妊娠期外阴阴道假丝酵母菌病阴道乳杆菌的变化

Changes of vaginal lactobacillus in women with vulvovaginal candidiasis during pregnancy

目的探讨妊娠期外阴阴道假丝酵母菌病（VVC）患者与妊娠期健康妇女、非妊娠期VVC患者相比阴道内乳杆菌种类的变化，检测3组中优势菌卷曲乳杆菌产过氧化氢（H2O2）和产酸能力。方法选取妊娠期VVC组和妊娠期健康组各24例，非妊娠期VVC组62例，通过种特异性聚合酶链反应（PCR）法检测阴道分泌物中的乳杆菌分布；比较妊娠期VVC组，妊娠期健康组，非妊娠期VVC组卷曲乳杆菌产H2O2和产酸能力。结果（1）妊娠期VVC组、妊娠期健康组和非妊娠期VVC组阴道内惰性乳杆菌检出率分别为8．3％，62．5％，6．5％，妊娠期VVC组与妊娠期健康组比较，差异有统计学意义；卷曲乳杆菌检出率分别为83．3％，66．7％和79．0％，3组比较，差异无统计学意义；嗜酸乳杆菌检出率分别为50．0％，58．3％和16．1％，妊娠期VVC与非妊娠期VVC比较，差异有统计学意义；（2）妊娠期健康组、妊娠期VVC组和非妊娠期VVC组卷曲乳杆菌产H2O2的量分别为（2．5±0．2）mmol／L，（2．0±0．1）mmol／L和（2．0±0．1）mmol／L，妊娠期健康组卷曲乳杆菌产H2O2功能强于妊娠期VVC组和非孕期VVC组，差异有统计学意义，妊娠期VVC组与非妊娠期VVC组卷曲乳杆菌产H2O2功能比较，差异无统计学意义；（3）妊娠期健康组、妊娠期VVC组和非妊娠期VVC组卷曲乳杆菌产酸能力分别为（7．1×10^-5±3．1×10^-5）mol／L、（5．9×10^-5±2．5×10^-5）mol／L和（4．5×10^-5±2．0×10^-5）mol／L，妊娠期健康组分离的乳杆菌产酸能力强于妊娠期VVC组，妊娠期VVC组分离的乳杆菌产酸能力强于非孕期VVC组，差异均有统计学意义。结论惰性乳杆菌可能是阴道微环境改变的一个标志物；卷曲乳杆菌均为3组女性阴道内优势菌；尽管VVC患者阴道内卷曲乳杆菌检出率无减少，但卷曲乳杆菌的产H2O2和产酸能力下降。

Objective To investigate the distribution and function of lactobacillus in the vaginas of pregnant women with vulvovaginal candidiasis （WC）, healthy pregnant women, and non-pregnant women with WC. Methods Vaginal sampies from 24 pregnant women with VVC, 24 healthy pregnant women, and 62 non-pregnant women with VVC were analyzed using species-specific PCR followed by sequencing. The samples were cultured in Rogosa and MRS media. Lactobacillus crispatus strains from three groups were assessed for hydrogen peroxide （ H2O2 ） and acid production. Results （ 1 ） The rate of lactobacillus iners isolated in the vaginas of pregnant women with VVC, healthy pregnant women, and non-pregnant women was 8.3%, 62.5%, and 6. 5%, respectively. The rate oflactobacillus iners in pregnant women with VVC was significandy lower than that in healthy pregnant women. The most frequent species in the three groups were lactobaciUus crispatus, with a rate of 83. 3%, 66.7%, and 79. 0%, respectively. No statistical difference was observed between any of the two comparisons. The rate of lactobacillus aeidophilus isolated from these three groups was 50. 0%, 58. 3%, and 16. 1%, respectively, with a higher rate in pregnant women with VVC than that in non-pregnant women with VVC; （2） Level of H2 02 generated from lactobacillus crispatus isolated from healthy pregnant women, pregnant women with VVC, and non-pregnant women with VVC was （2. 5 ± 0. 2） mM, （2.0 ± 0. 1 ） mM, and （2. 0 ± 0. 1 ） mM, respectively, with a higher H2O2 level in healthy pregnant women than that in any of the other two groups. Level of acid from lactobacilhts crispatus isolated from the three groups was （7.1 × 10 ^-5 ± 3.1 × 10^ -5 ） mol/L, （5.9 × 10 ^-5 ± 2. 5 × 10^ -5 ） mol/L, and （4. 5 × 10^-5 ±2. 0 × 10^-5） mol/L, respectively, with a higher level in healthy pregnant women than that in pregnant women with VVC, and a higher level in pregnant women with VVC than that in non-pregnant women with VVC. Conclusion Lactobacillus iners seems to be a marker of changes in the vaginal flora. The predominant lactobacillus colonizing in the vaginas of these three groups was lactobacillus crispatus. Levels of H2O2 and the acid produced by lactobacillus crispatus in women with VVC was lower than those in healthy women.