中国汉族育龄女性阴道内乳杆菌的鉴定与系统发育分析

目的比较基质辅助激光解吸电离飞行时间质谱(MALDITOF MS)与16S rRNA基因测序鉴定女性阴道乳杆菌方法,同时探究不同阴道微生态背景的汉族育龄女性阴道内乳杆菌的种类及其分布情况。方法对260例汉族育龄女性阴道拭子进行阴道微生态分析及乳杆菌的分离培养,根据阴道微生态鉴定结果分为正常组(173例)、中间型细菌性阴道病组(IBV,55例)、细菌性阴道病组(BV,9例)和外阴阴道炎假丝酵母菌病组(VVC,23例),分离乳杆菌并进行纯化培养,纯化的乳杆菌经MALDITOF MS和16S rRNA基因测序鉴定并进行聚类分析。结果2种方法鉴定的一致率为95.3%。260例标本中149例(57.3%)检出了乳杆菌,共发现17种乳杆菌,检出的乳杆菌分布于5个乳杆菌系统发育群,其中分离出较多的乳杆菌为卷曲乳杆菌(47例)、加氏乳杆菌(38例)、阴道乳杆菌(21例)。正常组116例(67.1%)标本分离出乳杆菌,IBV组19例(34.5%),BV组2例(22.2%),VVC组12例(52.2%)。正常育龄女性与患BV女性乳杆菌种类与数量差异有统计学意义(χ²=22.936 0,P<0.000 1),与患VVC女性差异无统计学意义(χ²=1.983 0,P=0.160 0)。与其他组相比,正常组育龄女性中分离出卷曲乳杆菌的比例显著高于BV组和VVC组(χ²=4.548 0,P=0.033 0;χ²=5.605 0,P=0.020 0),VVC组育龄女性分离出加氏乳杆菌的比例显著高于正常组(χ²=5.090 0,P=0.035 0)。结论对比16S rRNA基因测序与MALDITOF MS方法的乳杆菌鉴定结果,除了阴道乳杆菌和人阴道乳杆菌出现不一致的鉴定结果,其余15种乳杆菌鉴定结果一致性均为100%,但基于测序与基于质谱的方法产生的乳杆菌聚类分析结果不完全一致。卷曲乳杆菌可能是反映育龄女性正常阴道微生态的重要标志物,加氏乳杆菌可能与女性VVC的发生有关。     

16057例中国北京地区健康妇女阴道菌群的结果分析

目的初步了解中国健康女性阴道菌群的情况。方法选取中国北京地区健康体检妇女16 057例,采集阴道分泌物,进行显微镜检。结果 (1)菌群正常者占75.7%。菌群密集度范围多在++~+++,占99.2%;菌群多样性多在+~++,占81.2%;优势菌均为革兰阳性大杆菌,占100.0%。(2)在健康妇女中仍存在24.3%异常菌群,依次为菌群失调、菌群增殖过度和菌群抑制。结论健康女性阴道菌群表现为多样性,阴道微生态评价有助于筛查无症状的阴道微生态失衡女性,并对临床评价阴道感染时的阴道微生态状况有一定的指导作用。     

妇科门诊育龄妇女与孕妇阴道菌群状态及常规感染的比较分析

目的比较妇科门诊育龄妇女与孕妇的阴道菌群状态及常规感染,分析阴道菌群改变对阴道常规感染影响。方法用革兰染色法分别检查普通育龄妇女和孕妇的阴道分泌物,并进行Nugent评分。结果妇科门诊育龄妇女和孕妇的假丝酵母菌阳性率分别为28．6％和9．2％,滴虫阳性率分别为2．4％和0．6％;细菌性阴道病（BV）阳性率分别为32．4％和9．6％;乳杆菌3＋到4＋的比例分别为74．4％和44．8％。2组之间比较差异均有显著性（P〈0．05）。结论相对于妇科门诊育龄妇女而言,孕妇的阴道微生态状况更健康,对各种病原微生物有更强的抵抗力,受假丝酵母菌、滴虫和细菌性阴道病等常规疾病感染的机会明显降低。     

The complex vaginal flora of West African women with bacterial vaginosis

Background

The spectrum of bacteria associated with bacterial vaginosis (BV) has recently expanded through taxonomic changes and the use of molecular methods. These methods have yet to be used in large-scale epidemiological studies in Africa where BV is highly prevalent.

