本文選題：陰道炎　切入點(diǎn)：假絲酵母　出處：《吉林大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：陰道炎是婦科門診常見的疾病，臨床上是指女性陰道黏膜及黏膜下結(jié)締組織發(fā)生的慢性炎癥。臨床研究結(jié)果表明，正常健康婦女的陰道對(duì)有害病原體的侵入和攻擊具有天然防御功能，因而不會(huì)發(fā)病。但是當(dāng)機(jī)體自身環(huán)境或外環(huán)境發(fā)生變化時(shí)，會(huì)破壞陰道的天然防御功能，從而使病原體容易入侵陰道，導(dǎo)致陰道炎的發(fā)生。假絲酵母性陰道炎的誘發(fā)因素主要包括口服避孕藥、濫用抗生素、大量使用糖皮質(zhì)激素和免疫抑制劑、不潔性生活、糖尿病、頻繁使用堿性洗液沖洗陰道等。在所有陰道炎的致病因素中假絲酵母感染，占20-25%。假絲酵母（Candida sp.）是一種機(jī)會(huì)致病菌，正常條件下存在于陰道中而不致病，但是當(dāng)陰道內(nèi)的微環(huán)境發(fā)生變化時(shí)就會(huì)引發(fā)陰道炎，85-90%的陰道炎中致病真菌為白假絲酵母（Candida albicans），而非白假絲酵母占有的比例很低，而且大都在免疫功能受損的女性陰道內(nèi)致病。非白假絲酵母包括克柔假絲酵母（C. krusei）、光滑假絲酵母（C. glabrata）、熱帶假絲酵母（C. tropicalis）和近平滑假絲（C. parapsilosis）等。 研究目的：研究在白城地區(qū)假絲酵母性陰道炎致病菌的分布及比例；通過流行病學(xué)的調(diào)查資料了解假絲酵母性陰道炎的高發(fā)年齡、好發(fā)季節(jié)及高危因素；觀察分析臨床主要假絲酵母對(duì)5-氟胞嘧啶、氟康唑、兩性霉素B和伊曲康唑等4種常見抗真菌藥物的敏感性；探討ITS序列單鏈構(gòu)象多態(tài)性在臨床主要假絲酵母鑒定中的作用。 研究方法：本研究患者標(biāo)本均來自白城市中心醫(yī)院，收集自2012年7月起至2013年7月疑似假絲酵母性陰道炎患者陰道分泌物，同時(shí)患者填寫流行病學(xué)調(diào)查表，詳細(xì)記錄患者的基本情況和疾病相關(guān)情況；將收集的分泌物標(biāo)本直接鏡檢和革蘭染色，對(duì)酵母菌分離培養(yǎng)后，利用科瑪嘉酵母菌顯色培養(yǎng)基和ITS序列分析法進(jìn)行鑒定；根據(jù)M27-A2方案，采用微量稀釋法，檢測臨床分離株對(duì)5-FC、FCZ、AmB和ICZ等4種常見抗真菌藥物的敏感性；利用單鏈構(gòu)象多態(tài)性技術(shù)（SSCP）的方法，通過對(duì)臨床主要假絲酵母的ITS序列圖譜分析，觀察種間差異性和種內(nèi)相似性。 研究結(jié)果：本研究采集了白城地區(qū)疑似假絲酵母性陰道炎標(biāo)本166例，對(duì)其分離培養(yǎng)后，得到酵母菌118株，分離陽性率為71.1%；118株酵母菌的鑒定結(jié)果顯示，白假絲酵母60株，光滑假絲酵母36株，熱帶假絲酵母18株，克柔假絲酵母1株，近平滑假絲酵母1株，庫德里阿茲威畢赤酵母（Pichia kudriavzevii）2株；假絲酵母性陰道炎流行病調(diào)查結(jié)果表明，本病好發(fā)年齡在21-39歲之間，高發(fā)時(shí)間為夏秋季，孕次、性生活頻率、服用避孕藥、穿緊身化纖內(nèi)衣、清洗液頻繁使用為本病的主要易感因素；白假絲酵母、光滑假絲酵母、熱帶假絲酵母、克柔假絲酵母和近平滑假絲酵母等116株5種假絲酵母對(duì)5-FC、AmB、FCZ和ICZ的敏感性分別為97.4%、99.1%、96.6%和82.8%；白假絲酵母、光滑假絲酵母、熱帶假絲酵母、克柔假絲酵母和近平滑假絲酵母等5種臨床主要假絲酵母等ITS序列的SSCP分析結(jié)果顯示，該方法具有較好的種間差異性和種內(nèi)相似性。 研究意義：本研究首次闡述了白城地區(qū)假絲酵母性陰道炎的發(fā)病規(guī)律及其易感因素，揭示了致病菌的分布情況，分析了假絲酵母臨床耐藥情況，，探討了PCR-SSCP技術(shù)在臨床假絲酵母鑒定的應(yīng)用。本研究為假絲酵母性陰道炎的有效預(yù)防、合理化用藥及其致病菌的準(zhǔn)確鑒定，提供了實(shí)驗(yàn)依據(jù)。
[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.

【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R711.31

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