23181例初诊的妇科门诊妇女阴道微生态分析

Analysis of vaginal microecology in 23181 cases of the gynecological female outpatients

目的分析妇科门诊初诊妇女中阴道炎人群和非阴道炎人群的阴道微生态状况。方法2018年12月至2020年12月就诊于首都医科大学附属北京妇产医院妇科门诊并完成阴道微生态检测的妇女共计30265例,排除反复就诊者后,按照初诊是否有阴道炎症状体征将23181例初诊妇女分为有阴道炎症状体征组(6697例)及无阴道炎症状体征组(16484例),并对两组阴道微生态状况进行对比分析。结果(1)23181例初诊妇女中阴道炎总检出率为34.87%(8083/23181),其中有阴道炎症状体征组阴道炎检出率为46.10%(3087/6697),无阴道炎症状体征组阴道炎检出率为30.31%(4996/16484),近1/3无阴道炎症状体征的妇科门诊妇女存在阴道炎。(2)单纯性阴道炎类型中,有阴道炎症状体征组中外阴阴道假丝酵母菌病(VVC)最多(16.01%,1072/6697)、需氧菌性阴道炎(AV)其次(12.83%,859/6697),与无阴道炎症状体征组比较,差异均有统计学意义(P均<0.001);而细菌性阴道病(BV)、滴虫阴道炎(TV)两组比较无显著差异(P均>0.05)。(3)23181例初诊妇女微生态检测共检出混合性阴道炎2632例,其中各种阴道炎组合比例由高到低依次为:BV+AV、VVC+AV、BV+AV+VVC、AV+TV、AV+TV+BV、BV+VVC。(4)微生态未诊断为阴道炎的15098例妇女的微生态检测结果:正常菌群者(包括菌群正常和菌群正常但功能下降者)14013例(92.81%,14013/15098),菌群异常者429例(2.84%,429/15098),BV中间型者656例(4.34%,656/15098)。结论微生态检测可以一次性诊断多种病原体感染,尤其是对于明确诊断混合性阴道炎以及临床症状不典型阴道炎有重要指导意义。应关注易被忽视的BV和TV等阴道感染。

Objective To analyze the vaginal microecological status of vaginitis population and non-vaginitis population of gynecological female outpatients.Methods A total of 30265 women who visited the gynecological outpatient clinic of Beijing Obstetrics and Gynecology Hospital from December 2018 to December 2020 completed vaginal microecological examination.After removing the follow-up patients,23181 women were divided into group with symptoms and signs of vaginitis(6697 cases)and group without symptoms and signs of vaginitis(16484 cases),according to whether the women with symptoms and signs of vaginitis or not.And the vaginal microecological status of the two groups was compared and analyzed.Results(1)The total detection rate of vaginitis in the initial women was 34.87%(8083/23181),of which 46.10%(3087/6697)in group with symptoms and signs of vaginitis and 30.31%(4996/16484)in group without symptoms and signs of vaginitis,nearly 1/3 of the gynecological outpatients without signs and symptoms of vaginitis had vaginitis.(2)Among the types of simple vaginitis,vulvovaginal candidiasis(VVC)was the most frequent in group with symptoms and signs of vaginitis(16.01%,1072/6697),followed by aerobic vaginitis(AV;12.83%,859/6697),with significant differences compared with group without symptoms and signs of vaginitis(all P<0.001).There were no statistical differences between the two groups of bacterial vaginosis(BV)and trichomonal vaginitis(TV),indicating that BV and TV were more likely to be neglected(all P>0.05).(3)The proportion of various combinations of vaginitis among 2632 cases of mixed vaginitis were,in descending order:BV+AV,VVC+AV,BV+AV+VVC,AV+TV,AV+TV+BV,BV+VVC.(4)Microecological analysis of 15098 cases diagnosed with non-vaginitis had normal flora(including those with normal flora and those with normal flora but decreased function)in 14013 cases(92.81%,14013/15098),abnormal flora in 429 cases(2.84%,429/15098)and the BV intermediate in 656 cases(4.34%,656/15098);this indicated that the vast majority of the microecological tests were normal in the vaginal microbiota of those without vaginitis.Conclusions Microecological examination could diagnose multiple pathogenic infections at once,and is especially important as a guide for the definitive diagnosis of mixed vaginitis and vaginitis with atypical clinical symptoms.Vaginal infections such as BV and TV that are easily overlooked should be concerned.