多囊卵巢综合征患者生殖道微生态状况研究

Study on the Microecological Status of Reproductive Tract in Patients with Polycystic Ovary Syndrome

目的探讨多囊卵巢综合征(PCOS)患者生殖道微生态的变化情况,为PCOS患者的治疗和预防提供理论依据。方法选取2018年1月~2020年7月江西省妇幼保健院收治的77例PCOS患者作为研究组,依据血清睾酮浓度不同分为正常值组(39例)和高于参考值组(18例),另外选择同期在该院进行健康体检、经腹部B超等检查排除PCOS的健康育龄妇女139例作为对照组;均于月经干净且无性生活3 d以上采集生殖道分泌物送检,比较研究组与对照组、正常值组与高于参考值组生殖道菌群密集度、多样性、乳酸杆菌比例、加德纳菌/普雷沃菌、白细胞、真菌孢子、滴虫、需氧菌性阴道炎(AV)评分、Nugent评分)、pH值和微生态差异。结果研究组AV评分异常率、白细胞异常率、pH值异常率及微生态失衡率高于对照组,乳酸杆菌比例低于对照组,差异有统计学意义(P<0.05);两组生殖道菌群密集度、菌群多样性、阴道加德纳菌/普雷沃菌、真菌、滴虫和Nugengt评分比较,差异无统计学意义(P>0.05);不同血清睾酮值PCOS患者生殖道微生态情况比较,高于参考值组真菌感染率高于正常值组,差异有统计学意义(P<0.05);正常值组与高于参考值组生殖道菌群多样性、菌群密集度、乳酸杆菌比例、阴道加德纳菌/普雷沃菌、滴虫、AV评分、Nugent评分、白细胞异常率、pH值、微生态失衡情况比较,差异无统计学意义(P>0.05)。结论POCS女性生殖道微生态失衡情况较健康女性严重,患阴道炎概率更大,且PCOS患者的高浓度的雄激素与真菌感染具有一定关联。

Objective To investigate the changes in the microecology of the reproductive tract in patients with polycystic ovary syndrome(PCOS),and to provide a theoretical basis for the treatment and prevention of PCOS patients.Methods A total of 77 PCOS patients admitted to Jiangxi Provincial Maternity and Child Health Hospital from January 2018 to July 2020 were selected as the study group.According to the serum testosterone concentration,they were divided into normal group(39 cases)and higher than reference value group(18 cases).In addition,139 healthy women of childbearing age who underwent physical examination in the hospital during the same period and excluded PCOS by abdominal B-ultrasound examination were selected as the control group;Reproductive tract secretions were collected and submitted for examination in both groups during clean menstruation and asexual life for more than 3 d.The study group and the control group,the normal value group and the higher than the reference value group were compared with the concentration,diversity,lactobacillus ratio,Gardnerella/Prevotella,white blood cells,fungal spores,trichomoniasis,aerobic vaginitis(AV)score,Nugent score,pH and microecological differences.Results The abnormal rate of AV score,the abnormal rate of white blood cell,the abnormal rate of pH value and the rate of microecological imbalance in the study group were higher than those of the control group,and the proportion of lactobacilli was lower than that of the control group,the difference was statistically significant(P<0.05);There was no statistically significant difference between the two groups of reproductive tract flora density,flora diversity,Gardnerella vaginalis/Prevotella,fungus,Trichomonas and Nugengt scores(P>0.05);Comparing the reproductive tract microecological status of PCOS patients with different serum testosterone values,the fungal infection rate of the higher than reference value group was higher than that of the normal value group,the difference was statistically significant(P<0.05);Reproductive tract flora diversity,flora density,lactobacillus ratio,Gardnerella vaginalis/Prevotella,Trichomonas,AV score,Nugent score,abnormal white blood cell rate,pH between the normal value group and the higher than reference value group Value and micro-ecological imbalance,the difference was not statistically significant(P>0.05).Conclusion POCS female reproductive tract microecological imbalance is more serious than healthy women,and the probability of suffering from vaginitis is higher.The high concentration of androgens in PCOS patients is related to fungal infection.