Methods

An analysis of samples obtained during a clinical trial of the management of vaginal discharge in four West African countries. Samples were available from 1555 participants; 843 (54%) had BV. Nucleic acids of 13 bacterial genera or species potentially associated with BV were detected through the polymerase chain reaction.

Results

The associations between various components of the vaginal flora were complex. Excluding Lactobacillus, the other 12 micro-organisms were all associated with each other at the p≤0.001 level. The prevalence of various bacterial genera or species varied according to age, sexual activity and HIV status. In multivariate analysis, the presence of Gardnerella vaginalis, Bifidobacterium, Megasphaera elsdenii, Dialister, Mycoplasma hominis, Leptotrichia, and Prevotella were independently associated with BV as was the absence of Lactobacillus and Peptoniphilus. However, Mobiluncus, Atopobium vaginae, Anaerococcus, and Eggerthella were not independently associated with BV. Unexpectedly, after treatment with a regimen that included either metronidazole or tinidazole, the proportion of patients with a complete resolution of symptoms by day 14 increased with the number of bacterial genera or species present at enrolment.

Conclusions

Numerous bacterial genera or species were strongly associated with each other in a pattern that suggested a symbiotic relationship. BV cases with a simpler flora were less likely to respond to treatment. Overall, the vaginal flora of West African women with BV was reminiscent of that of their counterparts in industrialized countries.     

惠州地区育龄妇女阴道微生态失衡因素调查

目的 探讨阴道炎患者的阴道微生态状况,为进一步施行干预措施提供依据。方法 选择2017年3月至2018年6月我院5 559名临床诊断为阴道炎的妇女及3001名健康体检妇女为研究对象,采用病例对照研究,采集研究对象下阴道1/3处的白带样本进行阴道微生态检测,判定研究对象的阴道微生态状况。结果 阴道炎患者的阴道微生态失衡状况较健康体检组妇女更严重。本地妇女发生阴道炎的因素为：阴道清洁度为Ⅲ~Ⅳ度（OR=1.64,P<0.001）、阴道出现炎症白细胞（OR=1.14,P=0.003）、阴道检出酵母菌菌丝/孢子（OR=2.02,P<0.001）及阴道菌群乳杆比较低（OR=2.13,P<0.001）。结论 本地区育龄妇女阴道微生态存在失衡状况,下一步需提出合理干预措施,减少阴道微生态失衡的发生。     

葫芦岛地区育龄期女性甲状腺功能指标的调查研究

目的探讨葫芦岛地区育龄期女性甲状腺功能水平与孕前促甲状腺激素(TSH)、抗甲状腺过氧化物酶抗体(TPO-Ab)筛查对优生优育的意义。方法选择葫芦岛市1 540例育龄女性,采用罗氏电化学发光E602检测血清TSH、游离甲状腺素(FT4)、游离三碘甲腺原氨酸(FT3)和TPO-Ab。结果 1 540例育龄妇女中,TSH异常135例,总异常率为8.7%,不同年龄组间TSH的异常率差异有统计学意义(χ2=33.56,P0.05)。TPO-Ab总阳性率为8.2%,TSH正常与异常组间的比较差异有统计学意义(χ2=34.84,P0.05)。进一步分层分析,TSH异常者中,甲亢与甲减组TPO-Ab阳性率的比较组间差异无统计学意义(χ2=0.043,P0.05)。结论葫芦岛地区育龄期女性甲状腺功能异常率较高,应对孕产妇常规进行甲状腺功能检测。     

The reproductive biology of the New Zealand flora

New Zealand's long isolation from other elements of Gondwanaland, oceanic climate, the unusual combination of ancient Gondwanic, tropical and more recently arrived elements in its flora, and its relatively depauperate pollinator and disperser fauna have set the stage for the evolution of a subtle, complex and distinctive reproductive biology. This contrasts markedly with the neighbouring continent of Australia where the fauna is diverse and the flowers vivid. Recent advances in understanding New Zealand's floral biology include evidence that the ancestor to the anthophytes was cosexual, with insect pollinators receiving stigmatic nectar rewards; the discovery of ground-level bat pollination in an obligate root parasite; the finding that the greater resource sensitivity of fruit set in males than in females may account for sex ratio variation in gynodioecious species; and, evidence for much more pronounced mast seeding at higher altitudes even in the absence of mammalian seed predators.     

