白城地区假丝酵母性阴道炎的病原学及流行病学研究

发布时间：2018-03-09 01:18

本文选题：阴道炎　切入点：假丝酵母　出处：《吉林大学》2014年硕士论文　论文类型：学位论文

【摘要】：阴道炎是妇科门诊常见的疾病，临床上是指女性阴道黏膜及黏膜下结缔组织发生的慢性炎症。临床研究结果表明，正常健康妇女的阴道对有害病原体的侵入和攻击具有天然防御功能，因而不会发病。但是当机体自身环境或外环境发生变化时，会破坏阴道的天然防御功能，从而使病原体容易入侵阴道，导致阴道炎的发生。假丝酵母性阴道炎的诱发因素主要包括口服避孕药、滥用抗生素、大量使用糖皮质激素和免疫抑制剂、不洁性生活、糖尿病、频繁使用碱性洗液冲洗阴道等。在所有阴道炎的致病因素中假丝酵母感染，占20-25%。假丝酵母（Candida sp.）是一种机会致病菌，正常条件下存在于阴道中而不致病，但是当阴道内的微环境发生变化时就会引发阴道炎，85-90%的阴道炎中致病真菌为白假丝酵母（Candida albicans），而非白假丝酵母占有的比例很低，而且大都在免疫功能受损的女性阴道内致病。非白假丝酵母包括克柔假丝酵母（C. krusei）、光滑假丝酵母（C. glabrata）、热带假丝酵母（C. tropicalis）和近平滑假丝（C. parapsilosis）等。研究目的：研究在白城地区假丝酵母性阴道炎致病菌的分布及比例；通过流行病学的调查资料了解假丝酵母性阴道炎的高发年龄、好发季节及高危因素；观察分析临床主要假丝酵母对5-氟胞嘧啶、氟康唑、两性霉素B和伊曲康唑等4种常见抗真菌药物的敏感性；探讨ITS序列单链构象多态性在临床主要假丝酵母鉴定中的作用。研究方法：本研究患者标本均来自白城市中心医院，收集自2012年7月起至2013年7月疑似假丝酵母性阴道炎患者阴道分泌物，同时患者填写流行病学调查表，详细记录患者的基本情况和疾病相关情况；将收集的分泌物标本直接镜检和革兰染色，对酵母菌分离培养后，利用科玛嘉酵母菌显色培养基和ITS序列分析法进行鉴定；根据M27-A2方案，采用微量稀释法，检测临床分离株对5-FC、FCZ、AmB和ICZ等4种常见抗真菌药物的敏感性；利用单链构象多态性技术（SSCP）的方法，通过对临床主要假丝酵母的ITS序列图谱分析，观察种间差异性和种内相似性。研究结果：本研究采集了白城地区疑似假丝酵母性阴道炎标本166例，对其分离培养后，得到酵母菌118株，分离阳性率为71.1%；118株酵母菌的鉴定结果显示，白假丝酵母60株，光滑假丝酵母36株，热带假丝酵母18株，克柔假丝酵母1株，近平滑假丝酵母1株，库德里阿兹威毕赤酵母（Pichia kudriavzevii）2株；假丝酵母性阴道炎流行病调查结果表明，本病好发年龄在21-39岁之间，高发时间为夏秋季，孕次、性生活频率、服用避孕药、穿紧身化纤内衣、清洗液频繁使用为本病的主要易感因素；白假丝酵母、光滑假丝酵母、热带假丝酵母、克柔假丝酵母和近平滑假丝酵母等116株5种假丝酵母对5-FC、AmB、FCZ和ICZ的敏感性分别为97.4%、99.1%、96.6%和82.8%；白假丝酵母、光滑假丝酵母、热带假丝酵母、克柔假丝酵母和近平滑假丝酵母等5种临床主要假丝酵母等ITS序列的SSCP分析结果显示，该方法具有较好的种间差异性和种内相似性。研究意义：本研究首次阐述了白城地区假丝酵母性阴道炎的发病规律及其易感因素，揭示了致病菌的分布情况，分析了假丝酵母临床耐药情况，，探讨了PCR-SSCP技术在临床假丝酵母鉴定的应用。本研究为假丝酵母性阴道炎的有效预防、合理化用药及其致病菌的准确鉴定，提供了实验依据。
[Abstract]:Vaginitis is a common disease in gynecology outpatient clinic, is a chronic inflammation of connective tissue of female vagina mucosa and submucosa. Clinical research results show that healthy women vagina of harmful pathogens invasion and attack with natural defenses, thus not disease. But when the body's external environment or the environment change. Will damage the vaginal natural defenses, so the pathogens easily invaded the vagina, cause the occurrence of vaginitis. Predisposing factors of Candida vaginitis include oral contraceptives, abuse of antibiotics, greater use of corticosteroids and immunosuppressive agents, feculent sexual life, diabetes, frequent use of alkaline lotion to wash vagina Candida infection. All the pathogenic factors in yeast vaginitis, 20-25%. Candida (Candida sp.) is an opportunistic pathogen, under normal conditions in the vagina Not pathogenic, but when the micro environment of the vagina changes will cause vaginitis, vaginitis pathogenic fungi 85-90% in Candida albicans (Candida albicans), and non Candida albicans proportion is very low, and most of the female vagina impaired immune function in the pathogenesis of non albicans yeast including. G softcandida yeast (C. krusei), Candida glabrata (C. glabrata), Candida tropicalis (C. tropicalis) and nearly smooth Candida (C. parapsilosis).
