女性类风湿关节炎患者阴道支原体感染状况及药物敏感性分析

发布时间：2018-05-26 00:59

本文选题：女性 + 类风湿关节炎　；参考：《第三军医大学》2015年硕士论文

【摘要】：类风湿关节炎(Rheumatoid arthritis,RA)是一种慢性、全身性的自身免疫性疾病,其病理改变以全身的关节滑膜炎症为主,以人体四肢小关节(如手、腕等)反复出现慢性、对称性、多关节的炎症性改变为主要临床表现,能够刺激血管翳形成,从而导致关节内软骨及骨的破坏,关节出现功能障碍,甚则致残。同时,可出现关节外病变,如可能出现心脏、肺脏、肾脏病变,以及胃肠道、神经系统等病变。RA是多种因素共同作用所致的疾病,其可能与遗传、环境因素、心理因素、社会因素,以及与吸烟、饮酒等多种因素相关。阴道内支原体作为环境因素之一,对类风湿关节炎的发病产生影响。阴道内支原体是条件致病菌,支原体寄生于女性阴道内,若免疫力低下或粘膜损害等因素破坏了阴道微生态平衡,即可导致疾病的发生。目前,鲜有针对女性RA患者阴道内支原体感染情况、药物敏感性研究及血清学变化分析,我们的工作弥补了这方面研究的空白,有利于揭示女性类风湿关节炎与阴道支原体的关系,指导临床治疗方案的拟定;同时,关注了女性RA患者支原体感染后造成血清学变化情况、临床意义,从而预知潜在风险防患于未然。方法:1.研究女性RA与阴道支原体的关系。本研究将女性人群分为三组,分别为女性RA患者(RA组)、女性非RA其它疾病患者(非RA组)及女性健康体检者(健康组),通过支原体培养及分型技术,将取自女性RA患者、女性非RA其它疾病患者及女性健康体检者的宫颈管口上皮细胞及分泌物标本进行支原体检测及分型,然后,统计分析这三组的阴道支原体感染及分型的构成情况,从而揭示女性RA与阴道支原体的关系。2.研究女性RA患者阴道支原体感染药物敏感性情况。将第一部分试验筛选的女性RA患者阴道支原体感染者的宫颈上皮细胞及分泌物拭子,从-70℃冰箱中取出,复温后对其进行药物敏感性试验。3.研究女性RA患者阴道支原体感染后的血清学变化及临床意义。将第一部分试验筛选的女性RA患者,分为支原体感染组(感染组)及支原体未感染组(未感染组),对其血清学、DAS28等数据进行统计学处理、分析,研究感染组较未感染组的血清学变化情况及趋势,以及初步了解二组的RA疾病活动性情况,并判断其临床意义。结果:1.实验纳入女性RA患者(RA组)246例、女性非RA其它疾病患者(非RA组)113例、女性健康体检者(健康组)126例,合计485例,支原体感染者合计290例,总的阳性率为59.79%,将三组支原体阳性率进行比较后未见差异,不具有统计学意义(P0.05)。其后,将支原体阳性者进行支原体分型,RA组144例,解脲脲原体(Uu)构成比为35.42%(51/144)、人型支原体(Mh)构成比为3.47%(5/144)、Uu+Mh构成比为61.11%(88/144);健康组80例,Uu构成比为57.50%(46/80)、Mh构成比为2.50%(2/80)、Uu+Mh构成比为40.00%(32/80),RA组、健康组二组组间比较明显不同,差异具有统计学意义(P0.001)。2.上述支原体感染及分型试验中支原体感染者共290例,其中,女性RA患者支原体感染者144例,其耐药率分别为交沙霉素10.42%、强力霉素18.06%、米诺环素22.22%、四环素28.47%、克拉霉素48.61%、阿齐霉素50.69%、罗红霉素61.11%、左氧沙星61.81%、氧氟沙星64.58%、司巴沙星71.53%、红霉素74.31%、环丙沙星88.19%。3.女性RA患者阴道支原体感染者(感染组)血清中人体白细胞(WBC)、中性粒细胞(Neu)、淋巴细胞(Lymph)、单核细胞(Mon)、血小板(PLT)计数分别为为(6.60±2.95)、(4.38±2.61)、(1.61±0.64)、(0.46±0.23)、(282.34±140.81)10^9/L,均高于女性RA患者阴道支原体未感染者(未感染组)[分别为(6.01±2.08)、(4.04±1.82)、(1.43±0.63)、(0.40±0.20)、(237.26±98.39)10^9/L],差异有统计学意义(P0.05)。感染组血清中嗜酸性粒细胞(Eos)计数、血钙(Ca2+)浓度分别为(0.14±0.13)10^9/L、(2.17±0.12)mmol/L,低于未感染组[分别为(0.17±0.22)10^9/L、(2.19±0.11)mmol/L],差异有统计学意义(P0.05)。结论:1.女性RA患者阴道支原体感染率与健康体检者比较未见明显不同;2.女性RA患者阴道支原体感染类型的构成情况较女性健康体检者发生了明显改变。3.女性RA患者阴道支原体感染后对四环素类抗生素的药物耐药程度低,对大环内酯类抗生素的药物敏感程度中介或耐药程度高。4.女性RA患者阴道支原体感染应用米诺环素抗感染治疗后,RA病情活动性、ESR较用药前有所降低。5.女性RA患者阴道支原体感染后,血WBC、Neu、Lymph、Mon、PLT计数较未感染者呈上升趋势,有加重炎症反应及促进凝血的趋势,有使Eos计数、血Ca2+下降的倾向。6.女性RA患者阴道支原体感染后RA疾病活动性未出现明显改变,也未出现血沉(ESR)、C-反应蛋白(CRP)血清学明显变化。
[Abstract]:Rheumatoid arthritis (Rheumatoid arthritis, RA) is a chronic, systemic autoimmune disease whose pathological changes are based on systemic synovitis, with repeated chronic, symmetrical features of the small joints of the limbs (such as hand, wrist, etc.). The inflammatory changes of multiple joints are the main clinical manifestations, which can stimulate pannus formation and lead to the formation of pannus. The destruction of the cartilage and bone in the joint, the dysfunction of the joints, and the disability. At the same time, there can be extraarticular lesions, such as the possible occurrence of heart, lung, kidney disease, and