青春期前糖尿病女童外阴阴道炎临床特征及综合干预疗效观察

Clinical characteristics of vulvovaginitis in prepubertal girls with diabetes mellitus and the efficacy of comprehensive intervention

摘要

目的 探讨青春期前糖尿病女童外阴阴道炎的临床特点,以提高对本病的认识,实现早期治疗并预防复发。方法 回顾性分析2016年1月至2022年9月于北京儿童医院就诊的38例青春期前糖尿病合并外阴阴道炎女童的临床资料,分析临床特征及治疗预后情况。结果 38例女童平均年龄6.6岁,均为青春期前乳房尚未发育的女童.糖尿病病程中位数24.6天,外阴阴道炎病程中位数5.3天.病原学检测显示真菌感染27例,占71.05%,1型糖尿病组真菌感染比例略高于2型糖尿病,但无统计学意义(P>0.05).糖尿病酮症组中73.3%患儿确诊真菌性外阴阴道炎;非酮症组为62.5%,差异无统计学意义(P>0.05).真菌感染组7.4%患儿出现阴道黄色分泌物,非真菌感染组为90.9%,差异具有显著统计学意义(χ²=25.222,P<0.01).真菌感染组中81.5%患儿有外阴瘙痒症状;非真菌感染组为63.6%,两组无统计学差异(χ²=1.377,P>0.05).所有患儿采用综合干预措施,治疗1周,36例痊愈(94.7%),2例明显好转(5.3%)。结论 青春期前糖尿病女童外阴阴道炎以真菌感染为主,病原学特点显著区别于无基础疾病的女童;真菌感染比例与糖尿病分型及是否合并酮症无关;阴道黄色分泌物可作为非真菌感染临床特点之一.综合干预治疗措施对治疗改善青春期前女童外阴阴道炎症状具有重要意义.

Abstract

Objective To investigate the clinical characteristics of vulvovaginitis in prepubertal diabetic girls, in order to improve the understanding of this disease, and strive for early treatment and prevention of recurrence. Methods The clinical data of 38 girls with prepubertal diabetes mellitus combined with vulvovaginitis who attended Beijing Children's Hospital from January 2016 to September 2022 were retrospectively analyzed for clinical characteristics and treatment prognosis. Results The mean age of the 38 girls was 6.6 years old, and all of them were prepubertal girls with undeveloped breasts. The median duration of diabetes mellitus was 24.6 days, and the median duration of vulvovaginitis was 5.3 days. Pathological testing showed fungal infection in 27 cases, accounting for 71.05%, and the proportion of fungal infection in the type 1 diabetes group was slightly higher than that in type 2 diabetes group, but was not statistically significant (P>0.05). Fungal vulvovaginitis was diagnosed in 73.3% of children in the diabetic ketoacidosis group; in the non-ketoacidosis group was 62.5%, and the difference was not statistically significant (P>0.05). Vaginal yellow discharge was present in 7.4% of children in the fungal infection group and 90.9% in the non-fungal infection group, with a statistically significant difference (χ²=25.222, P<0.01). Vulvovaginal itching was present in 81.5% of the children in the fungal infection group and 63.6% in the non-fungal infection group, there was no statistically difference between the two groups (χ²=1.377, P>0.05). All children were treated with comprehensive interventions for 1 week, and 36 cases were cured (94.7%), and 2 cases were significantly improved (5.3%). Conclusion Vulvovaginitis in prepubertal diabetic girls is mainly a fungal infection, and the pathogenetic features are significantly different from those of girls without underlying diseases. The proportion of fungal infection is not related to diabetes mellitus typing and whether it is combined with ketoacidosis or not. The vaginal yellow secretion may be one of the clinical characteristics of non-fungal infection. Comprehensive therapeutic interventions are important for the treatment and improvement of vulvovaginitis symptoms in prepubertal girls.

关键词

外阴阴道炎 / 青春期前女童 / 糖尿病 / 真菌感染

Key words

vulvovaginitis / prepubescent girls / diabetes mellitus / fungal infections

参考文献

[1] Wang J, Wu W, Dong G, et al. Pediatric diabetes in China: challenges and actions[J]. Pediatr Diabetes, 2022, 23(5): 545-550.

