需氧菌阴道炎、细菌性阴道病阴道菌群分析

用阴道分泌物直接涂片、革兰染色、选择性培养分离和细菌预成酶谱分析等微生物学方法和生物化学方法,分析了正常女性、AV、BV患者的阴道菌群。正常女性阴道中以乳酸杆菌为主,产H2O2乳酸杆菌的检出率89%,AV的致病菌主要是革兰阳性率需氧菌、检出率可达80%,其中金黄色葡萄球菌,粪肠球菌和埃希氏大肠菌较为常见,B族链球菌的检出率较低;BV的致病菌主要是厌氧菌,以革兰阴性厌氧菌的检出率最高,加德纳菌的检出率不足40%。48例BV患者中有8例合并AV感染,31例AV患者中有6例合并BV感染。细菌谱分析发现,AV患者易感染消化链球菌、普雷沃菌等厌氧菌和加德纳菌,BV患者易感染粪肠球菌、大肠埃希菌等需氧菌。     

细菌性阴道病的病因及其诊断

1　引言细菌性阴道病 (ｂａｃｔｅｒｉａｌｖａｇｉｎｏｓｉｓ,ＢＶ)是阴道微生态环境内菌群与分泌物生化性质变化引起的常见阴道疾病 ,表现为正常阴道乳酸杆菌数量减少而代之以阴道加特纳菌等兼性厌氧、厌氧菌数量增加并伴随分泌物ｐＨ值升高等重要生化成分变化的临床症候群。在 1892～ 1989年间 ,因对ＢＶ认识上的局限性而报道过不同的名称 ,如非特异性阴道炎、嗜血杆菌阴道炎、加特纳阴道炎、厌氧性阴道炎、厌氧性阴道病、阴道细菌病 (ｖａｇｉｎａｌｂａｃｔｅｒｉｏｓｉｓ) [1,2 ] ,但 1984年瑞典专题国际会议正式命名的“细菌性阴道病…     

细菌性阴道病的诊断和治疗

细菌性阴道病 (bacterial vaginosis,BV)是世界范围内常见的一种阴道疾病 ,该病与许多严重的妇产科并发症有直接联系 ,许多并发症可通过明确诊断并正确治疗 BV而得到了预防 [1 ,2 ]。本文就 BV诊断和治疗技术的研究进展作一综述。1　 BV的诊断BV是阴道微生态环境内菌群与分泌物生化性质变化引起的疾病 ,表现为正常阴道乳酸杆菌减少而代之以阴道加特纳菌、普雷沃菌、动弯杆菌、人型支原体等兼性厌氧、厌氧菌数量增加并伴随分泌物 p H值升高等重要生化成份变化的临床症候群。单一种微生物的定性培养结果并不能作为 BV诊断的准确依据。 1…     

联合用药治疗细菌性阴道病

根据细菌性阴道病的特点,可以选择用微生物类药品联合硝基咪唑类药品治疗细菌性阴道病（BV）,主要是为了寻找一种疗效好且不易复发的方法。药敏试验发现,定君生（乳杆菌活菌胶囊,一种微生物类药）对甲硝唑（硝基咪唑类药）极不敏感,两者可以联合用药。近一年来,通过对门诊50例细菌性阴道病患者的联合用药治疗,取得了满意的效果,可以达到这一要求。     

阴道加德纳菌生物型与细菌性阴道病的关系

对１２０例细菌性阴道病患者和９０例正常对照组进行阴道加德纳菌的分离鉴定,同时采用Ｐｉｏｔ分型法对分离出的９３株Ｇｖ进行生物分型,结果显示ＢＶ患者Ｇｖ的检出率（５９．２％）明显高于正常对照组（２４．４％）,Ｐ〈０．０１。９３株Ｇｖ中,８个生物型全检测到,其中１型２３．７％,２型１８．３％,４型３２．３％,６型１０．８％,３型和５型均为５．４％,７型和８型为２．２％。ＢＶ患者主要为１、２、４型,显著高于正常对照组（８７．３％和３１．８％,Ｐ〈０．０１）。     

