本文選題：復(fù)發(fā)性外陰陰道假絲酵母菌病　切入點：陰道菌群　出處：《南方醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景復(fù)發(fā)性外陰陰道假絲酵母菌病(Recurrent Vulvovaginal Candidiasis,RVVC),是指經(jīng)過治療后臨床癥狀消失、真菌學(xué)檢查陰性后再次復(fù)發(fā),且在1年內(nèi)發(fā)作4次或以上。局部抗真菌治療是目前RWC的主要治療方案,但反復(fù)復(fù)發(fā)一直是疾病治療的瓶頸。研究顯示,陰道微生態(tài)環(huán)境的變化可能在RWC的發(fā)生發(fā)展中起重要作用,但目前關(guān)于RVVC陰道微生態(tài)的研究結(jié)果尚未有定論。本研究擬在不同時間點采集RVVC患者及正常對照女性的陰道分泌物,通過Illumina高通量測序技術(shù)以及BIPES生物信息分析方法,比較兩組間菌群結(jié)構(gòu)及在月經(jīng)周期中的動態(tài)變化以及RWC患者復(fù)發(fā)前后陰道菌群結(jié)構(gòu)的差異,有望為RVVC復(fù)發(fā)的機(jī)制研究及指導(dǎo)臨床治療提供理論基礎(chǔ)。研究目的探究復(fù)發(fā)性外陰陰道假絲酵母菌病(RVVC)患者陰道菌群的動態(tài)變遷。研究方法1.研究對象:①RVVC組:選取6名于2015年12月～2016年6月在南方醫(yī)科大學(xué)珠江醫(yī)院婦產(chǎn)科就診的RWC患者;②對照組:于同期招募5名正常女性作為對照組納入研究。2.標(biāo)本采集:詳細(xì)告知研究對象本實驗研究方案及意義并簽署知情同意書后,囑研究對象自行在家至少每隔3天采集一次陰道分泌物,采集時間不少于2個月經(jīng)周期。采集方法:使用一次性棉簽拭子在陰道下1/3處輕輕旋轉(zhuǎn)至少10次,采集完后先置于-20℃冰箱冷凍,后定期將拭子轉(zhuǎn)移至實驗室-80℃低溫冰箱保存。3.實驗方法:分別對每個樣本進(jìn)行細(xì)菌總基因組DNA提取、16SrRNAV4區(qū)基因擴(kuò)增及采用Illumina高通量測序技術(shù)對擴(kuò)增的PCR產(chǎn)物進(jìn)行測序等步驟,再通過BIPES生物信息分析方法,分析比較兩組陰道菌群物種豐度和結(jié)構(gòu)以及菌群動態(tài)變化。4.統(tǒng)計學(xué)處理:應(yīng)用SPSS20.0軟件進(jìn)行統(tǒng)計學(xué)處理,對多樣性指數(shù)應(yīng)用Mann-WhitneyU檢驗。P0.05認(rèn)為差異具有統(tǒng)計學(xué)意義。研究結(jié)果1.正常女性除了以乳酸桿菌屬為優(yōu)勢菌屬外,加德納氏菌屬、普氏菌屬等均可以成為優(yōu)勢菌屬,當(dāng)女性以乳酸桿菌為優(yōu)勢菌屬時,其中又以卷曲乳酸桿菌占比居多;而RVVC患者陰道菌群豐富度明顯降低,多數(shù)RVVC患者是以惰性乳酸桿菌為優(yōu)勢菌屬,卷曲乳酸桿菌含量明顯減少;2.正常女性陰道菌群可隨月經(jīng)周期的變化出現(xiàn)波動,其中在月經(jīng)期的波動最為明顯,其優(yōu)勢菌屬在月經(jīng)周期中呈現(xiàn)相互交替或保持絕對優(yōu)勢的變化模式;而RVVC患者的陰道菌群相對穩(wěn)定,波動性減弱,并且在月經(jīng)期、發(fā)作期以及間歇期菌群結(jié)構(gòu)相似。研究結(jié)論1.RVVC患者陰道菌群相對穩(wěn)定,在月經(jīng)期、發(fā)作期以及間歇期菌群結(jié)構(gòu)相似;2.多數(shù)RVVC患者是以惰性乳酸桿菌為優(yōu)勢菌屬;3.RVVC的治療應(yīng)注重陰道微生態(tài)環(huán)境的調(diào)理,誘導(dǎo)卷曲乳酸桿菌產(chǎn)生或抑制惰性乳酸桿菌定植,從而恢復(fù)陰道菌群比例,可能可以治愈RVVC。
[Abstract]:Background Recurrent Vulvovaginal Candida Candida (RVV), a recurrent vulvovaginal candidiasis, means that after treatment, the clinical symptoms disappear and the mycology is negative, and then recur again. Local antifungal therapy is the main treatment for RWC at present, but recurrent recurrence has always been the bottleneck of disease treatment. The changes of vaginal microecological environment may play an important role in the occurrence and development of RWC, but the results of the study on vaginal microecology of RVVC have not been concluded. This study intends to collect vaginal secretions from RVVC patients and normal women at different time points. Illumina high-throughput sequencing and BIPES bioinformatics analysis were used to compare the structure of microflora and the dynamic changes in menstrual cycle between the two groups, as well as the differences of vaginal flora before and after the recurrence of RWC. Objective to explore the dynamic changes of vaginal flora in patients with recurrent vulvovaginal candidiasis. Six RWC patients in Zhujiang Hospital of Southern Medical University from December 2015 to June 2016 were selected as control group: 5 normal women were recruited as control group in the same period. Like this experimental research program and its significance, and after signing the informed consent letter, The subjects were told to collect vaginal secretions at least once every 3 days at home for no less than 2 menstrual cycles. After collecting, refrigerated at -20 鈩，

本文編號：1604172