600例健康体检妇女阴道微生态状况分析

目的研究深圳宝安地区健康妇女阴道微生态状况。方法对2011年9月至2012年2月在深圳宝安区人民医院体检中心进行健康体检的600例妇女阴道分泌物进行检测,检测指标包括清洁度、念珠菌、滴虫、阴道酸碱度、唾液酸苷酶、白细胞酯酶、过氧化氢（H2O2）浓度。结果研究对象中阴道微生态正常328例（54．67％）,微生态失调者272例（45．33％）;阴道微生态失调者中,微生态功能检测阳性率及致病菌的检出率均明显大于微生态正常者,差异有统计学意义（P〈0．05）。结论深圳宝安地区健康体检妇女部分患有阴道炎或存在阴道微生态失调或亚失调状态;阴道微生态联合检测法简便、快速、价廉实用,值得推广。     

改良丁字带对妇科阴式手术后阴道微生态的影响

目的探讨改良丁字带对比传统丁字带对妇科阴式手术后患者阴道微生态的影响。方法选择妇科阴式手术患者186例作为研究对象,随机分为两组,观察组93例使用改良丁字带固定,对照组93例使用传统丁字带固定。对比分析两组患者术后阴道微生态,敷料污染,引流管阻塞、脱落,皮肤受损,排尿困难等的发生情况。结果观察组阴道微生态失衡发生率为23.66%,敷料污染发生率为29.03%,引流管阻塞发生率为7.52%,皮肤受损发生率为3.23%,均明显低于对照组,差异具有统计学意义(均P0.05)。结论妇科阴式手术后使用改良丁字带固定能够减少手术患者阴道微生态失衡及相关并发症的发生率,提高患者生活质量。     

女性阴道单纯感染和多重感染的鉴别诊断

目的 调查临安市女性阴道感染类型及其所占比例.方法 采用“白带常规+需氧菌阴道炎/细菌性阴道病联合测定技术”对随机选取的1 000例就诊女性的阴道分泌物进行检测.结果 检出阴道感染患者763例,单纯感染患者257例(占患病人数的33.68％),多重感染506例(占患病人数的66.32％).单纯感染患者中,需氧菌阴道炎(AV)患者115例,细菌性阴道病(BV)患者67例,细胞溶解性阴道病(CV)患者12例,外阴阴道假丝酵母菌病(VVC)患者48例,滴虫性阴道炎(TV)患者15例;多重感染患者中,AV+ BV患者244例,AV+ VVC患者63例,AV+ TV患者18例,BV+ VVC患者162例,BV+ TV患者19例.结论 女性阴道多重感染和AV发病率较高,临床应引起高度重视.     

Development and evaluation of acid-buffering bioadhesive vaginal tablet for mixed vaginal infections

An acid-buffering bioadhesive vaginal tablet was developed for the treatment of genitourinary tract infections. From the bioadhesion experiment and release studies it was found that polycarbophil and sodium carboxymethylcellulose is a good combination for an acid-buffering bioadhesive vaginal tablet. Sodium monocitrate was used as a buffering agent to provide acidic pH (4.4), which is an attribute of a healthy vagina. The effervescent mixture (citric acid and sodium bicarbonate) along with a superdisintegrant (Ac-Di-sol) was used to enhance the swellability of the bioadhesive tablet. The drugs clotrimazole (antifungal) and metronidazole (antiprotozoal as well as an antibacterial) were used in the formulation along with Lactobacillus acidophilus spores to treat mixed vaginal infections. From the ex vivo retention study it was found that the bioadhesive polymers hold the tablet for more than 24 hours inside the vaginal tube. The hardness of the acid-buffering bioadhesive vaginal tablet was optimized, at 4 to 5 kg hardness the swelling was found to be good and the cumulative release profile of the developed tablet was matched with a marketed conventional tablet (Infa-V). The in vitro spreadability of the swelled tablet was comparable to the marketed gel. In the in vitro antimicrobial study it was found that the acid-buffering bioadhesive tablet produces better antimicrobial action than marketed intravaginal drug delivery systems (Infa-V, Candid-V and Canesten 1).     

