细菌性阴道病的临床和阴道微生态特征研究
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摘要
目的
细菌性阴道病(BV)是育龄女性最常见的阴道感染,其治疗后复发率高。通过对BV患者进行微生态评价,探讨BV的临床和阴道微生态特征,以期对BV的临床治疗及预防复发提供依据。
方法
选择2008年10月至2009年9月在北京大学深圳医院妇科门诊就诊的220例体检妇女和380例临床诊断BV的患者,取其阴道分泌物,经革兰染色后进行Nugent评分和微生态评价(阴道菌群的密集度、多样性、优势菌、炎性反应),同时检测支原体、沙眼衣原体,进行假丝酵母菌培养及鉴定。
结果
BV的临床特征中,白带异味者占50.79%(193/380),白带增多者占33.42%(127/380),阴道均匀稀薄分泌物者占74.47%(283/380),阴道pH>4.5者占93.95%(357/380),线索细胞阳性者占100%(380/380),胺试验阳性者占55.79%(212/380)。Nugent革兰染色评分法诊断BV的灵敏度为71.84%,特异度为100%。根据阴道分泌物涂片Nugent革兰染色评分法将600例育龄妇女分为正常组(0～3分)214例(35.67%),中间菌群组(4～6分)113例(18.83%),BV组(7～10分)273例(45.50%)。BV组阴道加德纳菌占优势者为96.70%(264/273),菌群密集度增加,Ⅲ～Ⅳ级者为77.66%(212/273),乳杆菌偶见或缺失,菌群多样性增加,白细胞数量无增多。BV组宫颈解脲脲原体、人型支原体和沙眼衣原体检出率分别为76.19%(208/273)、41.76%(114/273)和5.86%(16/273),均高于正常组(P<0.05)。BV患者中复发性BV占2.63%(10/380)。
结论
阴道分泌物增多伴鱼腥臭味是BV最主要的临床特征,Nugent革兰染色评分法诊断BV的特异度高。阴道加德纳菌为BV的优势菌且密集度增加,乳杆菌偶见或缺失,菌群多样性增加,白细胞数量无增多。BV患者中解脲脲原体、人型支原体和沙眼衣原体检出率高。BV患者中存在复发性BV。
Object
To investigate the clinical and vaginal microecology features in women with bacterial vaginosis (BV).
Methods
From October 2008 to September 2009, 220 cases with health women and 380 cases with BV diagnosed by Amsel criteria were studied. The vaginal secretions were grouped by Nugent scoring system, examined by Gram stain inspection of vaginal bacteria and microecology appraisal. Ureaplasma urealyticum, Mycoplasma hominis, Chlamydia trachomatis, fungal cultures and identification were tested.
Results
50.79% of BV was found with fishy odor vaginal discharge, 33.42% was found with increased vaginal discharge. 74.47% was found with a thin and homogeneous discharge. 93.95% was found with vaginal pH>4.5 and 100% was found with clue cell positive. The diagnostic sensitivity and specificity of Nugent scoring system compared with Amsel criteria was 71.84% and 100%. Among 600 cases, 214 cases were identified as normal vaginal microecology, 113 cases were intermediate and 273 cases were BV by Nugent scoring system. 296.70% (64/273) of BV group vaginal flora was predominated by Gardnerella vaginalis with the deficiency of lactobacillus. The population density and multiplicity was increased except the quantity of leukocyte. U.urealyticum was isolated in 76.19% of BV group, 69.03% in intermediate group and 59.81% in normal group. M.hominis was isolated in 41.76%, 21.24% and 18.69% respectively. C.trachomatis was isolated in 5.86%, 1.77% and 0.93% respectively. There were statistical differences in the isolation rates. The prevalence of recurrent BV was 2.63% (10/380).
Conclusion
The main clinical feature of BV is the increased vaginal discharge with fishy odor. The diagnostic specificity of Nugent scoring system is high. Gardnerella vaginalis is the predominate bacteria in BV with deficiency of lactobacillus. There is significant high prevalence of U.urealyticum, M.hominis and C.trachomatis in women with BV. The recurrent BV is existed.
