摘要
目的对妊娠与非妊娠假丝酵母菌性外阴阴道病（VVC）致病菌株进行基因分型,并初步探讨不同基因型菌株对抗真菌药物是否存在敏感性差异。方法选取2011—2014年在昆明医科大学第一附属医院妇产科门诊就诊的VVC患者373例,其中非妊娠VVC患者197例,妊娠（10~40周）VVC患者176例。以科玛嘉显色培养基和VITEK 2系统鉴定致病菌菌种,采用改良的微量平板稀释法进行克霉唑、制霉菌素和咪康唑的体外药敏实验,特异引物PCR对致病白假丝酵母菌基因分型,并对不同基因型致病菌的体外药敏结果进行比较。结果非妊娠VVC患者检出白假丝酵母菌166株（84.26%）,妊娠VVC患者检出白假丝酵母菌134株（76.14%）,妊娠VVC患者白假丝酵母菌检出率低于非妊娠VVC患者,差异有统计学意义（χ~2=3.901,P=0.048）。妊娠与非妊娠VVC患者致病白假丝酵母菌克霉唑、咪康唑最小抑菌浓度（MIC）值均低于非白假丝酵母菌（妊娠：Z_（克霉唑）=6.275,P〈0.001;Z_（咪康唑）=5.102,P〈0.001;非妊娠：Z_（克霉唑）=3.095,P=0.002;Z_（咪康唑）=2.169,P=0.030）;妊娠VVC致病白假丝酵母菌咪康唑、制霉菌素MIC值低于非妊娠VVC患者（Z=3.074,P=0.002;Z=4.982,P〈0.001）。妊娠VVC致病白假丝酵母菌对克霉唑、咪康唑敏感率较高（≥91.04%）,少有耐药菌株;非妊娠VVC致病白假丝酵母菌菌株对克霉唑敏感率达96.38%。妊娠VVC患者A基因型菌株113株,B基因型菌株10株,C基因型菌株11株;非妊娠VVC患者分别为152、5、9株,两组患者不同基因型白假丝酵母菌菌株构成比比较,差异无统计学意义（χ~2=4.189,P=0.114）。妊娠VVC患者A基因型菌株的咪康唑MIC值高于非妊娠VVC患者A基因型菌株（Z=2.804,P=0.005）,而制霉菌素MIC值低于非妊娠VVC患者A基因型菌株（Z=4.869,P〈0.001）。妊娠VVC致病白假丝酵母菌B、C基因型菌株全部对克霉唑、咪康唑敏感,而A基因型菌株敏感率�
Objective To conduct genetic typing on pathogenic microorganisms in pregnant and non - pregnant patients with vulvovaginal candidiasis （VVC） and investigate the difference in the .susceptibility of pathogenic microorganisms of different genotypes towards antifungal drugs. Methods We enrolled 373 VVC outpatients who were treated in the Department of Obstetrics ＆ Gynecology of the First Affiliated Hospital of Kunming Medical Universty from 2011 to 2014, among which 197 patients were not pregnant and 176 pateins were pregnant （ 10 weeks to 40 weeks）. Using CHROM agar Salmonella Medium and Vitek 2 system, the pathogenic microorganisms were identified. In vitro tests on drug sensitivity to clotrimazole, nystatin and miconazole were conducted using the improved version of trace plate, dilution method. Specific primer PCR was used to congduct genetic typing on pathogenic candida albicans. In vitro chemo - drug sensitive tests were undertaken on candida isolates with different genotypes of VVC. Results A total of 166 （84. 26% ） stains of candida albicans were detected in non - pregnant VVC patients, and 134 （76. 14% ） stainswere detected in pregnant VVC patients. Pregnant VVC patients had lower detection rate of candida albicans than non pregnant VVC patients （ X2 = 3. 901, P = 0. 048 ）. In all patients, the MIC values of clotrimazole and miconazole of pathogenic candida albicans were lower than non candida albicans candida species （ pregnant： Zmiconazole =6. 275, P 〈 0. 001 ; Zmiconazole = 5. 102, P 〈 0. 001 ; non - pregnant： Zmiconazole= 3. 095, P = 0. 002; Zmiconazole=2. 169, P = 0. 030） ; pregnant patients had lower MIC values of miconazole and nystatin than non pregnant patients （ Z = 3. 074, P = 0. 002; Z = 4. 982, P 〈 0. 001 ）. Pregnant patients had high proportion （ ≥91.04% ） of strains of pathogenic candida albicans sensitive to clotrimazole and miconazole, and strains with drug resistance was in a small proportion ; non - pregnant patients had high proportion （96.
出处
《中国全科医学》
CAS
CSCD
北大核心
2016年第2期233-237,共5页
Chinese General Practice
基金
国家自然科学基金资助项目(81160076)
云南省中青年学术技术带头人后备人才培养项目(2012HB029)
云南省医学学科带头人培养项目(D-201225)
