乳杆菌制剂对非特异性阴道炎的治疗及其机制的研究

本文对３２例非特异性阴道炎患者以乳杆菌进行治疗,比较用药前后阴道分泌物ｐＨ及阴道常见的乳杆菌、葡萄球菌、肠杆菌、酵母菌的定量变化,同时观察其临床治疗效果。结果表明：治疗后阴道分泌物ｐＨ明显降低,乳杆菌数量明显增多,葡萄球菌、肠杆菌、酵母菌数量明显减少。治疗后阴道炎的症状、体征明显好转。     

阴道微生态失调与早产相关性研究进展

健康育龄妇女的阴道微生态环境呈现多样性,阴道内微生物菌群以乳杆菌为主。乳杆菌可维持妇女阴道微环境平衡和保持阴道酸性环境以抑制致病性病原体生长。当乳杆菌比例低至致病阈值以下或无乳杆菌存在时,阴道微环境的菌群组成转变成以兼性需氧及厌氧菌为主。越来越多的证据表明,怀孕期间阴道菌群的异常与早产、及因早产和围产期结局不佳导致的潜在新生儿后遗症有关。本文综述了妊娠期阴道菌群的变化、细菌性阴道炎与早产发生风险等方面的问题,目的是帮助临床医生确定怀孕期间有阴道炎症状女性是否可接受治疗,从而降低早产、早产胎膜早破、绒毛膜羊膜炎和母胎传染病的发病率。     

Clinical Trials with Agents Currently Used in the Management of Vaginitis

Results of treatment of 151 cases of vaginitis in patients attending a leukorrhea clinic were studied. The incidence of each type of vaginitis is recorded. Analysis of results of treatment with six compounds currently used in the therapy of vaginitis indicated that acetarsol or pimaricin compounds, with their broader spectra of activity, appeared to be most useful, prior to establishment of a definite diagnosis by means of cultures. Chlordantoin is an effective antifungal agent and is associated with a high percentage of “culture cures”. Resistant cases should be investigated for diabetes mellitus, and many are aided by a low carbohydrate diet. Metronidazole was used only for resistant cases of trichomoniasis, with a cure rate of over 80% when both partners were treated simultaneously. Triple-sulfa vaginal cream was effective in over 80% of patients with nonspecific vaginitis; no cases of resistant bacterial infections were encountered. Dienestrol cream was effective in relieving the symptoms of atrophic vaginitis.     

定君生在预防阴道炎复发中的临床效果

目的评价定君生在预防阴道炎复发中的临床效果。方法将2010年10月至2011年6月四川省人民医院妇科门诊686例阴道炎（细菌性阴道病,假丝酵母菌阴道炎,滴虫性阴道炎）患者随机分为两组,研究组在阴道炎常规治疗后给予定君生巩固治疗;对照组仅给予常规治疗。结果研究组复发率明显低于对照组,差异具有统计学意义（P〈0．01）。结论定君生能调整阴道菌群比例,维持阴道酸碱平衡,从而有效减少阴道炎的复发。     

细菌性阴道病微生态与益生菌

细菌性阴道病(BV)是育龄妇女阴道炎的最常见原因,其特征是栖居在阴道内的乳酸杆菌减少导致阴道菌群平衡失调的复杂变化。用乳酸杆菌替代抗生素是治疗BV的一种有效的治疗措施。乳酸杆菌产生过氧化氢、乳酸、杆菌素能抑制引起BV的细菌生长。多胺在BV的病理机制中有重要作用。本研究拟综述BV患者阴道菌群的变化,免疫防御反应,阴道乳酸杆菌对BV的影响,多胺的意义,益生菌在治疗选择中的作用。     

阴道炎患者乳酸杆菌数量变化与临床的研究

目的探讨阴道炎患者的阴道乳酸杆菌数量的变化,以指导临床治疗。方法用LBS培养基分离乳酸杆菌,观察阴道炎患者乳酸杆菌变化的情况。结果172例阴道炎病例中,乳酸杆菌数量平均数明显减少。结论乳酸杆菌数量的减少、阴道菌群的改变是阴道炎发病的重要原因,重新构建阴道正常菌群是阴道炎治疗的重点。     

31例非特异性阴道炎病人阴道微生物群的研究

本文对31例非特异性阴道炎病人和31例正常人阴道微生物群进行定性、定量分析.结果表明,阴道炎病人的阴道乳杆菌的平均浓度明显低于正常人,而肠杆菌科、葡萄球菌、棒状杆菌、类杆菌属、支原体却明显增多,阴道炎病人未发现特异性病原体,菌群失调可能是其发病因素。乳杆菌为阴道正常优势菌,对改善阴道的微环境,防止条件致病菌引起的内源性感染具有重要的生理作用。     

