478例复发性外阴阴道假丝酵母菌病的病原菌分布及耐药情况分析  

Investigation of the pathogen flora and drug resistence analysis in 478 recurrent vulvovaginal candidiasis cases

作　　者：刘瑛[1] 黄振宇[1] 王颖[1] 王玉凤 王晓茜[1] 张蕾[1] 廖秦平[1] LIU Ying;HUANG Zhenyu;WANG Ying;WANG Tufeng;WANG Xiaoqian;ZHANG Lei;LIAO Qinping(Department of Obstetrics and Gynecology,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China)

机构地区：[1]清华大学附属北京清华长庚医院妇产科、清华大学临床医学院,102218

出　　处：《中国妇产科临床杂志》2022年第4期374-377,共4页Chinese Journal of Clinical Obstetrics and Gynecology

基　　金：国家自然科学基金(81671409);北京市自然科学基金(7202239);北京市属医院科研培育计划项目(PX2017040)。

摘　　要：目的探讨复发性外阴阴道假丝酵母菌病(recurrent vulvovaginal candidiasis,RVVC)的病原菌分布及其耐药情况。方法选取2015年4月至2020年3月于清华大学附属北京清华长庚医院妇科门诊确诊为RVVC的患者478例,留取阴道分泌物行真菌体外培养,通过菌种分离及药敏试验对其病原菌进行鉴定与耐药性分析。结果按分离的5种真菌菌株所占菌株总数比例计算,其中白色假丝酵母菌、光滑假丝酵母菌、克柔假丝酵母菌、热带假丝酵母菌和其他假丝酵母菌分别占74.48%(356/478)、14.64%(70/478)、2.30%(11/478)、1.46%(7/478)和7.11%(34/478),差异有统计学意义(P<0.001)。5种假丝酵母菌对克霉唑、氟康唑、咪康唑、伊曲康唑、制霉菌素的耐药率分别为14.85%、35.56%、40.59%、53.14%和0.42%,差异有统计学意义(P<0.001);白色假丝酵母菌对5种药物的耐药率分别为9.27%、21.07%、45.51%、45.51%和0.28%;光滑假丝酵母菌5种药物的耐药率分别为40.00%、91.43%、25.71%、85.71%和1.43%。结论RVVC病原菌仍以白色假丝酵母菌为主,其中以光滑假丝酵母菌为主;不同RVVC菌株对5种不同抗真菌药物耐药性有显著差异,在治疗中应结合致病菌的种类和耐药情况合理选择抗真菌药物。Objective To investigate the pathogen flora and drug resistance of recurrent vulvovaginal candidiasis(RVVC).Methods Fungal culture and drug sensitivity tests of vaginal secretion for 478 RVVC patients were performed in Beijing Tsinghua Changgung Hospital from April 2015 to March 2020.Results According to the proportion of 5 fungal strains in the total number of isolates,candida albicans,Candida glabricis,Candida croce,Candida tropicalis and other candida accounting for 74.48%,14.64%,2.30%,1.46%and 7.11%respectively,the difference was statistically significant(P<0.001).Through drug sensitivity test,it was found that the resistance rate of these five Candida species to to clotrimazole,flucanazole,miconazole,itraconazole and nystatin were 14.85%,35.56%,40.59%,53.14%and 0.42%respectively(P<0.0001).Drug resistance rates of Candida albicans to to 5kinds of drugswere 9.27%,21.07%,45.51%,45.51%and 0.28%respectively.Drug resistance rates of Candida glabrata to these drugs were 40.00%,91.43%,25.71%,85.71%and 1.43%respectively.Conclusion The main pathogen of RVVC is Candida albicans.Among which,Candida glabrata accounted for the highest proportion.The drug resistance rates of different RVVC species to clotrimazole,flucanazole,miconazole,itraconazole and nystatin varies significantly.In the treatment of RVVC cases,the rational choice of antifungal agents according to the drug resistance situation can help improving the clinical efficacy.

关 键 词：复发性外阴阴道假丝酵母菌病 真菌培养 耐药性 抗真菌药 

分 类 号：R711.31[医药卫生—妇产科学]