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Lactate
dehydrogenase activity in vaginal fluid is elevated in samples from
women with vaginal inflammation.
Lactate dehydrogenase
and its isoenzymes in vaginal fluid in vaginitis/vaginosis cases and in
healthy controls.
Niklasson O, Skude G, Mårdh P-A
International
Journal of STD & AIDS 2003;14:270-273
Summary:
Question
What is the lactate dehydrogenase activity, including the isoenzyme
pattern, in vaginal fluid samples collected by lavage and by brush, which
were stored under different conditions, obtained from women of different
ages, presenting with and without signs of vaginitis, vaginosis, and
cervicitis?
Design
The total lactate dehydrogenase (LD) activity and the activity of LD
isoenzymes 1, 2, 3, 4, and 5 were measured in vaginal lavage and brush
samples collected from women with vaginitis/vaginosis and from healthy
controls.
Participants
Twenty-eight women, including 8 who were postmenopausal, with no signs of
inflammation by vaginal wet mount examination, 8 women with either
vulvovaginal candidosis, bacterial vaginosis, trichomoniasis, or senile
colpitis, 51 women with various gynecological disorders, and 100 women
screened for C. trachomatis who attended for contraceptive
counseling were tested. Women whose wet mount contained spermatozoa were
excluded from further analyses.
Description of Tests and Diagnostic
Standard
Fluid samples were collected from the posterior vaginal fornix with a
brush (Cytobrush, Medscand, Sweden) or by instilling 5 ml of saline and
aspirating the fluid into a syringe. Both samples were placed into 5 ml of
Tris buffer, centrifuged, and the supernatants used for determination of
LD activity within a few minutes of collection and after storage at room
temperature and at 4oC for 6 h. The tip of the vaginal speculum inserted
for the pelvic examination was used to measure pH and to prepare a wet
mount. Vaginal inflammation was measured by determining the number of
granulocytes in wet mounts. Leukocyte esterase in vaginal samples was
measured using a dipstick (Combur-4, Roche Diagnostics, Basel).
Chlamydiazyme ELISA (Abbott Diagnostics, Chicago) was used to detect
chlamydial infections. Positive results were confirmed.
Main Outcome Measures
The influence of different sample collection and storage conditions on LD
activity was evaluated. LD activity (μkat/L) was correlated to
vaginal pH, the grade of inflammation as determined by the number of
granulocytes in a wet mount, C. trachomatis infection, leukocyte
esterase activity, and vaginitis.
Main Results
There were no differences in the amount of LD measured in lavage samples
compared to brush samples, in samples analyzed immediately compared to
after 6 h, or in samples stored at room temperature compared to
refrigerated. In women with no signs of genital inflammation, the total LD
activity was low (<3.0 μkat/L) and the isoenzyme pattern was
dominated by LD5. Most women with inflammation on wet mount (>10
granulocytes/high power field) had higher LD activity and vaginal pH than
women with no or mild inflammation. Vaginal LD activity increased with
increasing pH and was high in women positive for C. trachomatis.
All patients with an elevated leukocyte esterase result (grade 3) had
increased LD activity. The total LD and LD isoenzyme activities in vaginal
lavage fluid samples from normal controls and from women with vaginitis/vaginosis
are shown in the table.
Authors' Conclusions
Determination of the total concentration of
LD was sensitive enough to discriminate cases with genital inflammation
from healthy individuals. The more intense the inflammation, the higher
was the LD activity. Analysis of individual isoenzymes was not necessary.
Source of funding: None given.
For correspondence: Per-Andres Mårdh,
Department of Obstetrics and Gynecology, Lund University Hospital, 22185
Lund. E-mail address: per-anders.mardh@gyn.lu.se
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