外阴阴道假丝酵母菌病患者肠道假丝酵母菌携带与阴道假丝酵母菌感染之间的关系

摘要

Objective To investigate the relationship between vaginal and intestinal Candida in patients with vulvovaginal candidiasis by using microbiological and molecular methods. Methods The samples of vaginal discharge and anal swabs were collected from 148 cases with vulvovaginal candidiasis,followed by fungal culture, identification, purification and genome DNA extraction. The genome sequences from respective locations were aligned and typed according to their homology analyzed by internal transcribed spacer (ITS) PCR and random amplified polymorphic DNA (RAPD) PCR. Patients with vulvovaginal infection or those with infections in intestine and vulvovagina were pooled respectively, while the recurrent incidences after local anti-fungal treatments were analyzed. Results Candida albicans is the dominant pathogen in 148 cases with vulvovaginal candidiasis (91.9% , 136/148) ; 33. 1% (49/148) of patients with vulvovaginal candidiasis were infected in both intestine and vulvovagina. While 92% (22/24) of patients with intestinal and vaginal Candida infection showed high homology. The recurrent rate of patients with vulvovaginal candidiasis complicated with concurrent intestinal Candida infection (7/14) was significantly higher than that of solo vaginal infected patients [21% (6/29)] after vaginal treatment (P < 0. 05) . Conclusions The infection of vulvovaginal candidiasis is highly associated with the concurrent infection of intestinal Candida. The recurrent rate is high in patients with vulvovaginal candidiasis with concurrent infection of intestinal Candida after vaginal treatment. The general management to those patients infected by both vulvovaginal and intestinal Candida is necessary in reducing the recurrence of the disease.%目的 采用微生物学和分子生物学方法,研究外阴阴道假丝酵母菌病患者肠道假丝酵母菌携带与阴道假丝酵母菌感染之间的关系.方法 收集2006年4月至2008年2月问上海市长宁区中心医院就诊的148例外阴阴道假丝酵母菌病患者的阴道分泌物和肛拭子标本进行假丝酵母菌的培养和鉴定.采用内转录间隔区(ITS)PCR和随机扩增多态性DNA(RAPD)PCR方法 对两处假丝酵母菌基因组DNA进行比对和分型,从而确定其关系.比较合并肠道携带假丝酵母菌的外阴阴道假丝酵母菌病患者与单纯阴道感染假丝酵母菌但肠道内无假丝酵母菌携带者阴道局部使用抗真菌药物治疗后复发率的差异.结果 148例外阴阴道假丝酵母菌患者中,白假丝酵母菌感染占绝大多数(91.9%,136/148);33.1%(49/148)的患者合并肠道携带假丝酵母菌.ITS PCR结果 显示,92%(22/24)的患者肠道与阴道假丝酵母菌菌株间有高度同源性.患者在接受阴道局部抗真菌治疗后,合并肠道携带假丝酵母菌的外阴阴道假丝酵母菌病患者,其复发率(7/14)高于单纯的阴道感染者[复发率为21%(6/29)],两者比较,差异有统计学意义(P<0.05).结论 肠道携带假丝酵母菌与外阴阴道假丝酵母菌病之间存在着一定的关系.外阴阴道假丝酵母菌病患者在合并肠道携带假丝酵母菌时,阴道局部治疗后的外阴阴道假丝酵母菌病复发率较高.