产后6周妇女阴道菌群分布及应用阴道乳杆菌胶囊的效果

Distribution of vaginal flora in the women at six weeks after delivery and the effect of vaginal application of lactobacilli capsule

目的:探讨产后6周妇女阴道菌群分布情况,研究微生物制剂(阴道乳杆菌胶囊)对恢复产后妇女阴道内环境,预防生殖道感染发生的临床意义。方法:收集11 453例产后6周妇女阴道分泌物,采用革兰氏染色法检查,进行Nugent评分,了解产后6周妇女阴道内环境状态及乳酸杆菌和条件致病菌分布情况。结果:11 453例产后6周妇女Nugent评分正常5 216例,临界5 342例,细菌性阴道病535例,阴道假丝酵母菌339例和滴虫21例。11 453例产后6周妇女有6 237例发生阴道炎症,疾病构成比以非特异性阴道炎为主5 342例,特异性阴道炎较为少见。所有产后6周妇女阴道pH值均为5.0以上。在所有涂片中,被认为在维持正常阴道微生态平衡中起关键作用的乳杆菌数量和比例明显不足。300例产后6周阴道分泌物正常妇女阴道内放置乳酸杆菌活菌胶囊,观察1年,结果显示研究组阴道pH明显降低,接近正常女性阴道pH水平(P<0.05);且阴道乳酸杆菌数量明显增多(P<0.05);同时产后3个月、6个月、9个月、12个月阴道炎的发生率均明显低于对照组(P<0.05)。结论:产后6周妇女阴道炎症以非特异性阴道炎为主,细菌性阴道病、真菌性阴道炎和滴虫性阴道炎较少见。乳杆菌胶囊作为生态治疗的活菌制剂,既能预防阴道感染,又无不良反应,还可以减少产后妇女阴道炎的复发率,值得临床推广应用。

Objective： To explore the distribution of vaginal flora in the women at six weeks after delivery, research the clinical significance of microbial agent （lactobacilli capsule） in recovering vaginal internal environment and preventing the onset of genital tract infection for the postpartum women. Methods： The vaginal secretion samples of 11 453 women at six weeks after delivery were collected, Gram staining was used to examine the samples, Nugent score was conducted, the vaginal internal environment and the distributions of lactobacilli and conditional pathogens were understood. Results： Among 11 453 postpartum women, 5 216 women were found with normal Nugent score, and 5 342 women were found with critical Nugent score; 535 women were found with bacterial vaginosis, 339 women were found with vulvovaginal candidiasis （VVC）, and 21 women were found with vaginal trichomoniasis. Among 11 453 postpartum women, 6 237 women were found with the symptoms of vaginal inflammation, non- specific vaginitis （5 342 women） was the major disease, specific vaginitis was un- common. The vaginal pH values of all the postpartum women were more than 5.0. Among all the smears, the number and proportion of lacto- bacilli which were considered to play an important role in maintaining normal vaginal microecosystem balance were deficient. Three hundred women with normal vaginal secretion at six months after delivery were treated with vaginal application of lactobacilli capsule, then they were followed up for one year, the results indicated that vaginal pH value of study group decreased significantly, which approached the vaginal pH value of normal women （P 〈 0. 05） ; the number of lactobacilli increased significantly （P 〈 0. 05） ; the incidences of vaginitis at 3, 6, and 9 months after delivery in study group were significantly lower than those in control group （ P 〈 0. 05 ） . Conclusion： Non - specific vaginitis was the main type of vaginal inflammation among the women at six months after delivery, bacterial vaginosis, fungal vaginosis, and trichomonas vaginitis were uncommon. As a kind of living bacteria agent for ecosystem cure, lactobacilli capsule can prevent vaginal infection and have no adverse reactions, which can reduce the recurrence rate of vaginitis among the postpartum women, and the method is worthy to be popularized in clinic.