Protocols for Vaginal Inoculation and Sample Collection in the Experimental Mouse Model of Candida vaginitis

Vulvovaginal candidiasis (VVC), caused by Candida species, is a fungal infection of the lower female genital tract that affects approximately 75% of otherwise healthy women during their reproductive years^18,32-34. Predisposing factors include antibiotic usage, uncontrolled diabetes and disturbance in reproductive hormone levels due to pregnancy, oral contraceptives or hormone replacement therapies^33,34. Recurrent VVC (RVVC), defined as three or more episodes per year, affects a separate 5 to 8% of women with no predisposing factors³³.An experimental mouse model of VVC has been established and used to study the pathogenesis and mucosal host response to Candida^{3,4,11,16,17,19,21,25,37}. This model has also been employed to test potential antifungal therapies in vivo^13,24. The model requires that the animals be maintained in a state of pseudoestrus for optimal Candida colonization/infection^6,14,23. Under such conditions, inoculated animals will have detectable vaginal fungal burden for weeks to months. Past studies show an extremely high parallel between the animal model and human infection relative to immunological and physiological properties^3,16,21. Differences, however, include a lack of Candida as normal vaginal flora and a neutral vaginal pH in the mice.Here, we demonstrate a series of key methods in the mouse vaginitis model that include vaginal inoculation, rapid collection of vaginal specimens, assessment of vaginal fungal burden, and tissue preparations for cellular extraction/isolation. This is followed by representative results for constituents of vaginal lavage fluid, fungal burden, and draining lymph node leukocyte yields. With the use of anesthetics, lavage samples can be collected at multiple time points on the same mice for longitudinal evaluation of infection/colonization. Furthermore, this model requires no immunosuppressive agents to initiate infection, allowing immunological studies under defined host conditions. Finally, the model and each technique introduced here could potentially give rise to use of the methodologies to examine other infectious diseases of the lower female genital tract (bacterial, parasitic, viral) and respective local or systemic host defenses.     

Increased Diversity of Fungal Flora in the Vagina of Patients with Recurrent Vaginal Candidiasis and Allergic Rhinitis

Recurrent vaginal candidiasis (RVC) is considered to be a hypersensitivity disorder that is associated with allergic rhinitis (AR) in immune deficiencies; however, whether or not the composition of the vaginal fungal flora in patients with AR and RVC is altered and if such alterations in patients with AR are associated with the development of RVC remain unclear. In the present study, a cultivation-independent method with the 18S rRNA gene clone library was used to analyze the diversity and composition of the vaginal fungal flora in patients with AR and RVC and to explore the association. Three fungal phyla (Ascomycotae, 22 out of 28; Basidiomycetes, 5 out of 28; and Oomycetes, 1 out of 28) were identified from groups of healthy volunteers, patients with AR, patients with RVC, and patients with RVC complicated by AR, including 28 phylotypes of fungal flora (10, 15, 17, and 21 phylotypes for each group, respectively). The predominant genera of fungi identified in the vagina included Candida, uncultured fungi, and Dothideomycetes. An increased proportion of Candida albicans accompanied with decreased proportions of Saccharomyces cerevisiae and uncultured fungi was observed in patients with AR or RVC (P?<?0.05). Candida glabrata, Eladia saccula, Trichosporon jirovecii, and Phytophthora spp. occurred simultaneously in the three patient groups. The composition of the fungal communities in the four groups was statistically different (P?<?0.001). The vaginal fungal diversity in patients with AR or RVC was significantly higher compared with healthy volunteers (P?<?0.05). The data revealed an increased diversity and varied composition of the vaginal fungal flora in patients with AR and RVC and indicated that disturbed vaginal fungal flora in patients with AR might be correlated with disease progression in patients with RVC.     

