外阴阴道念珠菌病的临床特征和硝酸咪康唑治疗的效果观察

Study on classification and treatment of vulvovaginal candidiasis

目的探讨外阴阴道念珠菌病(VVC)的临床特征及应用不同剂量的硝酸咪康唑治疗VVC不同时间后的效果。方法根据Sobel分类,将300例VVC患者,随机分为3组,即硝酸咪康唑400mg/d、治疗3d(3日组),硝酸咪康唑400mg/d、治疗6d(6日组),硝酸咪康唑200mg/d、治疗7d(7日组),于治疗后第14、35天进行疗效评价。结果300例患者中,单纯型VVC168例(56.0%),复杂型VVC132例(44.0%)。由白念珠菌所致的复杂型VVC患者严重临床症状和体征的发生率,较由非白念珠菌所致的复杂型VVC患者高,两者比较,差异统计学意义(P<0.01)。VVC致病菌为白念珠菌者271例(90.3%,271/300),非白念珠菌者29例(9.7%,29/300)。300例VVC患者中,完成全部治疗和随诊者275例,其中治愈234例,治愈率为85.1%(234/275)。治疗后第14天,3日组、6日组和7日组单纯型VVC的治愈率分别为96.0%、93.5%和98.0%,复杂型VVC的治愈率分别为86.7%、92.5%和86.4%;3组单纯型VVC的治愈率比较,及3组复杂型VVC的治愈率比较,差异均无统计学意义(P>0.05)。治疗后第35天,3日组、6日组和7日组单纯型VVC的治愈率分别为93.8%、95.3%和89.8%,复杂型VVC的治愈率分别为89.7%、97.3%和86.8%;3组单纯型VVC的治愈率比较,及3组复杂型VVC的治愈率比较,差异均无统计学意义(P>0.05)。275例中治疗失败41例,失败率为14.9%(41/275)。结论单纯型VVC及复杂型VVC的临床特征、致病菌种类均不同;对复杂型VVC,采用硝酸咪康唑400mg/d、治疗6d的效果最好。

Objective To determine the clinical manifestations of vulvovaginal candidiasis（VVC） and to study the mycologic eradication rate of different miconazole treatment courses for VVC. Methods Three hundred cases of VVC were recruited. The Candidas were cultured. A prospective and randomized study was performed to compare the treatment effect of 3 day miconazole（400 mg/d） , 6 day miconazole（400mg/d） , and 7 day miconazole（200 mg/d） for uncomplicated and complicated VVC. Results Among 300 cases of VVC, uncomplicated, complicated and recurrent VVC were 56. 0% , 44.0% and 9.7% （29/300） respectively. C. albicans was isolated most frequently 90. 3% （271/300）, followed by C. glabrata（7. 3% ） ,C. tropicalis（ 1. 3% ） ,C. krusei （0. 7% ） , and C. parapsilosis（0. 3 % ）. Mycologic eradication rate of 3 day, 6 day and 7 day miconazole courses for uncomplicated VVC at day 14 was 96. 0% ,93.5% and 98.0% , respectively （ P 〉 0.05 ） . Eradication rate of 3 day, 6 day and 7 day miconazole courses for complicated VVC at day 14 was 86. 7% , 92. 5% , and 86. 4% , respectively （P 〉0. 05）. Eradication rate of 3 day, 6 day and 7 day miconazole courses for uncomplicated VVC at day 35 was 93.8% ,95.3% , and 89. 8% ,respectively （P 〉 0. 05）. Eradication rate of 3 day, 6 day and 7 day miconazole courses for complicated VVC at day 35 was 89. 7%, 97.3% and 86. 8%, respectively （P 〉 0. 05 ） . Conclusion Treatment of VVC should be individualized, and women with complicated VVC achieve superior mycologic eradication by a 6 day miconazole course.