目的 探讨复发性外阴阴道假丝酵母菌病（RVVC）患者阴道微生物的物种组成及其变化情况。方法 招募6例RVVC患者,纳入患者均在发作间期每日采集1份高位阴道拭子进行阴道微生物的物种检测,并运用主坐标分析法（PCoA）、绘制样品热图、α多样性分析等方法分析RVVC患者阴道微生物的物种组成及其变化情况。结果 组间PCoA结果显示RVVC患者阴道微生物物种在发作间期的组成相似,但在临近发作期、发作日均出现物种差异增大的现象。样品热图分析提示,在RVVC发作期和发作间期阶段物种的距离较远,并在临近发作期的生物间差异性开始集中。RVVC患者阴道微生物物种组成结果分析显示,乳酸杆菌占比为64.25%,相对丰度在0.10%~1.00%的菌属有小类杆菌属、肠杆菌科、大芬戈尔德菌、奇异菌属、气球菌属、葡萄球菌属、厌氧球菌和乳球菌,相对丰度> 1.00%的菌属有乳酸杆菌属、普雷沃菌属、链球菌、加德纳菌和脲原体。样品α多样性分析结果提示在RVVC发作间期的物种丰度基本相似,临近发作期物种的丰度提升,在发作前大部分物种在较低的丰度水平。随访患者数个月经周期中以乳酸杆菌为绝对优势菌属,偶有波动但幅度不大,但在各组发作前均存在一过性的普雷沃菌增加,也存在加德纳菌的增加,时而波动,其他菌属（如小杆菌属、大芬戈尔德菌、奇异菌属、脲原体等）在月经期所占比例较低,偶有波动,其余菌属在月经周期维持在较低丰度水平。结论 RVVC患者阴道微生物以乳酸杆菌为主,阴道菌群相对稳定、波动性弱,临床对其治疗应注重阴道微生态环境的调理,或可通过恢复阴道菌群比例,达到治愈RVVC的目的。

Objective To investigate the species composition and dynamic changes of vaginal microbiota in patients with recurrent vulvovaginal candidiasis （RVVC）. Methods Six patients with confirmed symptomatic RVVC were enrolled in this study. During the onset of RVVC, 1 high vaginal swab sample was collected from each patient on a daily basis to identify the vaginal microbiota. Principal co-ordinate analysis （PCoA）, thermogram analysis and α diversity analysis were adopted to analyze the species composition and dynamic changes of vaginal microbiota in RVVC patients. Results PCoA analysis between groups showed that the species composition of vaginal microbiota in patients with RVVC was similar at the interval between onset, but the species difference was increased at several days before the onset and on the day of onset. Thermogram analysis suggested that the distance between microbiota was large in the onset stage and at the interval between onset of RVVC, and the intermediate difference of microbiota began to converge at several days before the onset stage. The species composition analysis of vaginal microbiota in patients with RVVC showed that Lactobacillus accounted for 64.25%. Bacterial genera with relative abundance between 0.10% and 1.00% included Dialister, Enterobacteriaceae, Finegoldia magna, Atopobium, Aerococcus, Staphylococcus, Anaerococcus and Lactococcus. The genera with relative abundance of >1.00% consisted of Lactobacillus, Prevotella, Streptococcus, Gardnerella and Ureaplasma. The α diversity index evaluation results indicated that the species abundance at the interval between onset of RVVC was similar, which was increased approaching the onset stage, and most returned to a low level of species abundance before the onset. Lactobacillus was the absolute dominant genus during several menstrual cycles of patients receiving follow-up, with small fluctuations. However, there was a transient increase of Prevotella in each group before the onset, and there was also an increase in Gardnerella, which occasionally fluctuated. The proportion of the other genera such as Dialister, Finegoldia magna, Atopobium and Ureaplasma was relatively low,and with few fluctuations. The remaining genera remained at a low level during the menstrual cycle.Conclusions Lactobacillus is the main vaginal microbiota in patients with RVVC. Vaginal microbiota in RVVC patients are relatively stable, with few fluctuations. In clinical treatment,widespread attention should be diverted to the regulation of vaginal microecological environment and restoring the proportion of vaginal microbiota.