白假丝酵母菌基因型和假丝酵母菌群分布与外阴阴道假丝酵母菌病严重程度的相关性分析

摘要

探讨致病假丝酵母菌菌群分布以及白假丝酵母菌基因型与外阴阴道假丝酵母菌病症状严重程度的关系.方法 我们对2009年9月～2010年10月在我院就诊的,以及生活习惯、饮食、既往用药及工作环境相似的急性VVC患者,利用聚合酶链反应-单链构象多态性分析技术(PCR-SSCP)对其阴道来源的假丝酵母菌进行分子水平的菌种鉴定,结合SSCP和基因扫描(GeneScan)对白假丝酵母菌CAI区进行多态性分析确定其基因型,对VVC的严重程度进行临床症状体征的评分.结果 从获得的198份标本中分离白假丝酵母菌140株(70.7%)；58株非白假丝酵母菌(29.3%).198名患者中重度VVC 95人,轻中度VVC 103人.白假丝酵母菌在重度VVC和轻中度VVC患者中所占比列分别为62.1%和76.6%(P=-0.011).140株C.albican共检出38种CA1基因型且集中分布于少数几种,其中基因型30-45(44株,31.43%)和32-46 (23株,16.43%)最常见,其次为基因型30-46(4株,2.86%)和32-47(9株,6.42%).以上4种优势基因型菌株在重度VVC和轻中度VVC患者中的分布差异有统计学意义(77.9%vs42.0%,P＜0.001).结论 白假丝酵母菌仍然是VVC的主要致病菌,但非白假丝酵母菌与白假丝酵母菌相比更容易引起重度VVC,白假丝酵母菌的基因型与VVC严重程度有关.%Objective To investigate the distribution of pathogenic C.albican genotype and Candida species in association with the severity of vulvovaginal candidiasis (VVC).Methods Polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) of the internal transcribed spacer analysis was employed to identify the Candida species isolated from the vaginal secretions of 198 patients with acute VVC.SSCP and GeneScan analyses of microsatellite locus I polymorphism were used to determine the genotypes of the clinical isolates of C.albican associated with VVC.All the patients were scored for clinical signs and symptoms to evaluate the severity of VVC.Results A total of 198 Candida strains were isolated from VVC patients,including 140 (70.7%) C.albicans strains and 58 (29.3%) non-albicans strains.In the 95 patients with severe VVC and 103 with mild-moderate VVC,Calbican was detected in 62.1% and 76.6% of the patients,respectively (P=0.011).Thirty-eight microsatellite locus I genotypes were detected in 140 unrelated C.albican strains,among which the dominant genotypes 30-45 (44 strians,31.43%) and 32-46 (23 strains,16.43%) were the most common,followed by genotypes 30-46 (4 strains,2.86%)and 32-47 (9 strains,6.42%).The overall frequencies of the 4 genotypes were significantly higher in severe VVC than in mild-moderate VVC cases (77.9% vs 42.0%,P＜0.001).Conclusion C.albicans remains the most common pathogenic Candia species in patients with VVC,but the non-alibcans species seem more likely to cause severe VVC.The dominant genotypes of C.albicans with a tropism for the vagina are correlated to the severity of VVC.