乳酸菌阴道胶囊辅助治疗对未足月胎膜早破的疗效及对其阴道微生态的影响

目的观察乳酸菌阴道胶囊辅助治疗对未足月胎膜早破的治疗效果,并探讨其对阴道微生态的影响。方法 86例未足月胎膜早破患者采用随机数表分为常规组与研究组,各43例。常规组予以常规治疗,研究组予以乳酸菌阴道胶囊联合常规治疗。比较治疗后两组阴道微生态、胎儿宫内感染率和分娩方式、母体和胎儿不良妊娠结局发生情况。结果治疗后研究组Chao1指数和Shannon指数均高于常规组(均P0.05),治疗后研究组阴道乳杆菌属、双歧杆菌属、优杆菌属相对丰度均高于常规组,表皮葡萄球菌属、假单胞菌属、奈瑟氏菌属、支原体属、加德纳菌属、肠球菌属相对丰度均低于常规组,差异均有统计学意义(均P0.05);研究组胎儿宫内感染率、剖宫产率均低于常规组(均P0.05),研究组自然分娩率高于常规组(P0.05);研究组母体早产、产褥期感染及不良妊娠结局发生率均低于常规组(均P0.05);研究组宫内窘迫及围产儿不良妊娠结局发生率均低于常规组(均P0.05)。结论乳酸菌阴道胶囊辅助治疗未足月胎膜早破相较于常规治疗可改善阴道微生态,还可降低胎儿宫内感染率、剖宫产率,减少母体和围产儿不良妊娠结局的发生。     

Characterization and selection of vaginal Lactobacillus strains for the preparation of vaginal tablets

AIMS: To characterize and select Lactobacillus strains for properties that would make them a good alternative to the use of antibiotics to treat human vaginal infections. METHODS AND RESULTS: Ten Lactobacillus strains belonging to four different Lactobacillus species were analysed for properties relating to mucosal colonization or microbial antagonism (adhesion to human epithelial cells, hydrogen peroxide production, antimicrobial activity towards Gardnerella vaginalis and Candida albicans and coaggregation with pathogens). The involvement of electrostatic interactions and the influence of bacterial metabolic state in the binding of lactobacilli to the cell surface were also studied. Adherence to epithelial cells varied greatly among the Lactobacillus species and among different strains belonging to the same Lactobacillus species. The reduction in surface negative electric charge promoted the binding of several Lactobacillus strains to the cell membrane whereas lyophilization reduced the adhesion capacity of many isolates. The antimicrobial activity of lactobacilli culture supernatant fluids was not directly related to the production of H2O2. CONCLUSIONS: Three strains (Lactobacillus brevis CD2, Lact. salivarius FV2 and Lact. gasseri MB335) showed optimal properties and were, therefore, selected for the preparation of vaginal tablets. The selected strains adhered to epithelial cells displacing vaginal pathogens; they produced high levels of H2O2, coaggregated with pathogens and inhibited the growth of G. vaginalis. SIGNIFICANCE AND IMPACT OF THE STUDY: The dosage formulation developed in this study appears to be a good candidate for the probiotic prophylaxis and treatment of human vaginal infections.     

