复发性外阴阴道假丝酵母菌病中药周期治疗与阴道局部Th17细胞免疫功能的关系

Relationship between Chinese herbal medicine treatment of recurrent vulvovaginal candidiasis and changes of local Th17 cellular immunity

目的 观察中药周期疗法对复发性外阴阴道假丝酵母菌病（RVVC）患者的远期疗效,及对阴道局部Th17细胞免疫功能的影响.方法 选取2010年10月至2012年4月就诊的生育年龄的RVVC患者共80例,随机分为两组,中西医结合治疗组和对照组各40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,中西医结合治疗组在巩固治疗的初期加用中药周期疗法治疗两个月.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（酶联免疫吸附试验）检测阴道局部IL-17AF浓度.结果 至2013年6月,共有69例完成远期随访.其中中西医结合治疗组36例、对照组33例,随访率为86.2％.随访时间最短13个月,最长32个月.在13～ 32个月的随访中,中西医结合治疗组及对照组复发率分别为36.1％ （13/36）、70.0％ （23/33）,差异具有统计学意义（P＜0.05）.中西医结合治疗组及对照组的平均复发时间分别为（8.6±2.8）个月、（2.7±2.3）个月,差异具有统计学意义（P＜0.05）.两组患者治疗后阴道灌洗液IL-17AF浓度均明显下降,与治疗前相比有统计学意义（P＜0.05）.中西医结合治疗组治疗后阴道灌洗液IL-17AF浓度下降的幅度更为明显,但与对照组相比,差异无统计学意义（两组IL-17AF浓度下降的幅度平均为（539.80 ±642.64） pg/ml,（279.94±639.47） pg/ml,P＞0.05）.结论 中药周期疗法可能通过改善RVVC患者阴道局部Th17细胞免疫功能,使复发率显著降低,复发时间显著延长,从而提高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 ）. Moreover, local Th17 cellular immunity changes of vagina was observed during the treatment. Methods 80 cases of RVVC patients were included in the study. They were randomly distributed into two groups： conrbined treatment group and the control group. Each group consisted of 40 cases. All the patients received antifungal treatment for a period of 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. Results 69 patients were successfully followed-up by June 2013, with a follow-up period ranged between 13 and 32 months. The relapse rate was 36.1% （13/36）in the combined treatment group, much lower than the control group （70.0% ,23/33 ） （ P 〈 0. 05 ）. The relapse interval was 8.6 ±2.8 months in the combined treatment group, much longer than the control group （ 2.7 ±2.3 months, P 〈 0. 05 ）. The IL-17AF level in vaginal lavage fluid decreased significantly after treatment in both groups （P 〈 0.05 ）. Furthermore, changes of local IL-17AF level before and after treatment were more remarkable in the combined treatment group than the control group, although no statistical significance was found in the study （P 〉 0. 05 ）. Conclusions Chinese herbal medicine may improve vaginal Th17 cellular immunity and long-term prognosis of RVVC patients. The relapse rate decreases and relapse interval increases after Chinese herbal medicine treatment.