The Study Of The Relationship Among Vulvovaginal Candidiasis From Human Defensins, Pathogens And Complicated Infection

Objective By comparing Candida vulvovaginal disease(VVC),recurrent vulvovaginal Candida disease(RVVC) patients and healthy women vaginal lavage content of human defensin HNP-1~3,study the relationship among the human defensins,VVC,and RVVC relationship,from the immunological aspects of VVC, RWC cause.Through secretions of the vagina and cervical of patients with VVC and RVVC,fungal culture are carried on to do strain typing,drug susceptibility test,mycoplasma and chlamydia testing,investigate the etiology of VVC recurrent reasons.By observing therapy the Miconazole of VVC and combination therapy the Kushen Tang and Miconazole of VVC,research the curative effect of combination therapy the traditional Chinese drug and western medicine.Methods Vaginal lavage were obtained from VVC patients(VVC group,50 cases), RVVC patients(RVVC group,28 cases) and normal women(control group,30 cases), concentration in vaginal lavage were determined by ELISA for HNP-1~3.The VVC group were randomly divided into western medicine treatment group(20 cases) and western and Chinese medicine combination treatment group(20 cases). western medicine treatment group:using 2%sodium bicarbonate solution and Miconazole;western and Chinese medicine combination treatment group:using Kushen Tang and Miconazole,the two groups at 7 days after stopping treatment, the same method to test the concentration of HNP-1~3.118 VVC patients were randomly divided into western medicine treatment group(47 cases) and western and Chinese medicine combination treatment group(53 cases),.The two groups stop the drug after the 7 days and in the following 3 months detect the vaginal secretions again and evaluate the curative effect.Vaginal and cervical secretions were obtained from 86 VVC patients,46 RVVC patients and 56 healthy women for fungal culture,strain typing,drug susceptibility test and detection of Chlamydia trachomatis(CT),Ureaplasma urealyticum(Uu), Mycoplasma hominis(Mh).Results(1) The concentration of HNP-1~3 in VVC group(89.2744±17.7876ng/ml) was significantly higher than the control(40.811±16.5991ng/ml)group,the concentration of HNP-1~3 in RVVC group(30.0976±10.0104 ng/ml) was lower than the control group and VVC group,the differences were statistically significant(P<0.05).(2) Western medicine treatment group and western and Chinese medicine combination treatment group after treatment,HNP-1~3 of the content(of 34.2677±17.4952 ng/ml,30.5826±19.7172 ng/ml) were significantly lower than before treatment(the content of 96.3359±15.1094ng/ml,86.4513±18.6335ng/ml),the differences were statistically significant(P<0.05).(3) Western and Chinese medicine to alleviate symptoms of the treatment group a short time in western medicine treatment group,the difference was statistically significant(P<0.05).(4) The proportion of Candida albicans in RVVC group and VVCgroup was higher than the non-Candida albicans.The proportion of non-Candida albicans in RVVC group(19.6%) is higher than the VVC group(6%),the difference was statistically significant(P<0.05).(5) The sensitivity to fluconazole(88%) of VVC group was higher than RVVC group(69.6%),the difference was statistically significant(P<0.05);the sensitivity of Candida albicans to fluconazole,clotrimazole/miconazole (83.3%,89.33%) were higher than that of non-Candida albicans(both 50%),the resistance to fluconazole(8.3%) was lower than the non-Candida albicans (33.3%),the difference was statistically significant(P<0.05).(6)Uu,Mh and CT infection rate of RVVC(54.3%,13%,17.4%) was higher than the normal group(16.1%,1.8%,3.6%),The Uu and CT infection rate of RVVC was higher than the VVCgroup(33.7%,4.7%),the difference was statistically significant (P<0.05).Conclusion 1.The human defensins appear to participate in the host defense in Candida vulvovaginal disease and play a protective effect.The absence of local secretion of human defensins may be correlated with RVVC.2.The main pathogens of WC and RVVC are Candida albicans.RWC more easier caused by non-Candida albicans.The sensitivity and resistance to antifungal agents of White and non-wite albicans Candida are different,but are easily to have azole drug resistance.The fungal culture,strain typing,drug susceptibility test should be tested for RVVC patients.3.Mycoplasma infect VVC and RVVC patient more easier than normal person, and the complicated infection may induce RVVC.The detection of mycoplasma and chlamydia should be done if necessary,and the anti non-gonococcal therapy and antimycotic therapy should be used.