阴道乳杆菌胶囊对产后6周妇女特异性阴道炎防治作用的临床探讨

目的探讨微生物制剂（阴道乳杆菌胶囊）对产后6周妇女特异性阴道炎（细菌性阴道病、滴虫性阴道炎、外阴阴道念珠菌病）的防治作用。方法采用前瞻性研究方法。自2009年6月至2011年8月先后收集895例产后6周特异性阴道炎妇女,包括细菌性阴道病535例、外阴阴道念珠菌病339例和滴虫性阴道炎21例,随机分成三组,第一组（n=200）阴道局部用乳杆菌胶囊（定君生）250 mg/d,连用10 d;第二组（n=200）阴道局部用抗菌药（细菌性阴道病或滴虫性阴道炎：甲硝唑栓500 mg/d,外阴阴道念珠菌病：克霉唑栓150 mg/d,连用10 d）;第三组（n=200）阴道局部用抗菌药＋乳杆菌胶囊（细菌性阴道病或滴虫性阴道炎：甲硝唑栓500 mg/d＋定君生250 mg/d,外阴阴道念珠菌病：克霉唑栓150 mg/d＋定君生250mg/d,连用10 d）,三组均于停药1周后复查阴道分泌物以了解疗效,以及产后3、6、9、12个月分别复查阴道分泌物,以了解三组产后1年内阴道pH、乳杆菌数量变化情况及阴道炎复发率情况。结果 600例产后6周特异性阴道炎妇女中,单用定君生治疗组总有效率为76.5%;用甲硝唑栓或克霉唑栓治疗组总有效率为77.5%;两组总疗效比较差异无统计学意义（P〉0.05）。用抗菌药（甲硝唑栓或克霉唑栓）＋定君生治疗组总有效率为95.0%,与前两组比较差异有统计学意义（P〈0.05）。应用定君生治疗两组1年内阴道pH明显降低,阴道乳酸杆菌数量明显增多,以＋＋＋~＋＋＋＋比例为主,且追踪1年阴道炎的发生率均明显降低,与只用抗生素治疗组相比差异有统计学意义（P〈0.05）。结论阴道乳杆菌胶囊（定君生）是治疗特异性阴道炎的有效药物,与传统抗生素相比疗效差异无统计学意义,且定君生联合抗生素治疗特异性阴道炎,疗效更为显著,这不失为一个新的治疗途径。产后6周妇女特异性阴道炎选用微生态制剂（阴道乳?     

Normal vaginal aerobic and anaerobic bacterial flora of the rhesus macaque (Macaca mulatta).

The most common bacterial species isolated from the vaginas of 37 healthy rhesus macaques were Streptococcus viridans, coagulase negative Staphylococcus, Mobiluncus curtisii ss. curtisii, Corynebacterium renale-like organisms, Peptostreptococcus anaerobius, Gardnerella-like organisms, and other Corynebacterium species. The vaginal flora of the rhesus macaque differs from that previously reported for five other primate species. A two-year retrospective review of clinical cases of vaginitis and metritis found Escherichia coli and coagulase positive Staphylococci to be the most common pathogens isolated.     

Aerobic Bacteria Occurring in the Vagina of Bitches with Reproductive Disorders

A retrospective survey was performed of aerobic bacterial species found in the vagina of 203 bitches with genital disorders, e.g. infertility, vaginitis, pyometra and puppy death. Escherichia coli, beta-hemolytic streptococci, Staphylococcus intermedius and Pasteurella multocida were the species most often isolated. From bitches with pyometra E. coli in pure culture was the most frequent isolate. In contrast, the majority of infertile bitches gave rise to mixed cultures, and no specific bacterial species was consistently associated with infertility. Thus, bacterial sampling from infertile bitches was concluded to be of low diagnostic value. Bacterial species isolated from the bitches having vaginitis were present in pure culture in 26.9% of the samples while nonspecific mixed cultures were obtained from 34.6% of the samples from these bitches. E. coli was the most frequently isolated bacterial species from bitches with dead puppies. However, in such cases it is important to relate the vaginal bacterial findings to autopsy findings and the results of bacteriological cultures of the pups.     

Immunoreactive systems in the healing of aseptic and infected wounds in an experiment

Main parameters of systemic immune reactivity were studied in 240 mature Wistar male rats with simulated aseptic and infected surface wounds before surgical intervention, and 1-10, 12 and 15 days after it. It was stated that aseptic wounds were responsible for nonspecific systemic response to the stress, whereas the presence of bacterial flora in the wound inhibited the development of humoral immune response in the presence of T-cell activation thus causing the dysfunction of the immune system and therefore affecting the course of wound progress. The consideration of all factors mentioned permits averting wound purulent complications in postsurgical period.     

Trichomonal vaginitis; the problem of chronic or recurring infection

In general practice and in gynecology, vaginal trichomoniasis is a frequent and troublesome problem. However, the trichomonas vaginalis organism is frequently found in an apparently healthy vagina, indicating that symptoms, recurrences, or exacerbations may depend on local changes in secretions, probably due in part to emotional stress. Therapy must, therefore, include not only the topical use of an effective trichomonacidal drug, but also sympathetic and considerate listening by the physician. The combination of furazolidone and nifuroxime in vaginal suppositories and vaginal insufflation powder was found to be an effective trichomonacidal compound. A total of 56 patients with trichomonal, monilial and nonspecific bacterial vaginitis was treated with this nitrofuran combination with good results. In topical therapy, powders seem more effective, probably because a dry environment is unfavorable to the flagellates. The patient should be instructed to insert two vaginal suppositories daily for the first week, then to decrease the dosage gradually as indicated by the physician after clinical examination and microscopic examination of vaginal secretions each week. Of great importance is the fact that some patients may need long-term maintenance therapy-one or two suppositories weekly-especially if the emotional difficulties appear to be insurmountable.     

