复发性外阴阴道假丝酵母菌病:附80例诊治分析

Analysis of the diagnosis and treatment of recurrent vulvovaginal candidiasis in 80 cases

目的探讨复发性外阴阴道假丝酵母菌病合适的诊治方法。方法 2005年7月～2008年7月在本院门诊确诊的80例复发性外阴阴道假丝酵母菌病(RVVC)患者,根据阴道分泌物真菌培养加药敏结果选择治疗方案,口服加阴道局部治疗。具体方法:氟康唑150mg3d后重复1次后,150mg/周或酮康唑200mg2/d共3d后,200mg/周或伊曲康唑200mg2/d共3d后,200mg/周;月经净后配伍阴道上药:制霉菌素阴道栓40万U/晚共1周或克霉唑栓100mg/晚共1周或两性霉素B泡腾片10mg共6d或咪康唑200mg/晚共1周,随后阴道上药定君生胶囊250mg1/晚共5d。症状消失伴真菌转阴后再巩固治疗2～5个疗程。结果 80例RVVC以白色假丝酵母菌感染为主(占74%),光滑假丝酵母菌感染占20%。药敏结果显示口服药中酮康唑敏感率(91.3%)、氟康唑(81.3%),伊曲康唑(62.5%),阴道用药中制霉菌素和两性霉素B敏感率(100%),克霉唑(92.5%),咪康唑(55.0%)。停药12个月后,治疗3个疗程及6个疗程的远期治愈率分别为78.9%、90.4%。结论 RVVC主要病原菌是白色假丝酵母菌,选择敏感药物强化及巩固治疗,同时加用乳酸杆菌恢复阴道酸性环境是治愈RVVC的有效措施。

Objective To investigate the appropriate therapy fortreating recurrent vulvovaginal candidiasis（RVVC）.Methods Individual consolidated and maintenance therapy were chosen according to fungal culture of vaginal secretion and antifungal drug sensitivity permonth as one therapy duration.Drugs were used orally and vaginally togetherto consolidate the therapy.Oral drugs were fluconazole（0.15 qw after0.15 q3d for2 times） orketoconazole（0.2,bid for3 days） oritroconazole（0.2 bid for 3 days）.After Nystain（400 000 unit qn for 7 days） or clotrimazole（0.1 qn for 7 days） or amphotericin B（0.01 qn for 6 days） being vaginally used,Living preparation of lactobacillus（0.25 qn for5 days） was vaginally used.The therapy was continued for2 to 5 therapy durations afterthe symptoms disappeared with negative fungal culture.Results Among 80 cases of RVVC,C.albicans was mostly detected（74%）,C.glabrata was 20%.The susceptivity to candidas of oral agents revealed that the sensitive rare of ketoconazole,fluconazole and itroconazole were（91.3%）,（81.3%） and（62.5%）,respectively.As for vaginal agents,nystain and amphotericin B were 100% sensitive,clotrimazole was 92.5%sensitive,miconazole was 55.0% sensitive.The remote cure of 3 and 6 therapy durations afterdiscontinuing for12 months was 78.9% and 90.4%.Conclusions The predominant pathogen in RVVC is C.albicans.The effective measures to cure RVVC are to choose sensitve drugs for individual consolidated,maintenance therapy and restore vaginal acidic environment.