女性生殖道乳酸杆菌密度与阴道病分类的相关性

Correlation of lactobacilli and bacterial vaginosis, vulvovaglnal candidiasis and trichomonal vaginitis in female reproductive tract

目的探讨女性生殖道乳酸杆菌和细菌性阴道病(BV)、真菌性阴道病(VVC)及滴虫性阴道病(TV)的相关性。方法选取2016年12月至2017年5月在海南医学院第二附属医院东湖分院门诊就诊患者中BV感染者136例、VVC感染者126例及TV感染者100例作为观察组,体检健康人员130例作为对照组。应用阴道微生态图象诊断系统检测阴道分泌物中细菌种类和密度,干化学检测p H、H2O2、白细胞酶和唾液腺酶,将观察组中的BV、VVC及TV患者和对照组健康者中阴道分必物的乳酸杆菌含量及相关指标进行比较。结果 BV、VVC及TV患者的p H值分别为(4.8±0.3)、(4.4±0.3)和(5.4±0.4),均明显高于对照组的(4.1±0.2),差异均有统计学意义(P<0.05);BV、VVC及TV患者的Nugent评分分别为(7.0±1)分、(3.0±1)分和(4.0±1)分,均显著高于对照组的(0.2±0.1),差异均有显著统计学意义(P<0.01);对照组的H_2O_2阴性率为100%(130/130),BV组为5.3%(8/136),VVC组为18.3%(23/130),TV组为9%(9/100),各观察组患者的H_2O_2阴性率明显低于对照组,差异均有显著统计学意义(P<0.01);观察组患者的乳酸杆菌密度明显低于对照组,阴道加特纳菌/普雷沃菌明显高于对照组,经Ridit分析,差异具有统计学意义(P<0.01)。结论乳酸杆菌的缺失或降低是阴道疾病的重要因素,治疗过程中,乳酸杆菌数量的恢复可作为评估疗效的标准之一。

Objective To evaluate the correlation of lactobacilli with bacterial vaginosis （BV）, vulvovaglnal candidiasis （VVC） and trichomonal vaginitis （TV） in female reproductive tract. Methods Gynecological outpatients in our hospital from December 2016 to May 2017 were enrolled in the study, including 136 BV patients, 126 VVC patients, and 100 TV patients. Besides, 130 healthy subjects for physical examination were selected as the control group. Vaginal microecology diagnostic system was used to detect the bacteria and the density of bacteria in vaginal discharge. Dry chemistry method was used to detect pH, H2O2, leukocyte enzymes and salivary gland enzymes. The levels of lactobacilli in BV patients, VVC patients, TV patients, and the control group were compared. Results The pH values were （4.8 ± 0.3） in BV patients, （4.4±0.3） in VVC patients, and （5.4±0.4） in TV patients, which were significantly higher than （4.1± 0.2） in control group （P〈0.05）. The Nugent scores were （7.0±1） in BV patients, （3.0±1） in VVC patients and （4.0±1） in TV patients, which were significantly higher than （0.2±0.1） in the control group （P〈0.05）. The H2O2 negative rates were 5.3%（8/136） in BV patients, 18.3%（23/130） in VVC patients, and 9%（9/100） in TV patients, which were significantly lower than 100%（130/130） in the control group （P〈0.01）. The density of lactobacillus in BV, VVC, TV patients was sig-nificantly lower than that in the control group, and that of Gardnerella vaginalis/Prevotella intermedius was significantly higher than that of the control group （P〈0.05）. Conclusion Loss or reduction of lactobacillus is an important factor in vaginal diseases during the treatment process, and the recovery of the number of lactobacilli can be used as one of the cri-teria to evaluate the efficacy.