Study On The Vaginal Microecology Of Patients With Recurrent Vulvovaginal Candida Disease Of Spleen Deficiency And Dampness Type

BackgroundBased on the previous investigation of the syndrome characteristics of patients with recurrent vulvovaginal candida disease,around the pathogenesis of RVVC,further in-depth research on vaginal microecology of RVVC Spleen Deficiency and Dampness Syndrome,In order to clarify the influence mechanism of vaginal microecology in recurrent vulvovaginal candidiasis.ObjectiveResearch objects included RVVC patients with spleen deficiency and dampness syndrome and damp-heat syndrome,RVVC and VVC patients with Spleen Deficiency and Dampness Type.Illumina Mi Seq high-throughput sequencing as a research tool,by observing the vaginal microecological changes of each group,comparing the similarities and differences of the colony composition of each group.In order to clarify the vaginal microecological characteristics related to spleen deficiency and dampness,to observe the changing trend of vaginal colonies behind repeated VVC attacks,to provide a certain theoretical basis for the prevention and treatment of RVVC.Methods1.Research on TCM Syndrome and TCM Physique:Apply the self-made"Symptom Questionnaire"and the"Traditional Chinese Medicine Physical Fitness Questionnaire"formulated by Professor Wang Qi of Beijing University of Chinese Medicine.A collection of RVVC and VVC patients who attended the gynecological clinic of the Fifth Affiliated Hospital of Southern Medical University from June 2020 to September 2020,Patients with syndrome differentiation of spleen deficiency and dampness syndrome and damp-heat syndrome.The control group came from healthy people from the Physical Examination Department of the Fifth Affiliated Hospital of Southern Medical University.Completed the questionnaire when the research subject visits a doctor,in order to explore the syndrome characteristics of RVVC patients by comparing the distribution and integral of syndromes,to analyze the physical characteristics of RVVC patients by discriminating physical fitness.2.Vaginal microecology research:The experiment was divided into RVVC group,VVC group,and control group,using case-control research methods.35cases were included in the RVVC group,39 cases in the VVC group,37 cases in the normal group,111 cases were included.Collected secretions on the 1/3of the vaginal side wall of each subject,Performed Illumina Mi Seq high-throughput sequencing and vaginal microecological examination.In order to compare the similarities and differences in the composition of vaginal microecology between groups,to explore the relationship between vaginal colony composition and the onset of RVVC.This study was approved by the Ethics Committee of the Fifth Affiliated Hospital of Southern Medical University(approval number:2020-FCK-K-002).Result1.Syndrome study:This study included 30 cases(30/35)with spleen deficiency and dampness syndrome in the RVVC group,5 cases(5/35)with damp-heat syndrome;30 cases(30/39)with spleen deficiency and dampness syndrome in the VVC group,and9 cases with damp-heat syndrome(9/39).There was no statistical difference in the distribution of spleen deficiency and dampness syndrome and damp-heat syndrome between the two groups.The score of spleen deficiency and dampness resistance in the RVVC group was 15.73±5.87,and the score of spleen deficiency and dampness resistance in the VVC group was 12.40±3.25.There was a statistical difference between the groups(P<0.05).The score of damp-heat syndrome in RVVC group was 20.80±2.25,and the score of damp-heat syndrome in VVC group was 17.33±1.67,there was no statistical difference between the groups(P>0.05).2.Research on vagina microecology:(1)Comparison of Cleanness degree of vagina(CDV):There are statistical differences in CDV distribution among the three groups,However,there was no significant difference in the distribution of CDV between the RVVC group and the VVC group in different syndrome types and different stages of the menstrual cycle.(2)Acetylglucosaminidase(NAG):Acetylglucosaminidase is an acid hydrolase in the lysosome,which is positive for Candida infection.There are statistical differences in NAG distribution among the three groups,However,there was no significant difference in the distribution of NAG between the RVVC group and the VVC group in different syndrome types and different stages of the menstrual cycle.(3)Leucocyte esterase(LE):Leucocyte esterase is an indicator of inflammation.There are statistical differences in LE distribution among the three groups,However,there was no significant difference in the distribution of LE between the RVVC group and the VVC group in different syndrome types and different stages of the menstrual cycle.(4)Hydrogen peroxide(H₂O₂):There was a statistical difference in H₂O₂distribution among the groups(P=0.01).There was a statistical difference in the positive rate of H₂O₂ between the RVVC group and the VVC group.However,there was no significant difference in the distribution of H₂O₂between the RVVC group and the VVC group in different syndrome types and different stages of the menstrual cycle.(5)Sialidase:Sialic neuraminidase is a marker of pathogenic bacteria such as Gardnerella.There was no statistical difference in the distribution of SNA among the groups(P=0.102),there was no significant difference in the distribution of SNA between the RVVC group and the VVC group in different syndrome types and different stages of the menstrual cycle.(6)?-glucosidase:?-glucuronidase is a kind of glycoside hydrolase.There was no statistical difference in GUS distribution in each group(P=0.33),and there was no significant difference in the distribution of GUS between the RVVC group and the VVC group in different syndrome types and different stages of the menstrual cycle.