细菌性阴道病发生的危险因素分析

目的了解平素的生活及卫生习惯对生育年龄女性细菌性阴道病发生的影响,寻找引起该年龄段女性细菌性阴道病发生的危险因素。方法选取2014年7月至2014年9月北京大学第一医院妇产科门诊就诊需要进行阴道微生态检查的生育年龄非妊娠期既往无阴道炎病史的细菌性阴道病270例患者及同期进行阴道微生态检查正常的660例患者进行问卷调查,调查结果进行细菌性阴道病发生的危险因素分析。结果性生活次数的增加、阴道冲洗、经期不清洗外阴、男性性生活前不清洗外阴、不使用避孕套避孕是细菌性阴道病发生的危险因素,两组之间相比差异有统计学意义,P0.05。结论平素不良的生活及卫生习惯与生育年龄女性细菌性阴道病的发生有关,对平素的生活及卫生习惯的健康教育有可能会降低该病的发病率。     

细菌性阴道病临床及实验室诊断方法

目的 细菌性阴道病(BV)是我国女性常见的下生殖道感染,BV患者约有50％无症状,有症状者多诉分泌物增多、有鱼腥臭味,阴道瘙痒、灼热等症,镜检可发现线索细胞,胺试验阳性.若得不到及时正确的诊治,极易引发不孕不育、子宫内膜炎、早产、流产,以及盆腔炎、宫颈炎等上生殖道感染,因此受到越来越多临床医生的关注.本研究对临床上细菌性阴道病常用的镜检法、培养法、生化法等诊断方法进行综述,为临床医生选择合理的检测方法提供参考.     

650例疑似细菌性阴道病BV患者阴道分泌物检测分析

目的探讨生化检测法在细菌性阴道病（BV）诊断中的应用价值。方法对绍兴市人民医院妇科门诊650例阴道分泌物进行常规及生化检测。结果在650例疑似细菌性阴道病患者中,以“唾液酸苷酶阳性＋过氧化氢阳性”为诊断标准,共检出BV患者483例（占总数的74．31％）;使用Amsel法检出细菌性阴道病患者481例（占总数的74％）。使用生化检测法和Amsel法检出细菌性阴道病的阳性率差异无统计学意义（x2=0．53,P〉O．05）,二者的符合率为94．15％（612／650）,具有很高的一致性。结论生化检测准确、快速,具有较高的临床应用价值。     

细菌性阴道病及其合并盆腔炎患者的阴道菌群分析

目的 对比细菌性阴道病及其合并盆腔炎患者与健康个体的阴道菌群,分析阴道菌群的结构,为确定该疾病的特征细菌及研究致病机制奠定基础。方法 采用临床Amsel标准筛选的17例细菌性阴道病患者、13例细菌性阴道病合并盆腔炎患者和52例健康者,使用无菌拭子采集阴道后穹窿分泌物以提取细菌基因组DNA。采用PCR技术扩增上一步得到的16S rRNA片段,而后将扩增产物通过变形梯度凝胶电泳（DGGE）分离以得到阴道细菌种属结构图谱,应用Quantity One软件进行聚类分析,应用凝胶测序法进行特异条带分析。检测16S rRNA基因,具体研究样品中的物种分类。结果 细菌性阴道病及其合并盆腔炎患者的阴道菌群的构成与健康者相比较具有显著性差异。其中,Firmicutes等菌门细菌减少,Actinobacteria等菌门细菌增多;G. vaginallis、P. vaginallis等厌氧菌数量均增加,L.crispatus、L.iners等益生菌数量均有减少。结论 细菌性阴道病及其合并盆腔炎患者的生殖道内的合并感染改变了阴道内的原有微生态平衡。两组疾病组患者的阴道菌群构成相比于健康对照组变化明显。     

喀什地区维吾尔族和汉族丙肝实验室检查的对比分析

目的:探讨喀什地区维吾尔族和汉族丙肝患者的实验室检查特征,为临床诊断治疗提供依据.方法:对424例丙肝患者血清采用酶联免疫吸附法检测抗-HCV,荧光定量聚合酶链反应法检测丙肝RNA,采用电化学发光法检测FER、CA125、CA199,采用酶法检测GGT,ALT,AST.结果:维吾尔族丙肝患者HCVRNA的阳性率65.25％明显高于汉族患者54.26％,且维吾尔族丙肝患者血清FER(476.35± 120.50)和GGT(71.22± 21.84)水平均高于汉族患者FER(333.44-105.71)、GGT(55.63± 15.16),差异均有统计学意义(P＜0.05).但两民族患者间抗-HCV阳性率、CAl25、CA199、ALT、AST水平无统计学差异(P＞0.05).结论:喀什地区维吾尔族和汉族丙肝患者不同,维吾尔族丙肝患者HCVRNA阳性率、FER、GGT水平均高于汉族患者,本研究提示维吾尔族丙肝患者可能肝细胞损害较重,更易发展为肝癌,临床应加以重视.     

