目的 探讨细菌性阴道病(BV)、外阴阴道假丝酵母菌病(VVC)和细胞溶解性阴道病(CV)之间阴道代谢物的差异性.方法 纳入2014年3至10月在西安高新医院门诊就诊的186例女性,其中BV女性50例,VVC女性41例,CV女性30例和健康女性65例;测定阴道分泌物中D-乳酸和L-乳酸、细胞外基质金属蛋白酶诱导因子(EMMPRIN)和基质金属蛋白酶-8(MMP-8)浓度,并分析其与三种阴道疾病的关系.结果 四组阴道分泌物L-乳酸、D-乳酸、EMMPRIN、MMP-8浓度均有显著性差异(F值分别为917.059、727.342、133.657、262.906,均P<0.05),BV组阴道分泌物D-乳酸和L-乳酸浓度与对照组和VVC组相比显著性减少(t值分别为15.624、80.106;26.299、87.663,均P<0.05),VVC组阴道分泌物中L-乳酸浓度与对照组相似(t=1.423,P>0.05).对照组、BV组和CV组女性阴道分泌物中EMMPRIN浓度相似,对照组和BV组女性阴道分泌物中MMP-8浓度相似(t=1.296,P>0.05).对照组、BV组、VVC组和CV组阴道分泌物中EMMPRIN和L-乳酸浓度高度相关(r值分别为0.501、0.629、0.374、0.671,均P<0.05).BV组阴道分泌物中EMMPRIN和D-乳酸浓度呈高度相关(r=0.311,P<0.05),而对照组、VVC组和CV组阴道分泌物中EMMPRIN和D-乳酸浓度则弱相关.对照组和VVC组阴道分泌物中EMMPRIN和MMP-8浓度高度相关(r值分别为0.462、0.519,均P<0.001).结论 BV女性阴道分泌物D-乳酸和L-乳酸分泌不足,而VVC女性的EMMPRIN和MMP-8水平提升,女性在L-乳酸水平提升;这些偏差可能为预防和治疗BV、VVC和CV提供新的手段.%Objective To investigate the difference in vaginal metabolites among women with bacterial vaginosis(BV),vulvovaginal candidiasis(VVC)and cytolytic vaginosis(CV).Methods A total of 186 women visiting outpatient department of Xi'an Hi-tech Hospital were enrolled in this study,including 50 women with BV,41 women with VVC,30 women with CV and 65 healthy women as controls.Concentrations of D-lactic acid,L-lactic acid,extracellular matrix metalloproteinase inducer(EMMPRIN)and matrix metalloproteinase-8(MMP-8)in vaginal secretions were detected and their relation with three kinds of vaginal diseases was analyzed.Results There were significant differences in concentrations of L-lactic acid,D-lactic acid,EMMPRIN and MMP-8 in vaginal secretions in 4 groups(F value was 917.059,727.342,133.657 and 262.906,respectively,all P<0.05).Concentrations of D-lactic acid and L-lactic acid in vaginal secretions in BV group were significantly lower than those in the control group and VVC group(t value was 15.624,80.106,26.299 and 87.663,respectively,all P<0.05).L-lactic acid concentration in vaginal secretions in VVC group was similar to that in the control group(t=1.423,P>0.05).Concentrations of EMMPRIN in vaginal secretions in the control group,BV group and CV group were similar,and concentrations of MMP-8 in vaginal secretions in the control group and BV group were similar(t=1.296,P>0.05).Concentrations of EMMPRIN were highly correlated with L-lactic acid in vaginal secretions in the control group,BV group,VVC group and CV group(r value was 0.501,0.629,0.374 and 0.671,respectively, all P<0.05).Concentrations of EMMPRIN were also closely related with D-lactic acid in vaginal secretions in BV group(r=0.311,P<0.05),whereas those were weakly correlated with D-lactic acid in vaginal secretions in the control group,VVC group and CV group.Concentrations of EMMPRIN and MMP-8 in vaginal secretions in the control group and VVC group were highly correlated(r value was 0.462 and 0.519,respectively,both P<0.001).Conclusion Concentrations of D-lactic acid and L-lactic acid in vaginal secretions of women with BV are deficient.Levels of EMMPRIN and MMP-8 in women with VVC are elevated,and L-lactic acid level in women with CV is elevated.These deviations may contribute to new methods for prevention and treatment of BV,VVC and CV.
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