Sobel J D
Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan 48201.
Ann N Y Acad Sci. 1988;544:547-57. doi: 10.1111/j.1749-6632.1988.tb40450.x.
In contrast to women with infrequent episodes of candidal vaginitis, women with chronic and recurrent candidal vaginitis do not have recognizable precipitating or causal factors. Analysis of vaginal yeast isolated from women with recurrent candidal vaginitis, although revealing a higher percentage of non-albicans Candida sp., indicates that resistance to imidazoles is not a causal factor, and other fungal virulence factors that could explain the repeated attacks have not been identified. Strain typing of sequential clinical isolates indicates a pattern of vaginal relapse rather than frequent vaginal reinfection, and attempts to reduce attacks by treating sexual partners and suppressing a gastrointestinal tract focus have failed. Recent immunological studies suggest the possibility of an acquired Candida antigen-specific immunological deficiency resulting in uncontrolled vaginal Candida proliferation and hence repeated clinical attacks. In support of the immunological hypothesis is the recent report of normal T lymphocyte suppression of Candida hyphal production.
与偶发性念珠菌性阴道炎的女性不同，患有慢性复发性念珠菌性阴道炎的女性没有可识别的诱发因素或病因。对复发性念珠菌性阴道炎女性分离出的阴道酵母菌进行分析，虽然发现非白色念珠菌属的比例较高，但表明对咪唑类药物的耐药性不是病因，且尚未发现其他可解释反复发病的真菌毒力因子。对连续临床分离株进行菌株分型显示为阴道复发模式，而非频繁的阴道再感染，通过治疗性伴侣和抑制胃肠道病灶来减少发作的尝试均告失败。最近的免疫学研究表明，可能存在获得性念珠菌抗原特异性免疫缺陷，导致阴道念珠菌不受控制地增殖，从而引发反复的临床发作。支持这一免疫学假说的是最近关于正常T淋巴细胞抑制念珠菌菌丝产生的报道。