[2] Mazarello Paes V, Barrett JK, Dunger DB, et al. Factors predicting poor glycemic control in the first two years of childhood onset type 1 diabetes in a cohort from East London, UK: analyses using mixed effects fractional polynomial models[J]. Pediatr Diabetes, 2020, 21(2): 288-299.

[3] Wu HB, Zhong JM, Hu RY, et al. Rapidly rising incidence of type 1 diabetes in children and adolescents aged 0-19 years in Zhejiang, China, 2007 to 2013[J]. Diabet Med, 2016, 33(10): 1339-1346.

[4] Fu JF, Liang L, Gong CX, et al. Status and trends of diabetes in Chinese children: analysis of data from 14 medical centers[J]. World J Pediatr, 2013, 9(2): 127-134.

[5] Choudhury AA, Devi Rajeswari V. Gestational diabetes mellitus-A metabolic and reproductive disorder[J]. Biomed Pharmacother, 2021, 143: 112183.

[6] 杨东梓, 石一复. 小儿与青春期妇科学[M]. 2版. 北京: 人民卫生出版社, 2008: 93-98.

[7] Loveless M, Myint O. Vulvovaginitis-presentation of more common problems in pediatric and adolescent gynecology[J]. Best Pract Res Clin Obstet Gynaecol, 2018, 48: 14-27.

[8] Paladine HL, Desai UA. Vaginitis: diagnosis and treatment[J]. Am Fam Physician, 2018, 97(5): 321-329.

[9] Blomberg L, Backman K, Kirjavainen PV, et al. Vulvovaginal yeast infections, gestational diabetes and pregnancy outcome[J]. BMC Pregnancy Childbirth, 2023, 23(1): 70.

[10] Miao J, Regan J, Cai C, et al. Glycogen metabolism in candida albicans impacts fitness and virulence during vulvovaginal and invasive candidiasis[J]. mBio, 2023, 14(2): e0004623.

[11] Hu BF, Hua CZ, Sun LY, et al. Microbiological findings of symptomatic vulvovaginitis in Chinese prepubertal girls[J]. J Pediatr Adolesc Gynecol, 2021, 34(6): 799-804.

[12] 李娜, 廖新, 文江舸. 女童糖尿病性外阴阴道炎九例临床分析[J]. 中国小儿急救医学, 2014, 21(8): 518-520.

[13] Donders GGG, Bellen G, Ruban K, et al. Short-and long-term influence of the levonorgestrel-releasing intrauterine system (Mirena®) on vaginal microbiota and Candida[J]. J Med Microbiol, 2018, 67(3): 308-313.

[14] Yano J, Sobel JD, Nyirjesy P, et al. Current patient perspectives of vulvovaginal candidiasis: incidence, symptoms, management and post-treatment outcomes[J]. BMC Womens Health, 2019, 19(1): 48.

[15] 刘慧丽, 柳静, 陈昭定. 洁童阴洗液治疗幼女外阴阴道炎的临床与实验研究[J]. 中国中西医结合杂志, 2002, 22(8): 590-593.

[16] 林瑾. 联苯苄唑乳膏、康复新液联合制霉素片阴道给药治疗儿童及青春期少女念珠菌性外阴阴道炎的临床研究[J]. 吉林医学, 2021, 42(3): 659-661.

[17] 杨亚超, 苏刘艳, 刘一丹, 等. 康复新液抗念珠菌性阴道炎的药效研究[J]. 中国现代中药, 2019, 21(7): 903-908.

[18] Mulinganya G, De Vulder A, Bisimwa G, et al. Prevalence, risk factors and adverse pregnancy outcomes of second trimester bacterial vaginosis among pregnant women in Bukavu, Democratic Republic of the Congo[J]. PLoS One, 2021, 16(10): e0257939.

基金资助

国家重点研发计划中医药现代化研究课题资助项目(2017YFC1703205)