念珠菌感染性阴道炎菌种分布、敏感性及Th1/Th2细胞因子的临床观察

Clinical observation of the distribution,sensibility and Th1/Th2 cytokines of Candida vaginitis

目的研究念珠菌感染性阴道炎的菌种分布特点、敏感性及Th1/Th2细胞因子变化。方法收集456例疑似念珠菌感染性阴道炎患者的阴道分泌物,培养其真菌标本,分析念珠菌菌种分布情况,通过药敏试验分析念珠菌对抗真菌药物的敏感性。在明确诊断为念珠菌阳性的标本中随机抽取100例作为观察组,另抽取100例体检健康女性作为对照组。检测并比较两组阴道分泌物标本中Th1/Th2细胞因子[干扰素-γ(IFN-γ)、白细胞介素-12(IL-12)、白细胞介素-4(IL-4)、IFN-γ/IL-4]水平。结果456例疑似念珠菌感染性阴道炎患者的阴道分泌物培养出278株念珠菌,占比为60.96%(278/456)。其中白色念珠菌、光滑念珠菌、克柔念珠菌、热带念珠菌及其他念珠菌占比分别为77.70%、8.99%、1.80%、4.32%、7.19%。念珠菌对两性霉素B、5-氟胞嘧啶、伏立康唑、伊曲康唑、氟康唑均具有较高的敏感性,其中对两性霉素B的敏感性最高,均为100.0%;白色念珠菌对各抗真菌药物的敏感性均最高。观察组阴道分泌物中IFN-γ、IL-12、IL-4水平分别为(1.21±0.15)、(1.35±0.12)、(1.36±0.16)×100 pg/ml,明显高于对照组的(0.74±0.11)、(0.67±0.09)、(0.37±0.05)×100 pg/ml,IFN-γ/IL-4(0.97±0.11)明显低于对照组的(2.04±0.25),差异有统计学意义(P<0.05)。结论念珠菌感染性阴道炎以白色念珠菌感染为主,菌种不同对抗菌药物敏感性也各异,所以临床上要通过对菌种的判断合理选择抗生素,防止念珠菌感染性阴道炎患者出现局部免疫功能紊乱现象。

Objective To observe the distribution,sensibility and Th1/Th2 cytokines of Candida vaginitis.Methods The vaginal secretions of 456 patients with suspected Candida vaginitis were collected,their fungal specimens were cultured,the distribution of Candida species was analyzed,and the sensitivity of Candida to antifungal drugs was analyzed by drug sensitivity test.Among the specimens clearly diagnosed as positive for Candida,100 cases were randomly selected as the observation group;100 cases of healthy women were selected as the control group.The levels of Th1/Th2 cytokine[interferon-γ(IFN-γ),interleukin-12(IL-12),interleukin-4(IL-4),and IFN-γ/IL-4]in the vaginal secretion specimens of the two groups were detected and compared.Results The vaginal secretions of 456 patients with suspected Candida vaginitis were cultured with 278 Candida strains,accounting for 60.96%(278/456).Among them,Candida albicans,Candida glabrata,Candida krusei,Candida tropicalis and other Candida accounted for 77.70%,8.99%,1.80%,4.32%and 7.19%respectively.Candida had high sensitivity to amphotericin B,5-fluorocytosine,voriconazole,itraconazole and fluconazole,among which the sensitivity to amphotericin B was the highest,all 100.0%;Candida albicans had the highest sensitivity to each antifungal drug.The levels of IFN-γ,IL-12 and IL-4 in the vaginal secretions of the observation group were(1.21±0.15)×100 pg/ml,(1.35±0.12)×100 pg/ml and(1.36±0.16)×100 pg/ml,which were significantly higher than(0.74±0.11)×100 pg/ml,(0.67±0.09)×100 pg/ml and(0.37±0.05)×100 pg/ml of the control group;the IFN-γ/IL-4(0.97±0.11)in the observation group was significantly lower than(2.04±0.25)in the control group;the differences were statistically significant(P<0.05).Conclusion Candida vaginitis is mainly caused by Candida albicans infection,and different strains have different sensitivity to antibiotics.So it is important to choose antibiotics rationally by judging the strains of bacteria to prevent local immune dysfunction in patients with Candida vaginitis.