Research On Characteristics Of Pathogenic Microbio And Serum Th1,Th2 And Th17 Ralated Cytokines In Patients With Recurrent Vulvovaginal Candidiasis

Objective: To determine epidemiological,clinical and mycological characteristics of recurrent vulvovaginal candidiasis(RVVC)and the expression of Th1,Th2 and Th17 associated pro-inflammatory and anti-inflammatory cytokines in the serum.From pathogenic fungi and host immunity level,we explore the possible pathogenesis of RVVC to provide theoretical basis for the prevention and treatment of RVVC.Methods: We collected the clinical epidemiology and pathogenic fungi of RVVC and vulvovaginal candidiasis(VVC)from October 2017 to May 2018 in Jining No’1 People’s Hospital,to identify of yeast species,compare species distribution and investigate the anti-fungal susceptibility profiles in vitro;and attain the serum to detect the levels of Th1,Th2 and Th17 related cytokines.Results: The age range of onset in the RVVC group/VVC group were 27-52 years old/16-55 years old,respectively;with the average age of 35.1 years/31.3 years old,and the incidence of two groups both were higher in 25-34 years old.The onset age and average age of the RVVC group were later than that of the VVC group(P>0.05).Age,host and external factors,genetics,species distribution as well as Candida strain were the inducers of RVVC and VVC.Of them,93(94.9%)C.albicans,3(3.1%)C.glabratas,and 2(2%)C.tropicalis were isolated.The proportion(10%)of non-albicans Candida species(NAC)in RVVC group was higher than that in VVC group(3.9%),but there was no statistical difference.The differences between susceptibility rates were not statistically significant between the two groups.Micafungin was the most active drugs against C.albicans isolated from RVVC and VVC(susceptibility rate: 100%/100%).The first resistant agent was Terbinafine,followed by Amphotericin B(resistance rate: 88.9/98.7%),itraconazole(14.7%/0%).Resistance rate of non-albicans Candida species was generally higher than that of C.albicans.The level of IFN-γand TNF-αin RVVC group were lower than that of VVC group,IL-4 was higher than that of VVC group,and there were statistically significant.The level of IL-17A/IL-17F/IL-10/IL-6 and IL-2 in RVVC group were lower than VVC group,but there were not statistically significant.Conclusion: RVVC and VVC both were a multifactorial disease.C.albicans(94.9%)was still the predominant species of RVVC/VVC,while C.glabrata(60%)was the main species in NAC.There was no significant difference in the characteristics of pathogenic microbio between two groups.The sensitive drugs included echinomycin and the second and third generation of triazole antifungal drugs,but the first generation of triazole antifungal drugs had shown partial drug resistance.From the perspective of host immunology,Th1/Th2 associated cellularimmunity played an important role in RVVC,but Th17-related immunity remained to be further validated.