阴道菌群改变与宫颈癌前病变相关性的初步研究

目的 本实验对130例健康、HPV感染[HPV（+）]及不同级别宫颈病变（CIN）患者阴道菌群进行研究分析,揭示阴道菌群变化与宫颈病变的发生及HPV感染的关系,为阻断宫颈病变的进一步发展提供理论依据。方法 收集2014—2015年大连市妇幼保健院门诊就诊的20~65岁患者130例,依据宫颈HPV检测和阴道镜下宫颈活组织检查病理诊断结果进行分组。采用QIAamp DNA mini和Blood mini试剂盒提取阴道菌群基因组DNA。利用PCR-DGGE技术对患者阴道菌群的变化进行分析,Quantity One软件进行聚类分析及凝胶测序法分析特异条带的种类。上述数据的处理和分析采用SPSS 19.0统计软件。结果 在DGGE图谱中,HPV（+）组阴道菌群丰度高于HPV（－）组。CIN组阴道菌群丰度较HPV（+）组升高。测序结果显示,HPV（－）组与HPV（+）组中3条共有强度较大的条带均属于厚壁菌门,HPV（+）组的特征谱带为阴道加德纳菌（Gardnerella vaginalis）。聚类分析和主成分分析（PCA）显示,HPV（+）组患者发生了菌群失调。结论 乳酸菌为阴道菌群中的优势菌;放线菌是HPV（+）的CIN患者的特殊细菌门,该菌属于阴道加德纳菌;HPV感染可引起阴道菌群稳态失调,且宫颈病变程度越重,阴道菌群失衡情况也相应加重。     

Correlation between levels of selected cytokines in cervico-vaginal fluid of women with abnormal vaginal bacterial flora

The aim of this study was to evaluate the rise of the levels of proinflammatory cytokines - IL-1alpha, IL-1beta, IL-6 and IL-8 in vagina of women with bacterial vaginosis (BV) and if there is any relationship between this levels. One hundred and twenty females between 22nd and 36th week of pregnancy were enrolled in the study. According to the bacterial flora of cervico-vaginal fluid evaluated by Gram stain, all women were divided into three groups. Group I (53 females; 44.2%)--normal bacterial flora, group II (35 females; 29.2%)--intermediate flora, and group with BV (32 females; 26.6%). The level of IL-1b in women with BV was over twelve times higher than in women from I group (131.35 and 10.6 pg/mL respectively). The next was the level of IL-1alpha--about seven times higher (128.45 vs 19.1 pg/mL) and the levels of IL-6 and IL-8, which were 1.7 times higher (16.2 vs 9.7 pg/mL and 656.7 vs 375.3 pg/mL respectively). Except for IL-6 these differences of levels were statistically significant (p<0.05). The levels of IL-1beta in group of women with BV correlated strongly with levels of IL-1alpha (r=0.72; p<0.0001) and weakly with levels of IL-6 (r=0.31; p=0.017). The correlation coefficient between levels of IL-6 and IL-8 rose gradually in II and BV group and reached levels r=0.575; p=0.0014 and r=0.67; p=0.0009 respectively. Our findings show that in vagina of women with BV the levels of proinflammatory cytokines rise, and that the rise of levels is in certain cases correlated.     

