细胞溶解性阴道病的临床特征及其与外阴假丝酵母菌病的鉴别要点

Clinical features of cytolytic vaginosis and differential diagnosis of vulvovaginal candidiasis

目的 探讨细胞溶解性阴道病（CV）的临床特征及其与外阴假丝酵母菌病（VVC）的鉴别要点,为CV的正确诊断提供依据.方法 对2012年1月～2013年1月因阴道炎反复发作而就诊于我院阴道感染科的患者进行查体及阴道分泌物检查,确诊病因,记录CV、VVC等确诊例数并统计构成比.分析CV患者的年龄分布、CV发病时患者所处的生理周期阶段,比较CV与VVC的临床表现、阴道分泌物检查结果.结果 在249例反复发作性阴道炎患者中共发现单纯感染238例,其中VVC、CV分别占37.4％、26.9％.64例CV患者中,76.5％的患者集中于25 ～ 30岁和31 ～ 35岁年龄段.CV发病时患者处于排卵期及黄体前期共45例,占CV患者的70.3％.CV患者灼烧感、外阴痛、性交痛的发生率高于VVC患者（P＜0.05）,外阴红肿发生率低于VVC患者（P＜0.01）,阴道分泌物呈乳状的发生率高于VVC患者（P＜0.01）,阴道pH值＜4.0的发生率高于VVC患者（P＜0.01）.结论 CV是阴道炎反复发作的主要病因之一.CV的发病可能与雌激素分泌有关.临床症状、阴道内pH值、分泌物性状有助于鉴别CV与VVC.

Objective To investigate the clinical significance of cytolytic vaginosis （CV） and analyze its clinical features in repetitive vaginitis and differential diagnosis of vulvovaginal candidiasis （VVC）,and therefore to provide the basis for the diagnosis.Methods A total of 249 patients with repetitive vaginitis treated at outpatient of Tianjin Central Obstetrics and Gynecology Hospital from January 2012 to January 2013 were selected.The symptoms,signs and vaginal discharge examination were investigated for making definite diagnosis.The clinical characteristics of CV were analyzed.The statistical ratio of CV and VVC was recorded.Results Among 249 patients,238 cases （95.6％） of single infection and 11 cases （4.4％） of mixed infections were founded.There were 89 cases （37.4％） with VVC,64 cases （26.9％） with CV in the single infection cases.Among 64 cases of patients with CV,76.4％ was in 25-30 and 31-35 years old.CV patients who were in the period of ovulation and luteal stages were 45 cases,accounting for 70.3 ％ of the total.Compared with patients with VVC,the patients with CV had more burning sensation,more severe vaginal,fewer vaginal discharge and lower pH value （P ＜ 0.05）.The incidence of vulvar swelling in patients with CV was lower than that in patients with VVC （P ＜0.01）,and the incidence that vaginal secretions was milky was higher than that of patients with VVC （P ＜0.01） as well as the incident of vaginal pH ＜ 4 Value （P ＜ 0.01）.Conclusions CV is one of the main causes of recurrent vaginitis.CV may be associated with the secretion of estrogen.The clinical symptoms,vaginal secretion and pH value are helpful to differentiate CV and VVC.