复发性外阴阴道假丝酵母菌病局部病因调查及治疗

Study of local risk factors and treatment in recurrent vulvovaginal candidiasis

目的调查复发性外阴阴道假丝酵母菌病（RVVC）的局部病因及探讨其合理有效的治疗方案。方法选择158例确诊为RVVC的患者，常规行肛周分泌物及性伴侣龟头分泌物真菌培养，另50例非阴道病患者同时行肛周分泌物真菌培养作为对照。158例研究病例随机分3组，A组：口服易启康（依曲康唑）0.1g，每天2次，连服7d为一疗程。B组：口服易启康＋克霉唑栓0．15g阴道上药每天1次，共10d为一疗程。C组：在B组基础上再进行维持治疗，克霉唑栓0．15g阴道上药，每隔3d1次，共3次。3组均每次月经干净后3d开始重复治疗，连续6个疗程。性伴侣龟头分泌物真菌培养阳性者同时口服抗真菌药物治疗。治疗完成后第4、8、12、24周分别进行临床及真菌观察评定疗效。结果158例患者肛周分泌物真菌培养阳性率100％（158／158）；50例非阴道病患者肛周分泌物真菌培养阳性率8％（4／50），两者差异有统计学意义（P〈0．05）。158例性伴侣中有18例有包皮过长或龟头炎，这18例性伴侣其龟头分泌物真菌培养阳性率100％（18／18），另140例性伴侣无龟头炎或包皮过长者，其龟头分泌物真菌培养阳性率为1．43％（2／140），两者差异有统计学意义（P〈0．05）。3组治疗4周后有效率差异无统计学意义（P〉0．05）；治疗8周后A组有效率显著低于B、C组，差异有统计学意义（P〈0．01）；24周后A组复发率显著高于B、C组，差异有统计学意义（P〈0．01）。结论消化道真菌感染可能是RVVC反复发作的病因之一；性伴侣有包皮过长或龟头炎时需同时治疗；小剂量、长时间口服易启康及口服加阴道用药治疗RVVC近期4周内均有较好疗效，但联合用药远期疗效优于单纯口服用药。

Objective To investigate the local cause of recurrent vulvovaginal candidiasis and explore a reasonable and effective treatment program. Methods One hundred and fifty-eight cases diagnosed as RVVC were enrolled in the study. Fungal culture of routine anal secretions and secretions of sexual partners balanoposthitis was performed. Another 50 cases with non-vaginal disease at the same time received perianal fungal culture as control. All the patients were randomly divided into three groups. Group A： oral itraconazole 0.1g,twice a day,even serving as a treatment for 7 days. Group B： not only oral itraconazole but 0. 15 g clotrimazole vaginal suppositories on the day of a meeting,a total of 10 days for a course of treatment. Group C： further maintenance therapy on the basis of Group B,clotrimazole vaginal suppositories 0.15 g,once every three days, a total of three times. Three groups began repeat treatment at the third day after menstruation ending for six courses. Sexual partners with balanoposthitis secretions positive fungal culture received oral antifungal treatment. After the completion of the 4th, 8th, 12th,24th week respectively clinical evaluation of efficacy and fungi. Results The positive rate of fungal culture in perianal secretions of 158 patients was 100% （158/158） ,which of 50 patients with non -vaginal disease was 8% （4/50）. The difference between the two kind of patients was statistical significance（ P 〈 0.05 ）. Eighteen cases of sexual partners in 158 cases were redundant prepuce or balanitis, and the positive rate of fungal culture in their balanus secretions was 100% （18/18）. Another 140 cases of sexual partners were not redundant prepuce or balanitis,the positive rate offungal culture in their balanus secretions was 1.43% （ 2/140 ）. There was significantly different （ P 〈 0.05 ）. The effective rate in three groups after treatment for 4 weeks was no significantly different（ P 〉 0.05 ）. The effective rate in group A was significantly lower than group B and C（ P 〈0.05 ） after treatment for 8 weeks. Compared with group B and C, the recurrence rate of group A was significantly higher after treatment for 24 weeks. The difference was all statistical significance（ P 〈 0.01 ）. Conclusions Fungous infection of digestive tract may be the one cause of RVVC recurrent attacks. The therapy must be carried out at the same time when the sexual partner had redundant prepuce or balanitis. Oral itraconazole for the small dosage and long time or oral adds vagina administration to treat RVVC in the followed 4 weeks all had a better curative effect,but the long - term efficacy of combination administration will supass the oral drugs.