(7)PH value of vagina:(1)The vaginal p H of the RVVC group,VVC group,and normal group were4.89±0.48,5.01±0.37,4.67±0.47,respectively,and there were statistical differences among the three groups(P=0.004).The vaginal p H value of the VVC group was higher than that of the control group(P=0.001).There was no statistical difference in the vaginal p H value between the RVVC group and the VVC group.There was no statistical difference in the p H value between the RVVC group and the control group.(2)There is no significant difference in vaginal p H between patients with spleen deficiency and dampness syndrome and damp-heat syndrome.The vaginal PH value of patients with damp-heat syndrome in the RVVC group(5.10±0.00)was higher than that of patients with spleen deficiency and dampness obstruction in the group(4.85±0.94),and there was a statistical difference(P<0.0001).There was no significant difference in vaginal p H between patients with spleen deficiency and dampness syndrome and damp-heat syndrome in the VVC group.(3)There was no significant difference in vaginal p H between RVVC group and VVC group with spleen deficiency and dampness obstruction(P=0.237).There was no significant difference in vaginal p H between RVVC group and VVC group with damp-heat syndrome(P=0.955).(4)There was no significant difference in vaginal p H between the RVVC group and the VVC group at different stages of the menstrual cycle(P>0.05).There was no statistical difference in the vaginal PH value at different stages of the menstrual cycle among the three groups(P>0.05).(5)The vaginal p H value of the RVVC group(35-45 years old)was higher than that of the group(20-34 years old),and there was a statistical difference(P=0.0004).The vaginal p H value of the VVC group(20-34 years old)was higher than that of the group(35-45 years old),and there was a statistical difference(P=0.0008).There was no statistical difference in vaginal PH between different age groups in the control group.3.Research on vaginal microbial diversity:(1)The dominant vaginal bacteria in each group are Lactobacillus,the content of Lactobacillus in the vaginal colonies of each group was:97.47%in RVVC group,60.74%in VVC group,69.43%in control group.The species diversity index of vaginal colonies in the RVVC group decreased significantly,which was lower than that in the VVC group and the normal group.(2)The proportion of lactobacilli in the vaginal colonies during the follicular phase and the luteal phase of the RVVC group increased significantly,and the species abundance decreased significantly,which was lower than that of the VVC group and the normal group.The abundance of vaginal colonies in the normal group was higher in the follicular phase and decreased in the luteal phase.(3)The abundance of vaginal colonies in the patients with spleen deficiency and dampness obstruction syndrome in the VVC group and RVVC group decreased significantly.(4)The luteal phase vaginal colonies of the three groups were tested for the significance of the differences in the flora between the groups,and significant statistical differences were found between the groups.At the genus level,Vellonella and Bacteroides only exist in the RVVC group.4.Physical fitness research:There are statistical differences in the distribution of peace and fitness among the three groups(P=0.045).There was no statistical difference in the distribution of biased physique among the three groups(P=0.280).There are statistical differences in the distribution of Qi-stagnation in each group(P=0.015).There was no statistical difference in the distribution of damp-heat quality and Yang-deficiency quality in each group(P>0.05).Conclusion1.Both RVVC and VVC patients have a certain imbalance in the vaginal microecological function,but there is no difference in different stages of the menstrual cycle.The abundance of vaginal colonies in patients with spleen deficiency and dampness obstruction was significantly decreased.Patients with RVVC spleen deficiency and dampness resistance syndrome and damp-heat syndrome have certain imbalances in vaginal microecological function,but RVVC patients with damp-heat syndrome have more significant performance,the vaginal PH value of patients with damp-heat syndrome was significantly higher than that of patients with damp-heat syndrome in the RVVC group.The score of spleen deficiency and dampness in the RVVC group was higher than that in the VVC group,due to repeated episodes of VVC,the disease will become more serious,or the righteousness of the patient is not enough,so it is easy to feel the damp evil,and needs to strengthen the body to eliminate the evil.2.The Veillonella and bacteroides were found in the RVVC group,but not in the other groups.The Veillonella and Bacteroides may be involved in the pathogenesis of RVVC.The Veillonella has the function of metabolizing lactic acid,so it is not conducive to the restoration of vaginal microecological balance in patients with RVVC.The Bacteroides is associated with poor repeated treatment of RVVC patients and may reduce the potency of antifungal drugs.The diversity of vaginal colonies in the RVVC group decreased,and the proportion of lactobacilli increased.The treatment of RVVC should pay attention to the reconstruction of vaginal colony abundance and promote the recovery of the function of dominant flora.3.The distribution of peace and physique in RVVC patients declines.The susceptible physique of RVVC patients is Qi-stagnation,Yang-deficiency and damp-heat.Qi stagnation constitution is higher in the biased physique of RVVC patients.