乳酸菌阴道胶囊对早产患者阴道菌群及分娩结局的影响

目的探讨乳酸菌阴道胶囊对菌群失调早产患者阴道菌群及分娩结局的影响。方法 2018年9月-2019年12月在龙华区人民医院接受治疗及分娩的菌群失调先兆早产患者80例,参照随机数表法分为对照组、研究组各40例。对照组患者接受硝呋太尔制霉素软胶囊治疗,研究组患者接受乳酸菌阴道胶囊治疗6 d。停药1周后,比较两组患者的pH值、乳酸菌菌落数、H_2O_2检出率,记录两组患者分娩结局。结果研究组用药后pH值明显降低(P0.05),研究组和对照组用药后pH值差异有统计学意义(P0.05);治疗后两组病原菌检出率差异无统计学意义(χ~2=0.556,P0.05);阴道乳酸菌菌落1/2面积检出阳性研究组明显增多,差异有统计学意义(χ~2=26.600,P0.05);产H_2O_2阳性率研究组明显高于对照组,差异有统计学意义(χ~2=9.141,P0.05);分娩时对照组复发率高(χ~2=20.093,P0.05);研究组不良妊娠结局发生率低于对照组患者(χ~2=6.263,P0.05)。结论乳酸菌阴道胶囊对菌群失调的早产患者阴道菌群、改善妊娠结局具有一定积极作用。     

Histological studies on the vaginal plate and vaginal epithelium in androgenized rats

Summary The present work is a histological study on the epithelium of the vaginal plate and vagina proper of intact rats, 5–45 days old, and of rats which were injected with 1.5 mg testosterone propionate at the age of 5 days (androgenized) and studied at different ages from 6–45 days. Moreover, the vaginal epithelium in adult androgenized rats was studied.A perforation of the vaginal plate and an external orifice of the vagina was seen in intact rats about 35 days old. The perforation resulted from cornification in scattered, later confluencing, regions in the epithelium of the plate.The androgenized rats developed a precocious vaginal opening at 12 days of age. Also in these animals the perforation of the plate resulted from a cornification in the center of the strongly thickened plate. After a lumen had developed the plate region presented a transitional epithelium. This was transformed into a stratified squamous epithelium at about 35–45 days, that is when the first oestrus occurred in intact controls. In contrast to the strong reaction to testosterone in the epithelium of the vaginal plate no effects could be seen in the vaginal epithelium proper, with the exception of some leucocytic infiltration.The adult androgenized rats had a cornified vaginal epithelium which in two cases showed some leucocytic infiltration. Acknowledgement. This investigation was supported by grants from the Swedish Medical Research Council (no 14X-571-02 and no Y 479) and from the Swedish Cancer Society (no 64164).     

乳杆菌属细菌对宫颈上皮内瘤变患者阴道菌群的影响

目的分析乳杆菌属细菌对宫颈上皮内瘤变(CIN)患者阴道菌群的影响,为该类患者的治疗提供参考。方法选择2019年1月至2020年1月我院收治的CIN患者137例,根据组织学病理结果分为CIN Ⅰ组(84例)和CIN Ⅱ、Ⅲ组(53例)。选择同期100例宫颈检查正常者为对照组。比较各组对象阴道菌群数量。根据患者阴道内乳杆菌数量将患者分为高数量组和低数量组,比较2组患者阴道菌群数量。结果CIN Ⅰ组患者阴道厚壁菌门数量低于CIN Ⅱ、Ⅲ组和对照组,而放线菌门数量高于CIN Ⅱ、Ⅲ组和对照组(均P<0.05)。CIN Ⅱ、Ⅲ组患者阴道乳杆菌属数量高于CIN Ⅰ组和对照组(均P<0.05)。CIN Ⅰ组患者阴道加德纳菌属、奇异菌属数量高于CIN Ⅱ、Ⅲ组和对照组(均P<0.05)。对照组对象阴道菌群Chao、ACE指数均低于CIN Ⅰ组和CIN Ⅱ、Ⅲ组(均P<0.05),同时CIN Ⅱ、Ⅲ组患者阴道菌群Chao、ACE指数均低于CIN Ⅰ组(均P<0.05)。高数量组患者阴道加德纳菌属、奇异菌属占比均低于低数量组(均P<0.05)。结论阴道中乳杆菌属数量的改变易影响阴道菌群,使其抗感染能力下降,增加女性CIN的风险。