下生殖道感染患者阴道局部免疫状态的研究

Study of local innnunity of lower genital tract infections

目的研究下生殖道感染患者阴道局部免疫状态及其与疾病发生的相关性。方法应用酶联免疫吸附试验测定外阴阴道假丝酵母菌病（VVC）60例（VVC组）、细菌性阴道病（BV）60例（BV组）、滴虫性阴道炎（TV）40例（TV组）、宫颈人乳头状瘤病毒（HPV）感染60例（HPV组）、宫颈沙眼衣原体（CT）感染60例（CT组）及各组同期60例正常妇女（对照组）的阴道灌洗液辅助性T淋巴细胞（Th细胞）1、2细胞因子水平，其中Th1细胞因子以白细胞介素（IL）2表示，Th2细胞因子以IL-4、5或IL-13表示，并结合临床资料进行分析。BV、TV组患者同时测定趋化因子——IL-8。所有患者进行人防御素5（HD5）的检测。结果（1）Th1细胞因子：VVC、BV、TV、CT组与各自的对照组IL-2水平比较，差异均无统计学意义（P〉0．05）。HPV组IL-2水平为（96±33）×10^-3pg／L，HPV对照组为（76±36）×10^-3pg／L，两组比较，差异有统计学意义（P〈0．05）。（2）Th2细胞因子：VVC、CT组与各自的对照组IL-4水平比较，差异无统计学意义（P〉0．05）；BV组与BV对照组IL-5水平比较，差异也无统计学意义（P〉0．05）；TV组IL-13水平为（42±15）×10^-3pg／L，TV对照组为（30±29）×10^-3pg／L，两组比较，差异有统计学意义（P〈0．05）；HPV组IL-4水平为（103±28）×10^-3pg／L，HPV对照组为（36±22）×10^-3pg／L，两组比较，差异也有统计学意义（P〈0．05）。（3）趋化因子：TV组IL-8水平为（5．8±2．7）pg／L，TV对照组为（2．6±2．4）pg／L，两组比较，差异有统计学意义（P〈0．05）；BV组与BV对照组IL-8水平比较，差异无统计学意义（P〉0．05）。（4）HD5：VVC、HPV、CT、BV、TV组HD5水平均高于各自对照组，差异均有统计学意义（P〈0．05）。结论（1）阴道上皮的先天免疫因子HD5是下生殖道感染发病过程中的重要因子。（2）IL-13等Th2细胞因子在不同下生殖道感染发病过程中的作用较IL-2可能更为重要。（3）趋化因子IL-8在TV发病过程中可能具有重要的意义。

Objective To investigate the profile of local immunity of vagina and the immune defense mechanisms against lower genital tract infections. Methods Vaginal lavage was collected from healthy women and patients of vulvovaginal candidiasis, bacterial vaginosis, Trichomonol vaginitis, human papilloma virus infection（VVC）, and chlamydia trachomatis infection. Each group included 60 cases. The level of interleukin （IL）2,4, 5, 13,8 and human defensin 5 （HD5） were detected by enzyme linked immunosorbent assay（ELISA）. Results （ 1 ） Cytokine of helper T cell 1 （ Thl ） ： the level of IL-2 between healthy women and VVC/ bacterial vaginosis （BV）/ trichomonol vaginitis （TV）/ chlamydia trachomatis （CT） patients had no significant difference. The IL-2 level（96 ±33 ）× 10^-3 pg/L of human papilloma virus （HPV） infection patients was significantly higher than that of healthy women （ P 〈 0. 05 ）. （2） Cytokine of helper T cell 2 （ Th2 ） ： the level of IL-4 between healthy women and VVC/CT patients had no significant difference. The level of IL-5 between healthy women and BV patients had no significant difference. The IL-13 level（42 ± 15） × 10^-3 pg/L of TV patients was significantly higher than that of healthy women （30 ±29） × 10^-3 pg/L （P 〈 0.05）. The IL-4 level （103 ± 28） × 10^-3 pg/L of HPV infection patients was significantly higher than that of healthy women （ 36 ± 22 ）× 10^-3 pg/L （ P 〈 0.05 ）. （ 3 ） IL-8 ： the IL-8 level （5.8 ± 2.7 ） pg/L of TV infection patients was significantly higher than that of healthy women （ 2.6 ± 2.4） pg/L （ P 〈 0.05 ）. The level of IL-8 between healthy women and BV patients had no significant difference. （4）HD5 ：the HD5 level of TV , BV, VVC, HPV and CT infection patients were significantly higher than that of healthy women （ P 〈 0.05 ）. Conclusions （ 1 ） HD5 plays an important role in the defence of vaginal epithelial cell. （2） Th2 may be more important than Thl in lower genital tract infections. （3） IL-8 plays an important role in extrinsic source infections.