放疗和化疗。     

复发性外阴阴道念珠菌病患者及性伴侣带菌情况分析

目的 研究复发性外阴阴道念珠菌病(RWC)复发相关因素.方法 选择55例RVVC患者及其中45位患者性伴侣,取阴道、肛门、口腔及龟头分泌物分离念珠菌,采用ITS1区单链构型多态性(SSCP)分析和大亚基26S rDNA基因D1/D2区序列分析相结合的方法进行菌种鉴定,应用微卫星CAI位点的SSCP和基因扫描分析相结合的...     

不同方法治疗反复性外阴阴道假丝酵母菌病的疗效观察

目的:观察3种不同方法治疗反复性外阴阴道假丝酵母菌病(RVVC)的疗效。方法:将我院门诊确诊为复性外阴阴道假丝酵母菌病患者420例,随机分为3组:A组采用硝酸咪康唑栓;B组硝酸咪康唑栓加乳酸杆菌活菌制剂;C组硝酸咪康唑栓加重组人干扰素α-2b栓。观察临床疗效及微生物学指标。结果:治疗结束后第7～14天总有效率比较3组间无明显差异(P>0.05)。停药1月随访,微生物学指标各组之间均有显著性差异(P<0.05);2月时,A组与B、C组间有显著性差异(P<0.05);停药后3个月、6个月时,A、B组与C组间有显著性差异(P<0.05)。结论:硝酸咪康唑栓治疗后加用乳酸杆菌活菌制剂比单一用药治疗效果佳。而加用干扰素栓远期病菌清除效果好,可在较长时间内明显降低其复发性。     

未足月胎膜早破患者阴道菌群微生态的分析

目的了解未足月胎膜早破患者阴道微生态的状况,探讨未足月胎膜早破(preterm premature rupture of membranes, PPROM)孕妇阴道微生态评价的临床意义。 方法选取2013年1月至2013年12月在伊犁州友谊医院常规进行产前检查,孕28～36^＋6周PPROM孕妇150例为PPROM组,同孕周正常孕妇150例为对照组,采集两组患者阴道分泌物,革兰染色涂片后进行阴道微生态学评价;计数资料比较采用t检验,计量资料比较采用χ²检验。 结果PPROM组阴道优势菌以革兰阳性球菌为主(34.67%,52/150),与对照组(12.00%,18/150)比较,χ²＝21.54,P<0.01,差异有统计学意义;对照组以革兰阳性杆菌为主(67.33%,101/150),与PPROM组(31.33%,47/150)比较,χ²＝38.89,P<0.01。PPROM组正常菌群密集度(Ⅱ级和Ⅲ级)的比例(63.33%,95/150),与对照组(88.00%,132/150)比较,χ²＝17.28,P<0.01,差异有统计学意义;PPROM组正常菌群多样性(Ⅱ级和Ⅲ级)(60.00%,95/150),与对照组(90.67%,136/150)比较,χ²＝37.96,P<0.01。PPROM组孕妇的细菌性阴道病(BV)、外阴阴道假丝酵母菌病(VVC)、BV＋VVC及菌群失调者的发生率分别为(21.33%,32/150)、(24.00%,36/150)、(13.33%,20/150)、(32.00%,48/150)对照组分别为(10.67%,16/150)、(10.67%,16/150)、(1.33%,2/150)、(20.67%,31/150),两组比较χ²值分别为6.33、9.27、27.33和4.95,P值分别为＝0.01、<0.01、<0.01和<0.05,差异均有统计学意义。PPROM组中无症状者有33.81%,处于微生态失调状态。 结论未足月胎膜早破孕妇阴道微生态改变表现为微生态失调比例升高。     

C. albicans activates cyclooxygenase but not its product prostaglandin E2 in HPV 16-stabilized cells

Objective

The selective induction of cyclooxygenase-2 (COX-2) in human cells by Candida albicans was the first report of its role in infectious disease. This led us to question whether recurrent vulvovaginal candidosis in the cancer patient is involved in the formation of malignant tumors of the genital tract. Our speculation coincided with the patients’ assessments in our hospital, where few cancer patients had a prior history of Candida infection. We wanted to study the contribution of C. albicans to gynecological cancers.

Study design

In the present study, we used the developed vaginal epithelial cells system, having an insertion of HPV 16 viral sequence, as a model system (VK2/E6E7) to investigate the effect of Candida infection on prostaglandin E2 synthesis, which is known to be associated with cancers. We infected VK2/E6E7 cells with wild-type C. albicans and determined its effect on COX-2 and prostaglandin E₂ synthesis, and its alteration in dependence on p53, and we analyzed the ubiquitin-proteasome degradation pathways and the involvement of 14-3-3 protein, which is involved in the modulation of the cell cycle.

Results

Our work using the cellular model indicates that recurrent Candida infection of the genital tract in patients carrying HPV 16 viral infection blocks the proliferation of host cells, PGE2 synthase expression and thus PGE2 production.

Conclusion

We found that Candida infection contributes only to cell cycle arrest and does not by itself contribute actively to the development of cancer, although it is associated with patients diagnosed as having cancer of the genital tract induced by HPV 16 virus.