育龄期多囊卵巢综合征患者阴道微生态特征分析  

Vaginal microecological characteristics in reproductive-age patients with polycystic ovarian syndrome

作　　者：马雪莲[1] 陆月红[2] 严李萍[2] 马英英[2] 陈昊 丁杰锋[1] 应群华[1] 王立昌 MA Xuelian;LU Yuehong;YAN Liping;MA Yingying;CHEN Hao;DING Jiefeng;YING Qunhua;WANG Lichang(Department of Clinical Laboratory,Shaoxing Maternal and Child Health Care Hospital,Shaoxing 312000,China)

机构地区：[1]绍兴市妇幼保健院检验科,312000 [2]绍兴市妇幼保健院生殖健康科,312000

出　　处：《浙江医学》2021年第19期2090-2095,I0005,共7页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(2019KY229);绍兴市科技局公益性技术应用研究计划项目(2018C30038)。

摘　　要：目的探讨育龄期多囊卵巢综合征(PCOS)患者阴道微生态的特征,以利于临床精细化治疗,并为助孕创建良好的生殖环境。方法选取绍兴市妇幼保健院2019年1月至2021年1月生殖科收治的317例育龄期PCOS患者(研究组)和200例育龄期非内分泌疾病患者(对照组)。检测两组患者阴道分泌物的pH值、菌群密集度、多样性、优势菌、炎症情况、假丝酵母菌及乳杆菌等情况并作比较,结合细菌培养结果,分析阴道微生态失调情况。将PCOS患者根据病情进一步分为普通PCOS组144例、高雄激素血症(HA)组70例和胰岛素抵抗(IR)组103例,结合细菌培养结果,对比菌群检出情况,分别进行阴道微生态分析;并通过对比各亚组Nugent评分的差异,分析其阴道微生态失调程度;同时测定并比较IR组95例与普通PCOS组94例患者的雌二醇(E2)、孕酮(P)水平,分析IR组细菌性阴道病(BV)发病率高的原因。结果研究组与对照组患者阴道菌群密集度、多样性、pH值、优势菌比较差异均无统计学意义(均P>0.05),但研究组白细胞>10个/HP占比、阴道微生态失调率明显高于对照组,差异均有统计学意义(均P<0.05)。在各PCOS亚组中,普通PCOS组与对照组菌群检出情况和阴道微生态失调率差异均无统计学意义(均P>0.05),而HA组和IR组的阴道微生态失调率明显高于普通PCOS组,差异有统计学意义(P<0.05)。HA组非特异性炎症率、IR组BV检出率均明显高于普通PCOS组,HA组和IR组的混合感染发生率也明显高于普通PCOS组,差异均有统计学意义(均P<0.05)。IR组Nugent评分低分段(0~3分)患者占比最少(61.17%),与普通PCOS组(74.31%)的差异有统计学意义(P<0.05);而Nugent评分高分段(≥7分)者占比最多(27.18%),与普通PCOS组(16.67%)的差异有统计学意义(P<0.05);E2水平显著低于普通PCOS组(P<0.05),而P水平差异无统计学意义(P>0.05)。HA组患者阴道分泌物炎症明显,白细胞出现聚集,基底旁上皮�Objective To explore the characteristics of vaginal microecology of reproductive-age patients with polycystic ovarian syndrome(PCOS).Methods From January 2019 to January 2021,317 PCOS patients of childbearing age(study group)and 200 patients with non-endocrine diseases(control group)from Department of Reproductive Health of Shaoxing Maternal and Child Health Hospital were enrolled in the study.The pH value,flora density,flora diversity,dominant bacteria,inflammation,Candida and Lactobacillus in vaginal discharge were detected.PCOS patients were further divided into three groups:144 in general PCOS group,70 in hyperandrogenemia(HA)group and 103 in insulin resistance(IR)group.The Nugent scoring was used for evaluation of the degree of vaginal microecology disorders.The levels of estradiol(E2)and progesterone(P)were measured and compared between IR group(n=95)and general PCOS group(n=94)to explore the cause of bacterial vaginosis(BV)in the IR group.Results There were no significant differences in vaginal flora density,diversity,pH value and dominant bacteria between the study group and control group,however,the rate of inflammatory leukocytes and vaginal microecology disorder in the study group was significantly higher than that in the control group(P<0.05).There were no significant differences in the detection of flora and the rate of vaginal microecology disorders between the general PCOS group and the control group,while the rate of vaginal microecology disorder in the HA group and the IR group was significantly higher than that in the general PCOS group(P<0.05).The rates of non-specific inflammation in HA group and the bacterial vaginitis(BV)in IR group were significantly higher than those in general PCOS group(P<0.05).The incidence of mixed infection in IR group and HA group was also significantly higher than that in general PCOS group(P<0.05).The proportion of cases with low Nugent score segment(0-3)in IR group was signifi-cantly lower than that in the general PCOS group(61.17%vs.74.31%,P<0.05),while the propo

关 键 词：多囊卵巢综合征 胰岛素抵抗 高雄激素血症 阴道微生态特征 对比研究 

分 类 号：R711.75[医药卫生—妇产科学]