不同形态真菌在外阴阴道假丝酵母菌病诊治中的价值探讨

Study on the value of different forms of fungi in the diagnosis and treatment of vulvovaginal candidiasis

目的探讨外阴阴道假丝酵母菌病(VVC)患者仅芽生孢子相和有菌丝相2种形态真菌对临床抗真菌药物的敏感度和阴道微生态指标的差异及其对临床指导用药的价值。方法收集2018年12月至2019年5月首都医科大学附属北京妇产医院妇科门诊确诊的VVC患者418例,根据革兰染色镜检下真菌形态分为仅芽生孢子组107例(25.60%)和有菌丝组311例(74.40%),分析比较两种形态真菌对5种临床常见抗真菌药物(氟康唑、克霉唑、咪康唑、伊曲康唑、制霉菌素)的敏感度,以及两组阴道微生态指标的差异。结果(1)仅芽生孢子组中90.65%为非白假丝酵母菌,而在有菌丝组中,97.11%为白假丝酵母菌。(2)有菌丝组与仅芽生孢子组相比,对氟康唑的敏感度分别为:敏感77.17%vs.23.36%,耐药3.22%vs.43.93%;对克霉唑的敏感度分别为:敏感95.50%vs.42.99%,耐药0.32%vs.15.89%;对咪康唑的敏感度分别为:敏感45.98%vs.85.05%,耐药41.16%vs.5.61%,以上差异均有统计学意义(P<0.001)。对伊曲康唑的敏感度分别为:敏感55.31%vs.48.60%,耐药39.87%vs.48.60%,差异均无统计学意义(P=0.239)。所有患者对制霉菌素均敏感。(3)与仅芽生孢子组相比,有菌丝组的菌群密集度升高,菌群多样性增加,白细胞数目、Nugent评分明显增加,各组差异均有统计学意义(P<0.001)。结论菌丝相和仅芽生孢子相真菌对克霉唑、氟康唑、咪康唑和伊曲康唑敏感度不同。各组阴道微生态指标不同,假菌丝存在时,患者阴道微生态失衡可能更加严重。

Objective To investigate the differences in clinical antifungal drugs sensitivity and vaginal microecologicalindicators between pseudohyphal and budding yeasts in patients with vulvovaginal candidiasis,and to explore its value inguiding clinical medication.MethodsA total of 418 patients with VVC treated in the Gynecological Clinic of BeijingObstetrics and Gynecology Hospital,Capital Medical University,from December 2018 to May 2019 were collected,107 cases in budding yeasts group and 311 cases in pseudohyphal group according to Gram staining microscopy.Thesensitivity of the two morphological fungi to 5 clinical drugs(fluconazole,clotrimazole,miconazole,itraconazole andnystatin)and the differences in the vaginal microecological indicators were analyzed.Results(1)In 107 cases ofbudding yeasts group,90.65%were non-candida albicans,while in 311 cases of pseudohyphal group,97.11%werecandida albicans.(2)Comparing pseudohyphal group with the budding yeasts group,the sensitivity to fluconazole was:sensitive 77.17%vs.23.36%,resistant 3.22%vs.43.93%,and the differences were statistically significant(P<0.001).The sensitivity to clotrimazole was:sensitive 95.50%vs.42.99%,resistant 0.32%vs.15.89%,and the differences werestatistically significant(P<0.001).The sensitivity to miconazole was:sensitive 45.98%vs.85.05%,resistant 41.16%vs.5.61%,and the differences were statistically significant(P<0.001).The sensitivity to itraconazole was:sensitive 55.31%vs.48.60%,resistant 39.87%vs.48.60%,and the differences were not statistically significant(P=0.239).All patients were sensitive to nystatin.(3)Compared with buddingyeasts group,the population concentration,diversity,number of white blood cells and Nugent score ofpseudohyphal group increased significantly,and the differences were statistically significant(P<0.001).ConclusionThe sensitivity of patients with VVC in pseudohyphalphase and budding yeasts phase to metronidazole,fluconazole,miconazole and itraconazole is significantly different,andthere are also significant differences in vaginal microecological indicators between the two groups.