Study On The Correlation Of Vaginal Innate Immunity Factor TLR4 And HD5 With Recurrent Vulvovaginal Candidiasis

Objective:To investigate the species of the clinical isolates of ulvovaginal Candidiasis(VVC) and recurrent vulvovaginal candidiasis(RVVC) and the drug resistance of candidasis.To analyze the relationship between innate immunity and RVVC by measuring the level of Toll-like receptor 4(TLR4) and human defensin 5(HD5) in cervicovaginal lavage fluid (CVL).Methods:CHROM agar and AP I Candida,AP I20CAUX were applied to isolate and determine the species of candida.ROSCO Neo-Sensitab disk diffusion was used for yeast sensitive test.44 VVC and 32 RVVC and 40 healthy women(control grouop) at the Women' s Hospital of Zhejiang University from May 2009 to August 2009 were recruited to the study.CVL was collected from these patients.The concentrations of TLR4 and HD5 were measured by enzyme-linked immunosorbent assay(ELISA).Results:1.The relevance ratio of non-candida albicans in RVVC group(18.8%) was no significantly higher than that in VVC group(15.6%).2.Drug susceptibilities were 100%for amphotericin B and fluconazole,92.2%for clotrimazole,98.7%for itraconazole,only 33.8%for miconazole.Respectively species of sensitive drug for miconazole in VVC group were higher than those in RVVC group, but there was no statistically significant difference.3.The sensitivity of miconazole in non-albicans strains were significantly higher than those in C.albicans.4.Compared to the control group,TLR4 was significantly increased in VVC and RVVC group(P=0.000,0.032),but there was no significant difference in the expression of TLR4 between VVC and RVVC groups(P=0.074).5.HD5 is increased in VVC and RVVC group than in the control group,but there was no significant difference in the expression of HD5 among VVC,RVVC and control groups.Conclusion:1.Candida albicans is still the major pathogen in VVC and RVVC.2.The strains isolated from VVC and RVVC patients are still highly sensitive to common antifungal drugs,except miconazole.3.The high level of TLR4 in the vaginal immunity environment may be one of the main pathogenesis of VVC and RVVC.4.HD5 may be irrelative with the incidence of RVVC.