与有症状的外阴阴道念珠菌病相关的因素：在南非夸祖鲁-纳塔尔省一家初级保健诊所就诊的女性中的一项研究。
Factors Associated with Symptomatic Vulvovaginal Candidiasis: A Study among Women Attending a Primary Healthcare Clinic in Kwazulu-Natal, South Africa.
作者信息
Apalata T, Longo-Mbenza B, Sturm Aw, Carr Wh, Moodley P
机构信息
Department of Infection Prevention and Control and Medical Microbiology, School of Laboratory-Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa ; Department of Medical Microbiology, Faculty of Health Sciences, Walter Sisulu University, Buffalo City, Eastern Cape, South Africa.
Department of Medical Microbiology, Faculty of Health Sciences, Walter Sisulu University, Buffalo City, Eastern Cape, South Africa.
出版信息
Ann Med Health Sci Res. 2014 May;4(3):410-6. doi: 10.4103/2141-9248.133470.
BACKGROUND
Symptomatic vulvovaginal candidiasis (VVC) is one of the most common problems leading women to seek advice in primary healthcare facilities.
AIM
The aim of this study is to describe the associations between some hypothesized factors and the presence of symptomatic VVC.
SUBJECTS AND METHODS
An analytical cross-sectional study was conducted. A total of 90 women diagnosed with symptomatic VVC and 108 women without symptomatic VVC were recruited when attending Umlazi D clinic, a primary health clinic in KwaZulu-Natal, South Africa between June 2011 and December 2011. Confirmed symptomatic VVC was determined by Gram stain and microbiological culture of vaginal swabs. For human immunodeficiency virus (HIV)-infected women, HIV ribonucleic acid load in plasma and genital fluid was determined by real-time-polymerase chain reaction (BioMerieux, Lyon, France). CD4 counts were obtained from patients' medical records. Data were analyzed using the statistical package for the social sciences (SPSS) version 21.0 (SPSS Inc.; Chicago, IL, USA). Multiple logistic regression models were used to exclude univariate confounders. All tests were two-sided and a P < 0.05 was considered to be significant.
RESULTS
A total of 90% (81/90) of patients with symptomatic VVC complained of vulval itching, soreness and vaginal discharge when compared to 75.9% (82/108) of patients without symptomatic VVC (P < 0.01). Whilst pregnancy was independently associated with symptomatic VVC (P < 0.01), the latter was inversely related to Nugent's scores (P < 0.01). When compared with HIV negative women, the odds for symptomatic VVC increased among women with HIV-associated immunocompromise (CD4 counts < 200 cells/mm(3), P < 0.001), significantly shedding HIV in their genital tracts (P = 0.04), with plasma HIV load > 1000 copies/mL (P < 0.001). There was a significant negative association between the use of highly active anti-retroviral therapy and the presence of symptomatic VVC in HIV-infected women (P < 0.01).
CONCLUSION
Although symptomatic VVC is not classified as acquired immunodeficiency syndrome-related condition, HIV-related immune compromised women and particularly those who are anti-retroviral therapy-naïve are likely to develop symptomatic VVC.
背景
有症状的外阴阴道念珠菌病（VVC）是导致女性在初级卫生保健机构寻求建议的最常见问题之一。
目的
本研究的目的是描述一些假设因素与有症状VVC存在之间的关联。
研究对象与方法
进行了一项分析性横断面研究。2011年6月至2011年12月期间，在南非夸祖鲁 - 纳塔尔省的一家初级卫生诊所Umlazi D诊所就诊时，共招募了90名被诊断为有症状VVC的女性和108名无有症状VVC的女性。通过阴道拭子的革兰氏染色和微生物培养确定确诊的有症状VVC。对于感染人类免疫缺陷病毒（HIV）的女性，通过实时聚合酶链反应（法国里昂生物梅里埃公司）测定血浆和生殖道中的HIV核糖核酸载量。从患者的病历中获取CD4细胞计数。使用社会科学统计软件包（SPSS）21.0版（SPSS公司；美国伊利诺伊州芝加哥）分析数据。使用多元逻辑回归模型排除单变量混杂因素。所有检验均为双侧检验，P < 0.05被认为具有统计学意义。
结果
与108名无有症状VVC的患者中的75.9%（82/108）相比，90%（81/90）有症状VVC患者主诉外阴瘙痒、疼痛和阴道分泌物（P < 0.01）。虽然怀孕与有症状VVC独立相关（P < 0.01），但后者与纽金特评分呈负相关（P < 0.01）。与HIV阴性女性相比，HIV相关免疫功能低下（CD4细胞计数<200个细胞/mm³，P < 0.001）、生殖道大量排出HIV（P = 0.04）、血浆HIV载量>1000拷贝/mL（P < 0.001）的女性发生有症状VVC的几率增加。在感染HIV的女性中，使用高效抗逆转录病毒疗法与有症状VVC的存在之间存在显著负相关（P < 0.01）。
结论
虽然有症状的VVC未被归类为与获得性免疫缺陷综合征相关的疾病，但与HIV相关的免疫功能低下的女性，尤其是那些未接受过抗逆转录病毒治疗的女性，很可能会发生有症状的VVC。
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