乌鲁木齐市维吾尔、汉、哈萨克族人群NA等位基因频率调查分析

目的：通过中性粒细胞抗原（NA）等位基因的频率调查,了解乌鲁木齐地区（乌市）健康、无血缘关系的维吾尔族、汉族、哈萨克族人群NA基因的多态性,为NA相关的输血性疾病建立可靠的基因诊断技术。方法：优化并建立了多重PCR—SSP法,对乌鲁木齐市健康、无血缘关系的维吾尔族120名,汉族118名,哈萨克族102名进行中性粒细胞抗原（NA）的NA1和NA2等位基因频率的调查。结果：维吾尔族NA基因频率（NA10．383,NA20．617）,汉族、哈萨克族NA基因频率（NA1分别为0．555、0．510;NA2基因频率为0．445、0．490）。结论：多重PCR—SSP法分析NA基因等位基因频率结果较为可靠,重复性良好,方法操作简单。     

Prevalence of Bacterial Vaginosis in Women Attending Family Planning Clinics

Prevalence of bacterial vaginosis in 242 women attending family planning clinics in Concepción, Chile was studied using the Nugent criteria. The syndrome was present in 33.1% of women. No statistical difference was found between the occurrence of bacterial vaginosis and the of oral contraceptives (31.9%) or intrauterine devices (33.1%). The sensitivity and specificity of the Nugent criteria compared with the Amsel criteria were 86.7% and 91.0%, respectively. Vaginal fluid pH and appearance had low specificity in this population. Microorganisms associated with bacterial vaginosis were Gardnerella vaginalis (96.3%), Prevotella/Porphyromonas (70%),Mobiluncus spp. (48.8%), Mycoplasma hominis (21.3%) and Ureaplasma urelyticum 21.3). These results suggest that preventive actions and management of clinical infection to prevent complications are needed.     

健康妇女及3例细菌性阴道病患者阴道菌群的非培养分析

根据Amsel标准及Nugent标准, 确诊筛选健康妇女及细菌性阴道病(bacterial vaginosis, BV)患者各3例。提取其阴道分泌物样本的总DNA, 构建16S rRNA基因克隆文库, 并对阳性克隆进行ARDRA和测序分析。结果表明, 健康妇女样本的基因文库中, 分别以卷曲乳酸杆菌(L. crispatus)和惰性乳酸杆菌(L. iners)的克隆子占较大比例, 另外存在少量的阴道乳酸杆菌(L. vaginalis)或詹氏乳酸杆菌(L. jensenii)的克隆子。BV患者样本的基因文库中, 克隆子所代表的菌种类型明显增多, 但均以阴道加德纳氏菌(Gardnerella vaginalis)和阴道阿托波氏菌(Atopobium vaginae)的克隆子占较大比例, 且无乳酸杆菌克隆子。说明健康妇女阴道菌群的种类单一, 以乳酸杆菌占优势, L. iners为优势菌种之一; BV患者阴道菌群的种类复杂多样, 但均以Gardnerella vaginalis及Atopobium vaginae共同占优势。     

健康妇女及3例细菌性阴道病患者阴道菌群的非培养分析

根据Amsel标准及Nugent标准,确诊筛选健康妇女及细菌性阴道病(bacterial vaginosis,BV)患者各3例.提取其阴道分泌物样本的总DNA,构建16S rRNA基因克隆文库,并对阳性克隆进行ARDRA和测序分析.结果表明,健康妇女样本的基因文库中,分别以卷曲乳酸杆菌(L.crispatus)和惰性乳酸杆菌(L. iners)的克隆子占较大比例,另外存在少量的阴道乳酸杆菌(L.vaginalis)或詹氏乳酸杆菌(L.jensenii)的克隆子.BV患者样本的基因文库中,克隆子所代表的菌种类型明显增多,但均以阴道加德纳氏菌(Gardnerella vaginalis)和阴道阿托波氏菌(Atopobium vaginae)的克隆子占较大比例,且无乳酸杆菌克隆子.说明健康妇女阴道菌群的种类单一,以乳酸杆菌占优势,L. iners为优势菌种之一;BV患者阴道菌群的种类复杂多样,但均以Gardnerella vaginalis及Atopobium vaginae共同占优势.     