更年期妇女三联抗幽门螺杆菌治疗对阴道菌群及阴道炎发病率的影响

目的探讨更年期妇女三联抗幽门螺杆菌(Helicobacter pylori,H.pylori)治疗对阴道菌群及阴道炎发病率的影响。方法选择在衢州市柯城区人民医院就诊感染H.pylori的更年期妇女共68例,所有患者均接受阿莫西林、甲硝唑及奥美拉唑三联抗H.pylori治疗。观察患者治疗前后阴道菌群、阴道sIgA含量及阴道炎发病率的变化。结果患者治疗后阴道菌群以乳酸杆菌为优势菌群的人数少于治疗前[61例vs 52例](χ2=4.24,P0.05);患者治疗后sIgA含量高于治疗前[(427.44±64.28)mg/L vs(244.57±54.78)mg/L,n=68](t=2.43,P0.05);患者治疗后阴道炎发病率高于治疗前(44.12%vs 26.47%,χ2=4.24,P0.05)。结论更年期妇女三联抗H.pylori治疗会导致阴道菌群失调,增加阴道炎的发病率,因此在抗H.pylori治疗的同时应预防阴道菌群失调及阴道炎的发生。     

婴儿肠道双歧杆菌种群多样性分析

使用分子生物学方法,对4例出生时间为17～120h婴儿的肠道双歧杆菌种群多样性进行分析。肠道中剖腹产婴儿在出生17h后,双歧杆菌就已定植;另外,婴儿肠道中双歧杆菌群有短双歧杆（Bifidobacterium breve）和长双歧杆菌（Bifidobacterium longum）,分别占双歧杆菌种群的65％和35％。     

育龄期妇女阴道微生态平衡与宫颈息肉的相关性

观察育龄期妇女阴道微生态平衡与宫颈息肉的相关性, 旨在为宫颈息肉的预防提供参考意见。

回顾性分析广西医科大学附属武鸣医院2019年1月至2020年12月收治89例宫颈息肉患者资料纳入宫颈息肉组; 回顾性分析广西医科大学附属武鸣医院同期91例健康体检育龄期妇女的临床资料纳入对照组。记录2组研究对象阴道微生态指标, 分析育龄期妇女阴道微生态平衡与宫颈息肉的关系, 并检验阴道微生态指标对宫颈息肉发生风险的评估价值。

初步比较宫颈息肉组、对照组研究对象阴道微生态指标后, 经回归分析检验结果显示, 育龄期妇女白细胞酯酶(LE)、唾液酸苷酶(SNA)、乙酰氨基葡萄糖苷酶(NAG)、清洁度、上皮细胞、白细胞、线索细胞、短杆菌及阴道微生态菌群异常与宫颈息肉的发生有关(OR=2.587、4.404、3.164、41.250、3.312、9.796、5.312、6.789、5.372, P=0.002、＜0.001、0.005、＜0.001、＜0.001、＜0.001、0.001、＜0.001、0.033);Kendall′s W相关性分析检验结果显示, 育龄期妇女LE、SNA、NAG、清洁度、上皮细胞、白细胞、线索细胞、短杆菌及阴道微生态菌群异常状况均与宫颈息肉发生呈正相关(r=0.333、0.278、0.316、0.449、0.389、0.424、0.357、0.373、0.331, 均P＜0.001);绘制受试者工作曲线(ROC), 育龄期妇女LE、SNA、NAG、清洁度、上皮细胞、白细胞、线索细胞、短杆菌及阴道微生态菌群异常情况用于评估宫颈息肉发生的曲线下面积(AUC)分别为0.617、0.613、0.586、0.715、0.644、0.686、0.591、0.664和0.566, 其中清洁度对宫颈息肉发生有中等评估价值, AUC＞0.70。

育龄期妇女阴道微生态平衡与宫颈息肉发生密切相关, LE、SNA、NAG、清洁度、上皮细胞、白细胞、线索细胞、短杆菌及阴道微生态菌群异常均与宫颈息肉发生有关, 其中清洁度可用于评估宫颈息肉的发生, 临床可根据患者阴道微生态平衡状况, 制定针对性措施。

     

The reproductive advantages of fat in women

Many hypotheses have been proposed for the evolution of fat deposition in women. Here we examine the empirical basis of the deceptive fat hypothesis. The available evidence suggests that body fat has direct effects on reproduction in women regardless of whether or not it is a signal of condition.