gastrointestinal, nervous system,.RA is a disease caused by a variety of factors, which can be associated with genetic, environmental, psychological, social, and suction. The vaginal mycoplasma is one of the environmental factors, which affects the pathogenesis of rheumatoid arthritis. The Mycoplasma in the vagina is a conditional pathogen. Mycoplasma is parasitic in the female vagina. If the immunity is low or the mucosal damage is damaged, the vaginal microecological balance can lead to the occurrence of the disease. There are few cases of vaginal mycoplasma infection in female RA patients, drug sensitivity research and serological change analysis. Our work has made up the gap in this study, which is helpful to reveal the relationship between female rheumatoid arthritis and Mycoplasma vagina, to guide the formulation of clinical treatment scheme, and to pay attention to mycoplasma infection in female RA patients. After the results of serological changes and clinical significance, the potential risk prevention was foreseen. Methods: 1. the relationship between female RA and Mycoplasma vaginae was studied. This study divided women into three groups: female RA patients (group RA), female non RA disease patients (non RA group) and female healthy persons (Health Group), through mycoplasma culture. And the classification technique will be taken from the female RA patients, women non RA other diseases and women's cervix oral epithelial cells and secretions to carry out mycoplasma detection and classification, and then analyze the three groups of vaginal mycoplasma infection and classification of the composition, so as to reveal the relationship between female RA and Mycoplasma vaginae in.2. research Study the drug sensitivity of female RA patients with Mycoplasma vagina infection. Cervical epithelial cells and secretions swabs from female RA patients infected with Mycoplasma vagina in the first part of the trial were taken out from -70 centigrade refrigerator, and after rewarming the drug sensitivity test.3. was used to study the serological changes in female RA patients after vaginal Mycoplasma infection. The first part of the screening of female RA patients was divided into mycoplasma infection group (infection group) and Mycoplasma uninfected group (uninfected group). The serology, DAS28 and other data were processed and analyzed. The serological changes and trends of the infected group compared with the uninfected group were analyzed, and the RA disease activity of the two groups was preliminarily understood. Results: the 1. experiment included 246 cases of female RA patients (group RA), 113 cases of non RA other patients (non RA group), 126 cases of female health examination (healthy group), 485 cases, 290 cases of mycoplasma infection, the total positive rate was 59.79%. No difference was found between the positive rates of Mycoplasma in the three groups, no difference