Associations between Vaginal Pathogenic Community and Bacterial Vaginosis in Chinese Reproductive-Age Women

Background

Bacterial vaginosis (BV) is one of the most common urogenital infections among women of reproductive age that represents shifts in microbiota from Lactobacillus spp. to diverse anaerobes. The aim of our study was to evalute the diagnostic values of Gardnerella, Atopobium, Eggerthella, Megasphaera typeI, Leptotrichia/Sneathia and Prevotella, defined as a vaginal pathogenic community for BV and their associations with vaginal pH and Nugent scores.

Methods and Findings

We investigated the vaginal pathogenic bacteria and Lactobacillus spp. with species-specific real-time quantitative PCR (qPCR) in 50 BV-positive and 50 BV-negative Chinese women of reproductive age. Relative to BV-negative subjects, a siginificant decline in Lactobacillus and an obvious increase in bacteria in the vaginal pathogenic community were observed in BV-postive subjects (P<0.05). With the exception of Megasphaera typeI, other vaginal pathogenic bacteria were highly predictable for BV with a better sensitivity and specificity. The vaginal pathogenic community was positively associated with vaginal pH and Nugent scores, while Lactobacillus spp., such as L. iners and L. crispatus was negatively associated with them (P<0.05).

Conclusions

Our data implied that the prevalance of vaginal pathogenic bacteria as well as the depletion of Lactobacillus was highly accurate for BV diagnosis. Vaginal microbiota shifts, especially the overgrowth of the vaginal pathogenic community, showed well diagnostic values in predicting BV. Postive correlations between those vaginal pathogenic bacteria and vaginal pH, Nugent score indicated the vaginal pathogenic community rather than a single vaginal microorganism, was participated in the onset of BV directly.     

Factors Associated with Bacterial Vaginosis among Women Who Have Sex with Women: A Systematic Review

Background

Women who have sex with women (WSW) have a higher burden of bacterial vaginosis (BV) than heterosexual women; studies of risk factors specific to this population are limited. We summarised current knowledge regarding risk factors for BV among WSW by systematic review.

Methods

This systematic review was conducted according to the PRISMA statement. PUBMED, EMBASE, Web of Science and The Cochrane Library were searched to 31^st December, 2014. Inclusion criteria: 1) WSW included in the study population; 2) accepted BV diagnostic method; 3) investigated or could extrapolate factors(s) associated with BV acquisition, persistence or transmission in WSW specifically by comparing BV positive to BV negative women. Search was limited to English-language publications.

Results

A limited number of studies have investigated BV in WSW. Of 71 unique references, 18 full-text articles were assessed and 14 studies fulfilled inclusion criteria. BV was positively associated with higher numbers of female partners, both lifetime and in the three months prior to diagnosis, and confirmed BV in a female partner, but inconsistently associated with partners’ BV history or symptoms. BV was not associated with ethnicity, vaginal douching or hormonal contraception. The impact of specific sexual activities, male sexual contact, smoking and the menstrual cycle varied considerably between study populations.

Conclusion

BV in WSW is associated with increased numbers of recent and past female partners and confirmed BV in a female partner. There are limited studies of BV in WSW populations, and research is needed to further elucidate risk factors for BV among WSW. However these data provide epidemiological evidence that BV risk in women is directly related to exposure to other female partners and a partner with BV, providing support for the concept that BV is likely to be transmitted between women.

Systematic Review Registration Number

CRD42014009536 (PROSPERO)     

Risks for Acquisition of Bacterial Vaginosis Among Women Who Report Sex with Women: A Cohort Study

Background

Bacterial vaginosis (BV) is common in women who have sex with women. While cross-sectional data support a role for sexual transmission, risks for incident BV have not been prospectively studied in this group.