TRICHOMONAL VAGINITIS—The Problem of Chronic or Recurring Infection

In general practice and in gynecology, vaginal trichomoniasis is a frequent and troublesome problem. However, the trichomonas vaginalis organism is frequently found in an apparently healthy vagina, indicating that symptoms, recurrences, or exacerbations may depend on local changes in secretions, probably due in part to emotional stress. Therapy must, therefore, include not only the topical use of an effective trichomonacidal drug, but also sympathetic and considerate listening by the physician.The combination of furazolidone and nifuroxime in vaginal suppositories and vaginal insufflation powder was found to be an effective trichomonacidal compound. A total of 56 patients with trichomonal, monilial and nonspecific bacterial vaginitis was treated with this nitrofuran combination with good results.In topical therapy, powders seem more effective, probably because a dry environment is unfavorable to the flagellates. The patient should be instructed to insert two vaginal suppositories daily for the first week, then to decrease the dosage gradually as indicated by the physician after clinical examination and microscopic examination of vaginal secretions each week. Of great importance is the fact that some patients may need long-term maintenance therapy—one or two suppositories weekly—especially if the emotional difficulties appear to be insurmountable.     

Antifungal resistance in yeast vaginitis

The increased number of vaginal yeast infections in the past few years has been a disturbing trend, and the scientific community has been searching for its etiology. Several theories have been put forth to explain the apparent increase. First, the recent widespread availability of low-dosage, azole-based over-the-counter antifungal medications for vaginal yeast infections encourages women to self-diagnose and treat, and women may be misdiagnosing themselves. Their vaginitis may be caused by bacteria, parasites or may be a symptom of another underlying health condition. As a result, they may be unnecessarily and chronically expose themselves to antifungal medications and encourage fungal resistance. Second, medical technology has increased the life span of seriously immune compromised individuals, yet these individuals are frequently plagued by opportunistic fungal infections. Long-term and intense azole-based antifungal treatment has been linked to an increase in resistant Candida and non-Candida species. Thus, the future of limiting antifungal resistance lies in identifying the factors promoting resistance and implementing policies to prevent it.     

细菌性阴道病联合检测技术在阴道感染诊断中的应用

目的探讨细菌性阴道病(BV)联合检测技术在阴道感染诊断中的应用价值。方法取2009年9月至2010年2月至苏州市木渎人民医院妇科门诊就诊的6 500例育龄期妇女阴道分泌物,分别对霉菌、滴虫、清洁度进行生理盐水涂片的检测与过氧化氢、唾液酸苷酶和白细胞酯酶三项联合测定。结果应用湿片镜检发现霉菌性阴道炎1 274例,阳性率为19.6%,滴虫性阴道炎195例,阳性率为3.0%。应用BV三项联合技术测定6 500例患者的阴道分泌物,BV阳性1 612例,阳性率为24.8%,其中BV合并霉菌性阴道炎感染465例,占BV发病的28.9%,BV合并滴虫感染79例,占BV发病的4.9%。结论三项联合检测技术操作简单、快速、准确,从功能学分别反映阴道正常菌和致病菌的指标,可与白带常规镜检互补,建议作为阴道分泌物常规检查对阴道感染进行筛查。     

Partial suppression of cell mediated immunity in chromoblastomycosis

The cellular immune response of 8 patients from the Brazilian Amazon region with chromoblastomycosis was analyzed. Primary immunological responses of patients were tested by contact sensitization to 2,4-dinitro-chlorobenzene (DNCB), or rejection of first set skin allografts. 2 of 8 patients were reactive to DNCB after sensitization, and skin allograft rejection occured in an average of 14 days. Capacity of patients to mount recall immunological responses was measured by skin testing with two fungal antigens and three bacterial antigens. Delayed skin reaction to trichophytin and Candida antigens was negative in the majority of the patients. However, reactivity to mycobacterial (tuberculin), and bacterial (staphylococcal, streptococcal) antigen was high, or only slightly diminished respectively. The data suggest that patients with chromoblastomycosis have suppressed nonspecific, cell mediated immunity for some antigens (skin allografts, DNCB, fungal antigens), while reactivity to bacterial and mycobacterial antigens is not impaired.     

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。