念珠菌感染性阴道炎的病原菌药物敏感性及免疫功能变化
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摘要
目的探讨念珠菌感染性阴道炎菌种分布特点、耐药性及Th1/Th2细胞因子变化情况。方法 456例阴道分泌物真菌培养标本进行菌种培养鉴定,统计念珠菌感染率及所感染的念珠菌构成及分布特点,药敏试验鉴定念珠菌对常用几种抗真菌药物的敏感性。在分离培养念珠菌为阳性的标本中随机选择100例设为观察组,另选取同期来本院体检的健康女性100例为对照组。酶联免疫吸附试验(ELISA)检测各阴道分泌物样本中干扰素-γ(IFN-γ)、白介素-12(IL-12)、白介素-4(IL-4)水平,并计算IFN-γ/IL-4值。结果入组456例阴道分泌物真菌培养标本中,共分离培养出念珠菌278株,念珠菌检出阳性率为60.96%(278/456);主要检出念珠菌种类包括:白色念珠菌、光滑念珠菌、克柔念珠菌、热带念珠菌等,白色念珠菌检出率最高(77.7%)。念珠菌对常用几种抗真菌药物均具有较好的敏感性,其中白色念珠菌对各抗真菌药物的敏感性均最高。观察组阴道分泌物中IFN-γ、IL-12、IL-4水平均明显高于对照组,IFN-γ/IL-4比值明显低于对照组,差异有统计学意义(P<0.01)。结论念珠菌性阴道炎以白色念珠菌感染为主,菌种不同对抗菌药物敏感性不同。念珠菌感染性阴道炎患者存在局部免疫功能紊乱现象。
Objective To observe the distribution characteristics,drug resistance and change patterns of Th1/Th2 cytokines in Candida infectious vaginitis. Methods 456 vaginal secretion fungal culture specimens were cultured and identified.Candida infection rate and the composition and distribution characteristics of Candida infected were counted. Drug sensitivity test was then conducted to identify the sensitivity of Candida to several commonly used antifungal drugs. 100 specimens randomly selected from the specimens having been tested positive for the isolation and culture of Candida were chosen as the experimental group. 100 healthy women admitted to the hospital during the same period were chosen as the control group. Enzyme-linked immunosorbent assay( ELISA) was used to detect interferon-γ( IFN-γ),interleukin-12( IL-12),and interleukin-4( IL-4) levels in each vaginal secretion sample and IFN-γ/IL-4 value was calculated. Results A total of 278 strains of Candida were isolated and cultured out of the 456 vaginal secretion fungal culture specimens. The positive rate of Candida was 60. 96%( 278/456). The main detectable species of Candida include Candida albicans,Candida glabrata,Candida krusei,Candida tropical. The highest detection rate of Candida albicans was 77.7%. Candida has good sensitivity to several commonly used antifungal drugs and Candida albicans has the highest sensitivity to various antifungal drugs. The levels of IFN-γ,IL-12 and IL-4 in the vaginal secretions of the experimental group were significantly higher than those of the control( P< 0.01). The ratio of IFN-γ/IL-4 was significantly lower than that of the control group( P<0. 01). Conclusions Candida vaginitis is mainly caused by Candida albicans. Different strains have different degrees of sensitivity to antimicrobial agents. Patients with Candida infectious vaginitis bear local immune dysfunction.
Objective To observe the distribution characteristics,drug resistance and change patterns of Th1/Th2 cytokines in Candida infectious vaginitis. Methods 456 vaginal secretion fungal culture specimens were cultured and identified.Candida infection rate and the composition and distribution characteristics of Candida infected were counted. Drug sensitivity test was then conducted to identify the sensitivity of Candida to several commonly used antifungal drugs. 100 specimens randomly selected from the specimens having been tested positive for the isolation and culture of Candida were chosen as the experimental group. 100 healthy women admitted to the hospital during the same period were chosen as the control group. Enzyme-linked immunosorbent assay( ELISA) was used to detect interferon-γ( IFN-γ),interleukin-12( IL-12),and interleukin-4( IL-4) levels in each vaginal secretion sample and IFN-γ/IL-4 value was calculated. Results A total of 278 strains of Candida were isolated and cultured out of the 456 vaginal secretion fungal culture specimens. The positive rate of Candida was 60. 96%( 278/456). The main detectable species of Candida include Candida albicans,Candida glabrata,Candida krusei,Candida tropical. The highest detection rate of Candida albicans was 77.7%. Candida has good sensitivity to several commonly used antifungal drugs and Candida albicans has the highest sensitivity to various antifungal drugs. The levels of IFN-γ,IL-12 and IL-4 in the vaginal secretions of the experimental group were significantly higher than those of the control( P< 0.01). The ratio of IFN-γ/IL-4 was significantly lower than that of the control group( P<0. 01). Conclusions Candida vaginitis is mainly caused by Candida albicans. Different strains have different degrees of sensitivity to antimicrobial agents. Patients with Candida infectious vaginitis bear local immune dysfunction.
