珍屯医学

标题: 需氧性阴道炎 [打印本页]

作者: 大江 时间: 2020-3-22 00:01
标题: 需氧性阴道炎
需氧性阴道炎（AV）是一种由Donders等人首先描述的阴道炎。在2002年。[1] [2] 它的特征是乳酸菌菌群或多或少受到严重破坏，并伴有炎症，萎缩以及主要由肠道菌或病原体组成的需氧菌群[3]。

可以认为是细菌性阴道病的有氧对应物。缺乏对这两种情况之间差异的认识，可能导致过去几项研究的结论不准确。[4] 被描述为“脱皮性炎性阴道炎”的实体可能对应于需氧性阴道炎的更严重形式。[5]

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需氧性阴道炎（在14周龄的孕妇中）：基底层细胞，乳酸杆菌缺乏和其他细菌过度生长，发炎

内容
1 体征和症状
1.1 并发症
2 诊断
3 治疗
4 流行病学
5 参考

体征和症状
需氧性阴道炎的妇女通常会出现阴道粘膜变红的变薄现象，有时会出现广泛的糜烂或溃疡和泛黄的分泌物（无鱼腥味，这是典型的细菌性阴道病）。 pH值通常很高。症状包括灼热，刺痛和性生活困难。这些症状可能会持续很长时间，有时甚至是几年。通常情况下，患者已经使用抗真菌药和抗生素药物数次治疗而没有缓解。[3]在无症状的情况下，有微观证据，但没有症状。无症状病例的患病率未知。[3]

并发症
需氧性阴道炎与多种妇科和产科并发症有关

胎膜早破
早产
升性绒膜羊膜炎[6]。
增加性传播感染（包括艾滋病毒）的风险[7]
子宫颈抹片检查结果异常[8] [9]

诊断
诊断基于微观标准。理想情况下，使用相差显微镜放大400倍（高功率场）。[10]为了评分，必须评估白细胞的相对数量，毒性白细胞的百分比，背景菌群和上皮细胞的比例，乳杆菌等级：

治疗
治疗并不总是那么容易，其目的是纠正需氧性阴道炎遇到的三个关键变化：萎缩，炎症和异常菌群的存在。治疗可以包括局部类固醇减少炎症和局部雌激素减少萎缩。使用和选择抗生素来减少需氧细菌的负荷/比例仍然是一个有争议的问题。可以选择使用局部抗生素，最好是局部非吸收性和广谱性的药物，包括肠溶性革兰氏阳性和革兰氏阴性需氧菌，例如卡那霉素。在某些情况下，全身性抗生素可能会有所帮助，例如阿莫克拉韦或莫西沙星。[11]用聚维酮碘冲洗阴道可快速缓解症状，但不能长期减少细菌负荷。[12]氯化异喹啉也可以作为治疗选择。[13]

流行病学
约5％至10％的妇女受到需氧性阴道炎的影响。[14]孕妇的报告指出患病率为8.3-10.8％。[15] [16]

考虑有症状的女性时，AV的患病率可高达23％。[17] [18] [19]

参考文献：
Donders, Gilbert G.G.; Vereecken, Annie; Bosmans, Eugene; Dekeersmaecker, Alfons; Salembier, Geert; Spitz, Bernard (2002). "Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis: aerobic vaginitis". BJOG. 109 (1): 34–43. doi:10.1111/j.1471-0528.2002.00432.x. PMID 11845812.
Donders, Gilbert G. G.; Bellen, Gert; Grinceviciene, Svitrigaile; Ruban, Kateryna; Vieira-Baptista, Pedro (2017-05-11). "Aerobic vaginitis: no longer a stranger". Research in Microbiology. 168 (9–10): 845–858. doi:10.1016/j.resmic.2017.04.004. ISSN 1769-7123. PMID 28502874.
Donders, G; Bellen, G; Rezeberga, D (2011). "Aerobic vaginitis in pregnancy". BJOG. 118 (10): 1163–70. doi:10.1111/j.1471-0528.2011.03020.x. PMID 21668769.
Han, Cha; Wu, Wenjuan; Fan, Aiping; Wang, Yingmei; Zhang, Huiying; Chu, Zanjun; Wang, Chen; Xue, Fengxia (2015). "Diagnostic and therapeutic advancements for aerobic vaginitis". Archives of Gynecology and Obstetrics. 291 (2): 251–7. doi:10.1007/s00404-014-3525-9. PMID 25367602.
Newbern, EC; Foxman, B; Leaman, D; Sobel, JD (2002). "Desquamative Inflammatory Vaginitis An Exploratory Case-Control Study". Annals of Epidemiology. 12 (5): 346–52. doi:10.1016/S1047-2797(01)00316-7. PMID 12062923.
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