细菌性阴道病(BV)是育龄女性最常见的阴道感染,其治疗后复发率高。通过对BV患者进行微生态评价,探讨BV的临床和阴道微生态特征,以期对BV的临床治疗及预防复发提供依据。
方法
选择2008年10月至2009年9月在北京大学深圳医院妇科门诊就诊的220例体检妇女和380例临床诊断BV的患者,取其阴道分泌物,经革兰染色后进行Nugent评分和微生态评价(阴道菌群的密集度、多样性、优势菌、炎性反应),同时检测支原体、沙眼衣原体,进行假丝酵母菌培养及鉴定。
结果
BV的临床特征中,白带异味者占50.79%(193/380),白带增多者占33.42%(127/380),阴道均匀稀薄分泌物者占74.47%(283/380),阴道pH>4.5者占93.95%(357/380),线索细胞阳性者占100%(380/380),胺试验阳性者占55.79%(212/380)。Nugent革兰染色评分法诊断BV的灵敏度为71.84%,特异度为100%。根据阴道分泌物涂片Nugent革兰染色评分法将600例育龄妇女分为正常组(0～3分)214例(35.67%),中间菌群组(4～6分)113例(18.83%),BV组(7～10分)273例(45.50%)。BV组阴道加德纳菌占优势者为96.70%(264/273),菌群密集度增加,Ⅲ～Ⅳ级者为77.66%(212/273),乳杆菌偶见或缺失,菌群多样性增加,白细胞数量无增多。BV组宫颈解脲脲原体、人型支原体和沙眼衣原体检出率分别为76.19%(208/273)、41.76%(114/273)和5.86%(16/273),均高于正常组(P<0.05)。BV患者中复发性BV占2.63%(10/380)。
结论
阴道分泌物增多伴鱼腥臭味是BV最主要的临床特征,Nugent革兰染色评分法诊断BV的特异度高。阴道加德纳菌为BV的优势菌且密集度增加,乳杆菌偶见或缺失,菌群多样性增加,白细胞数量无增多。BV患者中解脲脲原体、人型支原体和沙眼衣原体检出率高。BV患者中存在复发性BV。
Object
To investigate the clinical and vaginal microecology features in women with bacterial vaginosis (BV).
Methods
From October 2008 to September 2009, 220 cases with health women and 380 cases with BV diagnosed by Amsel criteria were studied. The vaginal secretions were grouped by Nugent scoring system, examined by Gram stain inspection of vaginal bacteria and microecology appraisal. Ureaplasma urealyticum, Mycoplasma hominis, Chlamydia trachomatis, fungal cultures and identification were tested.
Results
50.79% of BV was found with fishy odor vaginal discharge, 33.42% was found with increased vaginal discharge. 74.47% was found with a thin and homogeneous discharge. 93.95% was found with vaginal pH>4.5 and 100% was found with clue cell positive. The diagnostic sensitivity and specificity of Nugent scoring system compared with Amsel criteria was 71.84% and 100%. Among 600 cases, 214 cases were identified as normal vaginal microecology, 113 cases were intermediate and 273 cases were BV by Nugent scoring system. 296.70% (64/273) of BV group vaginal flora was predominated by Gardnerella vaginalis with the deficiency of lactobacillus. The population density and multiplicity was increased except the quantity of leukocyte. U.urealyticum was isolated in 76.19% of BV group, 69.03% in intermediate group and 59.81% in normal group. M.hominis was isolated in 41.76%, 21.24% and 18.69% respectively. C.trachomatis was isolated in 5.86%, 1.77% and 0.93% respectively. There were statistical differences in the isolation rates. The prevalence of recurrent BV was 2.63% (10/380).
Conclusion
The main clinical feature of BV is the increased vaginal discharge with fishy odor. The diagnostic specificity of Nugent scoring system is high. Gardnerella vaginalis is the predominate bacteria in BV with deficiency of lactobacillus. There is significant high prevalence of U.urealyticum, M.hominis and C.trachomatis in women with BV. The recurrent BV is existed.
引文
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