引文
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[14]Yano J,Noverr MC,Fidel PL Jr.Cytokines in the host response to Candida vaginitis:Identifying a role for non-classical immune mediators,S100 alarmins[J].Cytokine,2012,58(1):118-128.
[15]Johnson ML,Dasgupta T,Gopichandran N,et al.A Bayesian view of murine seminal cytokine networks[J].PLoS One,2017,12(11):e0188897.
[2]Faria DR,Sakita KM,Akimoto-Gunther LS,et al.Cell damage caused by vaginal Candida albicans isolates from women with different symptomatologies[J].J Med Microbiol,2017,66(8):1225-1228.
[3]Arroyo-Fajardo A,San Juan-Delgado MF,García-Rodríguez J.Candida glabrata vaginitis:The great ignored[J].Rev Iberoam Micol,2017,1406(17):30034-30037.
[4]Ng SM,Yap YY,Cheong JW,et al.Antifungal peptides:a potential new class of antifungals for treating vulvovaginal candidiasis caused by fluconazole-resistant Candida albicans[J].J Pept Sci,2017,23(3):215-221.
[5]Minooeianhaghighi MH,Sepehrian L,Shokri H.Antifungal effects of Lavandula binaludensis and Cuminum cyminum essential oils against Candida albicans strains isolated from patients with recurrent vulvovaginal candidiasis[J].J Mycol Med,2017,27(1):65-71.
[6]Chamorro-de-Vega E,Gil-Navarro MV,Perez-Blanco JL.Treatment of refractory Candida krusei vaginitis with topical amphotericin B[J].Med Clin(Barc),2016,147(12):565-566.
[7]Bhattacharya S,Sobel JD,White TC.A Combination fluorescence assay demonstrates increased efflux pump activity as a resistance mechanism in azole-resistant vaginal Candida albicans isolates[J].Antimicrob Agents Chemother,2016,60(10):5858-5866.
[8]Hong KH,Hong SK,Cho SI,et al.Analysis of the vaginal microbiome by next-generation sequencing and evaluation of its performance as a clinical diagnostic tool in vaginitis[J].Ann Lab Med,2016,36(5):441-449.
[9]Santos CM,Pires MC,Le2o TL,et al.Selection of Lactobacillus strains as potential probiotics for vaginitis treatment[J].Microbiology,2016,162(7):1195-1207.
[10]De Bernardis F,Arancia S,Sandini S,et al.Studies of immune responses in Candida vaginitis[J].Pathogens,2015,4(4):697-707.
[11]Moragues MD,Rementeria A,Sevilla MJ,et al.Candida antigens and immune responses:implications for a vaccine[J].Expert Rev Vaccines,2014,13(8):1001-1012.
[12]Peters BM,Palmer GE,Nash AK,et al.Fungal morphogenetic pathways are required for the hallmark inflammatory response during Candida albicans vaginitis[J].Infect Immun,2014,82(2):532-543.
[13]Lasarte S,Elsner D,Guía-González M,et al.Female sex hormones regulate the Th17 immune response to sperm and Candida albicans[J].Hum Reprod,2013,28(12):3283-3291.
[14]Yano J,Noverr MC,Fidel PL Jr.Cytokines in the host response to Candida vaginitis:Identifying a role for non-classical immune mediators,S100 alarmins[J].Cytokine,2012,58(1):118-128.
[15]Johnson ML,Dasgupta T,Gopichandran N,et al.A Bayesian view of murine seminal cytokine networks[J].PLoS One,2017,12(11):e0188897.