Zong X N, Feng Y Z, Bai H H, Wang H S Q, Shang X, Fan L Y, Li T, Zhang Z, Du M Y, Liu Z H
Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100026, China.
School of Basic Medicine, Capital Medical University, Beijing 100069, China.
Zhonghua Fu Chan Ke Za Zhi. 2023 Mar 25;58(3):191-197. doi: 10.3760/cma.j.cn112141-20221212-00754.
To analyze the vaginal microecological status of vaginitis population and non-vaginitis population of gynecological female outpatients. A total of 30 265 women who visited the gynecological outpatient clinic of Beijing Obstetrics and Gynecology Hospital from December 2018 to December 2020 completed vaginal microecological examination. After removing the follow-up patients, 23 181 women were divided into group with symptoms and signs of vaginitis (6 697 cases) and group without symptoms and signs of vaginitis (16 484 cases), according to whether the women with symptoms and signs of vaginitis or not. And the vaginal microecological status of the two groups was compared and analyzed. (1) The total detection rate of vaginitis in the initial women was 34.87% (8 083/23 181), of which 46.10% (3 087/6 697) in group with symptoms and signs of vaginitis and 30.31% (4 996/16 484) in group without symptoms and signs of vaginitis, nearly 1/3 of the gynecological outpatients without signs and symptoms of vaginitis had vaginitis. (2) Among the types of simple vaginitis, vulvovaginal candidiasis (VVC) was the most frequent in group with symptoms and signs of vaginitis (16.01%, 1 072/6 697), followed by aerobic vaginitis (AV; 12.83%, 859/6 697), with significant differences compared with group without symptoms and signs of vaginitis (all <0.001). There were no statistical differences between the two groups of bacterial vaginosis (BV) and trichomonal vaginitis (TV), indicating that BV and TV were more likely to be neglected (all >0.05). (3) The proportion of various combinations of vaginitis among 2 632 cases of mixed vaginitis were, in descending order: BV+AV, VVC+AV, BV+AV+VVC, AV+TV, AV+TV+BV, BV+VVC. (4) Microecological analysis of 15 098 cases diagnosed with non-vaginitis had normal flora (including those with normal flora and those with normal flora but decreased function) in 14 013 cases (92.81%, 14 013/15 098), abnormal flora in 429 cases (2.84%, 429/15 098) and the BV intermediate in 656 cases (4.34%, 656/15 098); this indicated that the vast majority of the microecological tests were normal in the vaginal microbiota of those without vaginitis. Microecological examination could diagnose multiple pathogenic infections at once, and is especially important as a guide for the definitive diagnosis of mixed vaginitis and vaginitis with atypical clinical symptoms. Vaginal infections such as BV and TV that are easily overlooked should be concerned.
分析妇科门诊女性阴道炎患者与非阴道炎患者的阴道微生态状况。2018年12月至2020年12月期间，共有30265名女性在北京妇产医院妇科门诊就诊并完成阴道微生态检查。剔除失访患者后，根据有无阴道炎症状体征，将23181名女性分为阴道炎症状体征组（6697例）和无阴道炎症状体征组（16484例），并对两组阴道微生态状况进行比较分析。（1）初诊女性阴道炎总检出率为34.87%（8083/23181），其中阴道炎症状体征组为46.10%（3087/6697），无阴道炎症状体征组为30.31%（4996/16484），近1/3无阴道炎症状体征的妇科门诊患者患有阴道炎。（2）在单纯性阴道炎类型中，阴道炎症状体征组外阴阴道假丝酵母菌病（VVC）最为常见（16.01%，1072/6697），其次是需氧菌性阴道炎（AV；12.83%，859/6697），与无阴道炎症状体征组相比差异有统计学意义（均<0.001）。两组细菌性阴道病（BV）和滴虫性阴道炎（TV）比较差异无统计学意义，提示BV和TV更易被漏诊（均>0.05）。（3）2632例混合性阴道炎中，各种阴道炎组合比例由高到低依次为：BV+AV、VVC+AV、BV+AV+VVC、AV+TV、AV+TV+BV、BV+VVC。（4）对15098例诊断为非阴道炎患者进行微生态分析，14013例（92.81%，14013/15098）菌群正常（包括菌群正常和菌群正常但功能下降），429例（2.84%，429/15098）菌群异常，656例（4.34%，656/15098）为BV中间型；这表明绝大多数无阴道炎患者阴道微生态检测正常。微生态检查可一次性诊断多种病原体感染，对于混合性阴道炎及临床症状不典型的阴道炎的明确诊断具有重要指导意义。应关注BV和TV等易被忽视的阴道感染。