was found. There were statistical significance (P0.05). Subsequently, Mycoplasma positive patients were divided into Mycoplasma genotyping, RA group 144, Ureaplasma urealyticum (Uu) composition ratio was 35.42% (51/144), Mycoplasma hominis (Mh) constituent ratio was 3.47% (5/144), Uu+Mh composition ratio was 61.11% (88/144); healthy group 80 cases, Uu composition ratio of 57.50% (46/80), Mh constituent ratio 2.50% (2/80), constitute ratio of 2.50% 40% (32/80), group RA and two groups in the health group were significantly different, and the difference was statistically significant (P0.001) 290 cases of mycoplasma infection and mycoplasma infection in.2.. Among them, 144 cases of mycoplasma infection in the female RA patients, the rate of resistance to Mycoplasma 10.42%, doxycycline 18.06%, minocycline 22.22%, and tetracycline 2, respectively. 8.47%, clarithromycin 48.61%, azithromycin 50.69%, roxithromycin 61.11%, levofloxacin 61.81%, ofloxacin 64.58%, sparfloxacin 71.53%, erythromycin 74.31%, and ciprofloxacin 88.19%.3. female RA patients with Mycoplasma vagina infection (WBC), neutrophils (Neu), lymphocyte (Lymph), mononuclear cells (Mon), blood The PLT counts were (6.60 + 2.95), (4.38 + 2.61), (1.61 + 0.64), (0.46 + 0.23) and (282.34 + 140.81) 10^9/L, all higher than those of uninfected vaginal Mycoplasma in female RA patients [6.01 + 2.08), (4.04 + 0.46), (0.64), (P0.05). The difference was statistically significant (P0.05). The count of eosinophils (Eos) and blood calcium (Ca2+) were (0.14 + 0.13) 10^9/L and (2.17 + 0.12) mmol/L respectively, lower than that of uninfected Group [0.17 + 0.22) 10^9/L and (2.19 + 0.11) mmol/L] (P0.05). Conclusion: the infection rate of Mycoplasma vaginae in 1. women RA patients was not significantly different from those in healthy persons; 2. women R. The composition of the type of Mycoplasma vaginae infection in A patients was significantly lower than that in women's healthy subjects. The drug resistance to tetracycline antibiotics in.3. RA patients was low, the drug sensitivity to the macrolide antibiotics, or the high degree of drug resistance in.4. female RA patients with Mycoplasma vaginae infection, should be observed. After the treatment of infection with minocycline, RA was active, and ESR decreased.5. female RA patients after vaginal mycoplasma infection. The blood WBC, Neu, Lymph, Mon, PLT counts were on the rise compared with those in the non infected patients. There was a tendency to increase the inflammatory response and promote the coagulation. There were Eos counts, and the tendency of Ca2+ decline in blood was the vaginal mycoplasma. There was no significant change in RA activity after infection, nor did erythrocyte sedimentation rate (ESR) and C- reactive protein (CRP) serology change significantly.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R593.22

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