Methodology/Principal Findings

We studied risks for BV acquisition in a prospective cohort study of women (age 16–35 years) who reported sex with other women (≥1 partner, prior year). Women were followed for one year with examinations at quarterly visits and for genital symptoms at any time. Species-specific 16S rRNA gene PCRs for BV-associated bacteria (BVAB) were applied to vaginal fluid obtained at enrollment. Sexual behaviors were ascertained by computer-assisted interview. Of 335 participants, 239 had no BV at baseline; 199 were seen in follow-up (median follow-up 355 days, 4.0 visits/subject). Forty women experienced ≥1 BV episode. Risks for incident BV were presentation ≤14 days since onset of menses (hazard ratio (HR) 2.3 (95% CI, 1.2–4.7), report of new sex partner with BV history (HR 3.63 (1.1–11.9)), change in vaginal discharge (HR 2.6 (1.3–5.2)) and detection of any of several BVAB in vaginal fluid at enrollment, including BVAB1 (HR 6.3 (1.4–28.1)), BVAB2 (HR 18.2 (6.4–51.8)), BVAB3 (HR 12.6 (2.7–58.4)), G. vaginalis (HR 3.9 (1.5–10.4)), Atopobium vaginae (HR 4.2 (1.9–9.3)), Leptotrichia spp (9.3 (3.0–24.4)), and Megasphaera-1 (HR 11.5 (5.0–26.6)). Detection of Lactobacillus crispatus at enrollment conferred reduced risk for subsequent BV (HR 0.18 (0.08–0.4)). Detailed analysis of behavioral data suggested a direct dose-response relationship with increasing number of episodes of receptive oral-vulvovaginal sex (HR 1.02 (95% CI, 1.00–1.04).

Conclusions/Significance

Vaginal detection of several BVAB in BV-negative women predicted subsequent BV, suggesting that changes in vaginal microbiota precede BV by weeks or months. BV acquisition was associated with report of new partner with BV; associations with sexual practices – specifically, receptive oral sex – require further investigation.     

新疆克拉玛依市维吾尔族和汉族成年人体部体质特征

为探讨新疆克拉玛依市维吾尔族与汉族成年人体部体质特征。采用整群分层随机抽样原则,按照《国民体质测试指导站各指标的测试方法及判断标准》规定的方法,测量并获得新疆克拉玛依市维吾尔族、汉族20~59岁共4108个成年人的有效样本,并按Martin法对所测体部项目进行体质特征研究。新疆克拉玛依市维吾尔族:除肩型男性为中肩型、女性为窄肩型外,男女均为超中等身材、宽胸型、宽骨盆型、窄手型、矮胖型。新疆克拉玛依市汉族:除身材分型男性为高型、女性为超中等身材外,男女均为宽胸型、窄肩型、宽骨盆型、窄手型、中间胖瘦型。维吾尔族与汉族之间体质特征总体水平差异具有统计学意义(p<0.01),且差异主要存在于维吾尔族与汉族女性之间。克拉玛依市维吾尔族和汉族成年人体质特征均具有北方人群的体质特征。     

Prevalence and Correlates of Bacterial Vaginosis in Different Sub-Populations of Women in Sub-Saharan Africa: A Cross-Sectional Study

Background

Clinical development of vaginally applied products aimed at reducing the transmission of HIV and other sexually transmitted infections, has highlighted the need for a better characterisation of the vaginal environment. We set out to characterise the vaginal environment in women in different settings in sub-Saharan Africa.

Methods

A longitudinal study was conducted in Kenya, Rwanda and South-Africa. Women were recruited into pre-defined study groups including adult, non-pregnant, HIV-negative women; pregnant women; adolescent girls; HIV-negative women engaging in vaginal practices; female sex workers; and HIV-positive women. Consenting women were interviewed and underwent a pelvic exam. Samples of vaginal fluid and a blood sample were taken and tested for bacterial vaginosis (BV), HIV and other reproductive tract infections (RTIs). This paper presents the cross-sectional analyses of BV Nugent scores and RTI prevalence and correlates at the screening and the enrolment visit.

Results

At the screening visit 38% of women had BV defined as a Nugent score of 7–10, and 64% had more than one RTI (N. gonorrhoea, C. trachomatis, T. vaginalis, syphilis) and/or Candida. At screening the likelihood of BV was lower in women using progestin-only contraception and higher in women with more than one RTI. At enrolment, BV scores were significantly associated with the presence of prostate specific antigen (PSA) in the vaginal fluid and with being a self-acknowledged sex worker. Further, sex workers were more likely to have incident BV by Nugent score at enrolment.

Conclusions

Our study confirmed some of the correlates of BV that have been previously reported but the most salient finding was the association between BV and the presence of PSA in the vaginal fluid which is suggestive of recent unprotected sexual intercourse.