Objective: To study the distribution and proportion in the Baicheng region of Candida vaginitis pathogens; understand Candida vaginitis age by epidemiologic data, good season and high risk factors; clinical observation and analysis of fluconazole mainly Candida 5- flucytosine, amphotericin B and itraconazole, 4 kinds of anti antifungal drug sensitivity; to explore the role of ITS sequences of single strand conformation polymorphism in the main clinical Candida identification.
Methods: in this study, patients were to confession City Central Hospital, collected from July 2012 to July 2013 suspected Candida vaginitis patients with vaginal secretion, while patients in the epidemiological survey, detailed records of patients basic situation and disease related conditions; the collected specimens from direct microscopy and Gram staining, separation of yeast after incubation, chromogenic medium and ITS sequences were identified and analyzed by using the method of CHROMagar yeast; according to the M27-A2 program, using the microdilution method, detection of clinical isolates of 5-FC, FCZ, AmB and ICZ 4 kinds of antifungal drug sensitivity; using single strand conformation polymorphism (SSCP) method by ITS the sequence of the main clinical Candida analysis, observed differences and similarity.
Results: This study collected in the Baicheng area of suspected Candida vaginitis specimens of 166 cases of isolated, 118 strains of yeast, isolation rate of 71.1%; the identification results of 118 yeast strains, 60 strains of Candida albicans, 36 strains of Candida glabrata, Candida tropicalis 18 heat g softcandida yeast strains, 1 strains, 1 strains of Candida parapsilosis, Delhi Wei Pichia Aziz Library (Pichia kudriavzevii) of 2 strains of Candida vaginitis; epidemiological survey results show that the disease occurs at the age of 21-39, in time for the summer and autumn, times of pregnancy, sexual life frequency take the pill, wearing tight underwear chemical cleaning liquid, the frequent use of this disease predisposing factors; Candida albicans, Candida glabrata, Candida tropicalis and Candida krusei and Candida parapsilosis, 116 strains of 5 species of Candida on 5-FC, AmB, FCZ and ICZ the sensitivity Sensitive were 97.4%, 99.1%, 96.6% and 82.8%; Candida albicans, Candida glabrata, Candida tropicalis, SSCP analysis results of G softcandida yeast and Candida parapsilosis and other 5 kinds of major clinical Candida ITS sequences show that this method has good interspecific differences and a similarity.
The significance of the study: This study describes for the first time occurrence of yeast Candida vaginitis in Baicheng area and its predisposing factors, reveals the distribution of pathogens and analysis of Candida clinical drug resistance, discusses the application of PCR-SSCP technology in clinical Candida identification. The research for the effective prevention of Candida vaginitis the accurate identification of reasonable use of drugs and pathogens, provide experimental basis.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.31

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