生活习惯及阴道局部免疫对VVC发病及复发的影响

发布时间：2018-05-08 16:32

本文选题：复发性外阴阴道假丝酵母菌病 + 干扰素-γ　；参考：《河北联合大学》2014年硕士论文

【摘要】：目的本研究通过调查外阴阴道假丝酵母菌病（vulvovaginal candidiasis, VVC）和复发性外阴阴道假丝酵母菌病（Recurrent vulvovaginal candidiasis, RVVC）患者的一般情况和生活卫生习惯等因素，同时检测VVC和RVVC患者阴道局部IFN-γ、IL-10的水平，，探讨阴道局部免疫功能与VVC和RVVC的发病的关系及发病的危险因素，以期为RVVC的发生和防治提供新的思路和方法。方法选取2012年6月至2012年12月在河北联合大学附属医院妇产科门诊就诊及进行健康体检的育龄妇女为研究对象，参照第7版《妇产科学》诊断标准，诊断出复发性外阴阴道假丝酵母菌病（RVVC）患者40例，另将健康组（40例）、单纯外阴阴道假丝酵母菌病（VVC）组（40例）作为对照，剔除阴道灌洗液中的血液污染者，实际研究样本为：健康对照组（28例）、单纯VVC组（30例）、RVVC组（30例）。据研究课题设计合理的调查表，调查工作由本人直接负责，采用面对面问卷调查形式，调查内容包括研究对象的一般情况、个人卫生习惯情况、性生活情况和饮食喜好等。所有研究对象经签署知情同意书后，均以5ml生理盐水冲洗阴道宫颈管部、阴道上段，于后穹窿回抽灌洗液约3ml，所有灌洗液均不含血液成分。将所得灌洗液以3000r/min离心5min，分离上清液和细胞成分，分别置于-20℃和-80℃的冰箱冻存。上清液采用酶联免疫吸附试验（ELISA）法测定IFN-γ和IL-10的浓度；细胞成分采用逆转录多聚酶链式反应（RT-PCR）法半定量测定细胞因子IFN-γ、IL-10mRNA的表达水平。整理所得数据，输入Microsoft Excel2007建库，采用SPSS17.0统计软件包进行统计分析。问卷调查数据采用单因素Logistic回归分析，再将与疾病发生相关的因素运用多因素Logistic回归分析。计量资料用均数+标准差（x—±s）表示，组间差异的比较采用方差检验或秩和检验。结果1单因素Logistic回归分析显示：棉质内裤（P=0.020，OR=0.278，95%CI为0.096~0.813）和阴道冲洗（P=0.002，OR=6.412，95%CI为2.356~16.915）对VVC的发生均有统计学意义。多分类多因素Logistic回归分析显示：棉质内裤（P=0.027，OR=0.284，95%CI为0.092~0.861）和阴道冲洗（P=0.001，OR=6.397，95%CI为2.329~17.021）与VVC的发生均有统计学意义。棉质内裤的OR值均小于1，对VVC的发生起保护性因素作用；阴道冲洗的OR值均大于1，为VVC发生的危险因素。2RVVC、单纯性VVC、健康女性IFN-γ蛋白水平分别为：1.67+0.14、1.81+0.16、1.92+0.12×100pg/ml，RVVC组和VVC组的表达水平均明显低于对照组（P0.05），且RVVC组和VVC组之间的表达水平也有显著性差异（P0.05），IFN-γmRNA表达结果与蛋白水平结果一致；RVVC、单纯性VVC、健康女性IL-10蛋白水平分别为：1.14+0.19、1.07+0.16、0.67+0.15×100pg/ml，患病两组的IL-10表达水平均明显高于健康组（P0.05），但RVVC组和VVC组之间的表达水平无显著性差异（P0.05），mRNA的表达与蛋白水平一致。结论1妇女穿棉质内裤可能会降低VVC发病的风险，而阴道冲洗可能会增加VVC发病的风险。2RVVC的发生可能与研究对象的一般情况、个人卫生习惯情况、性生活情况和饮食喜好等因素无关。3RVVC患者阴道的IFN-γ的水平明显降低，提示IFN-γ水平下降可能与VVC反复发生有关。4RVVC患者和VVC患者阴道的IL-10的水平均明显升高，提示阴道局部IL-10通过在下调T细胞免疫反应在RVVC及VVC发病中起着一定的作用。
[Abstract]:Objective To investigate the relationship between vaginal local immune function ( VVC ) and RVVC ( RVVC ) and the risk factors of vaginal local immune function ( VVC ) and RVVC ( RVVC ) , and to provide a new idea and method for the development and prevention of RVVC .

Methods 40 patients with recurrent vulvovaginal Candida disease ( RVVC ) were selected from June 2012 to December 2012 , and 40 healthy controls ( 40 cases ) and VVC group ( 40 cases ) were selected as controls . The results were as follows : healthy control group ( 28 cases ) , simple VVC group ( 30 cases ) and RVVC group ( 30 cases ) .
The expression level of cytokines IFN - 纬 and IL - 10mRNA was semiquantitatively determined by reverse transcription polymerase chain reaction ( RT - PCR ) method . The data obtained were analyzed by SPSS 17.0 statistical software package .

Results One - factor logistic regression analysis showed that cotton underwear ( P = 0.020 , OR = 0.278 , 95 % CI 0.096 ~ 0.813 ) and vaginal irrigation ( P = 0.002 , OR = 6.412 , 95 % CI 2.356 ~ 16.915 ) were statistically significant for VVC .
The expression levels of IFN - 纬 protein in RVVC group and VVC group were significantly lower than those in control group ( P0.05 ) , and the expression level of IFN - 纬 mRNA was consistent with the result of protein level .
The levels of IL - 10 in RVVC and VVC were 1.14 + 0.19 , 1.07 + 0.16 , 0.67 + 0.15 脳 100pg / ml , respectively . The levels of IL - 10 in both groups were significantly higher than those in healthy group ( P0.05 ) , but there was no significant difference between RVVC group and VVC group ( P0.05 ) .

Conclusion 1 Women wear cotton underwear may reduce the risk of VVC morbidity , and vaginal irrigation may increase the risk of VVC . The level of IFN - 纬 in the vagina of 3RVVC patients is obviously lower than that of VVC . The levels of IL - 10 in vagina of patients with RVVC and VVC are obviously increased , suggesting that local IL - 10 plays a role in the pathogenesis of RVVC and VVC in patients with RVVC and VVC .

【学位授予单位】：河北联合大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.31

【参考文献】