复发性外阴阴道假丝酵母菌病综合治疗的远期疗效及对阴道局部免疫功能的影响

Long-term Prognosis and Vaginal Cellular Immunity Changes of Recurrent Vulvovaginal Candidiasis after Combined Treatments

目的探讨综合治疗的方法(在常规抗真菌治疗的基础上配合中药方剂"扶正抗菌方"口服治疗两个月),能否有效提高复发性外阴阴道假丝酵母菌病(RVVC)患者的远期疗效,并观察治疗过程对RVVC患者阴道局部细胞免疫功能的影响.方法选取2006年2月至2008年12月就诊的生育年龄的RVVC患者共104例,随机分为两组,综合治疗组和对照组各52例.所有患者均根据真菌培养及药物敏感试验结果选取敏感药物进行强化治疗及巩固治疗,疗程为半年.在此基础上,综合治疗组在巩固治疗的初期加用中药方剂"扶正抗菌方"治疗两个月.患者开始治疗前及巩固治疗开始后的2个月末采集阴道灌洗液标本,采用ELISA法检测阴道局部IL-4及IFN-γ浓度.结果至2010年6月,共有90例完成随访,其中综合治疗组46例、对照组44例,随访率为86.5%.随访时间最短17个月,最长41个月.在17～41个月的随访中,综合治疗组及对照组复发率分别为41.3%、65.9%,综合治疗组复发率明显低于对照组,差异具有统计学意义(P<0.05).综合治疗组及对照组的平均复发时间分别为(8.5±2.9)月、(2.6±2.2)月,综合治疗组平均复发时间显著延长,差异具有统计学意义(P<0.05).综合治疗组患者治疗后阴道灌洗液IFN-γ水平降低,与治疗前比较,差异具有统计学意义(P<0.05);对照组治疗前后阴道灌洗液IFN-γ及IL-4水平差异均没有统计学意义(P>0.05).结论中药"扶正抗菌方"能明显改善RVVC患者阴道局部的细胞免疫功能,使复发率显著降低,复发时间显著延长,有效提高RVVC的远期疗效.

Objective To investigate whether Chinese herbal medicine combined with antifungal therapy can effectively improve long-term prognosis of recurrent vulvovaginal candidiasis（RVVC）,and to observe the local cellular immunity changes of vagina during the treatment.Methods 104 patients with RVVC from February 2006 to December 2008 were included in the study.They were randomly distributed into two groups： combined treatment group and the control group.Each group consisted of 52 cases.All the patients received antifungal treatment for six months based on in vitro sensitivity tests.Additional Chinese herbal medicine was added during the first two months of treatment in the combined treatment group.The vaginal lavage fluid was collected for cytokine analysis from both groups before the treatment and two months after consolidated treatment started.IFN-γ and IL-4 levels in vaginal lavage fluid was detected by ELISA.Results 90 patients（46 in combined treatment group and 44 in the control group）were successfully followed up by June 2010,with a follow-up period ranged between 17 and 41 months.The followe-up rate was 86.5%.The relapse rate was 41.3%（15/42）in the combined treatment group,much lower than the control group（65.9%,29/44）（P0.05）.The relapse interval was 8.5±2.9 months in the combined treatment group,much longer than the control group（2.6±2.2 months,P0.05）.The IFN-γ level in vaginal lavage fluid decreased significantly after combined treatment（P0.05）.However,IFN-γ and IL-4 level remained unchanged after consolidated treatment in the control group（P 0.05）.Conclusion Chinese herbal medicine can significantly improve vaginal cellular immunity and long-term prognosis of RVVC patients.The relapse rate decreases and relapse interval increases after Chinese herbal medicine treatment.