子宫肌瘤中阴道和肌瘤淋巴结的微生物群

E. S. Nikitina, A. N. Rymashevsky, Y. L. Naboka, M. A. Rymashevsky, I. Gudima, E. G. Svirava
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摘要

目的:研究子宫肌瘤患者阴道、肌瘤淋巴结及其床的微生物群。材料与方法:对83例26 ~ 50岁诊断为间质性、间质性-浆膜下子宫肌瘤的患者进行综合检查。按年龄划分,所有女性分为三组。进行了标准的临床和临床实验室检查、阴道镜检查、可拆卸阴道后穹窿微生物检查、肌瘤淋巴结及其床活检标本、肌瘤淋巴结及其床活检标本形态学检查。结果:在子宫肌瘤的临床表现结构中,以疼痛综合征为主(p0.05)。根据对第二组患者阴道后穹窿可脱性的细菌学研究结果显示,与第一组相比,乳酸菌的检出频率和数量均有所下降,而第三组女性则没有这些微生物。第1组和第2组厌氧菌中以真杆菌(Eubacterium spp)为主,第3组为胃链球菌(Peptostreptococcus spp),第3组患者检出拟杆菌(Bacteroides spp.)的频率显著增高(p<0.05)。在各组微生物的好氧谱中,凝固阴性葡萄球菌占主导地位。在活检标本的细菌学研究中,7.2%的病例观察到肌瘤淋巴结中没有微生物生长,17.7%的病例观察到肌瘤淋巴结床组织中没有微生物生长。肌瘤淋巴结及其床区微生物群以厌氧菌群为主。根据活检标本的形态学研究结果,未发现组织炎症反应。结论:在不同年龄组的子宫肌瘤患者中,阴道微生物群呈现多向变化。在大多数病例中,肌瘤结(92.8%)及其床(82.3%)不无菌,以厌氧微生物群为主。在“阴道-肌瘤结-肌瘤结床”位点中发现的显著相关性表明了它们之间的关系。根据形态学研究,肌瘤淋巴结及其床中各种微生物分类的检测与组织中感染和炎症过程的存在无关。
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Microbiota of the vagina and myoma nodes in uterine myoma
Objective: to study the microbiota of the vagina, myomatous nodes, their bed in patients with fibroids. Materials and methods: a comprehensive examination of 83 patients aged 26 to 50 years with diagnosed interstitial, interstitial-subserous uterine myoma was carried out. By age, all women are divided into 3 groups. Standard clinical and clinical laboratory studies, colposcopy, microbiological examination of the detachable posterior vaginal fornix, biopsy specimens of myomatous nodes and their bed, as well as morphological examination of biopsy specimens of myomatous nodes and their bed were performed.Results: in the structure of clinical manifestations of uterine fibroids, pain syndrome was the leading one (p<0.05). The number of myoma nodes in patients varied from 1 to 22. The duration of the operation and the amount of blood loss did not differ significantly (p>0.05). According to the results of a bacteriological study of the detachable posterior vaginal fornix in patients in the 2nd group, a decrease in the frequency of detection and the number of lactobacilli was revealed compared to the 1st group, and in women in the 3rd group, these microorganisms were absent. Among the anaerobic microorganisms in the 1st and 2nd groups, Eubacterium spp. dominated, in the 3rd — Peptostreptococcus spp. In patients of group 3, the frequency of detection of Bacteroides spp. was significantly increased (p<0.05). Among the aerobic spectrum of microorganisms in all groups, coagulasenegative staphylococci predominated. In a bacteriological study of biopsy specimens, the absence of growth of microorganisms in myomatous nodes was observed in 7.2% of cases, in the tissue of the bed of myomatous nodes in 17.7%. The microbiota of myomatous nodes and their bed in most cases was represented by anaerobic taxa. According to the results of a morphological study of biopsy specimens, no inflammatory reaction of tissues was detected. Conclusions: In women with uterine myoma of different age groups, multidirectional changes in the vaginal microbiota were revealed. In most cases, the myomatous node (92.8%) and its bed (82.3%) are not sterile with the dominance of anaerobic microbiota taxa. Identified significant correlations in the loci «vagina – myomatous node – myomatous node bed» indicate their relationship. The detection of various taxa of microorganisms in the myomatous node and its bed, according to morphological studies, is not associated with the presence of infectious and inflammatory processes in the tissues.
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