复发性假丝酵母菌性外阴阴道炎与肠道假丝酵母菌同源感染患者的临床治疗研究

Clinical Study of Patients with RVVC and Intestinal Candida Yeast Infection

目的:对复发性假丝酵母菌性外阴阴道炎(RVVC)与肠道假丝酵母菌同源感染患者的临床治疗进行进一步研究,从临床探究RVVC与肠道假丝酵母菌感染之间菌株的移行之间的关系。方法:对2009年6月—2013年3月RVVC患者进行外阴阴道分泌物和肛拭子分离菌株采集鉴定,通过聚合酶链反应(PCR)方法对双阳性患者的分泌物和肛拭子分离得到的假丝酵母菌进行同源性测定,分成同源患者与非同源患者。分别对两类患者进行随机分组,各分为2组:A组(同源全身治疗组)与B组(非同源全身治疗组)采用氟康唑口服并联合外用硝酸咪康唑栓进行治疗;C组(同源局部治疗组)与D组(非同源局部治疗组)外用硝酸咪康唑栓进行治疗。4组患者痊愈后(以微生物学疗效评定:念珠菌镜检和念珠菌培养均阴性,其中A、B组加测肠道假丝酵母菌)巩固治疗半年,随后进行1年随访,观察4组患者的复发情况。结果:共入组160例RVVC患者,其中RVVC同源性患者110例,非同源性患者50例。达到治疗效果后进行随访,结果显示A组患者的复发率最低,为10.7%;而C、D组的复发率较高,分别为70.4%和69.2%。首次的复发时间和复发程度方面,A组患者优于其他3组,而C、D组的患者情况相对严重。此外,对复发患者的双阳性以及部分双阳性患者的同源性进行测试,结果显示全身治疗组复发患者中同源性患者所占比例较低,而局部治疗组复发患者中的同源性比例较高。结论:RVVC与肠道假丝酵母菌感染之间菌株的移行可能与部分RVVC患者久治不愈关系密切。

Objective： Further study to the clinical study on the treatment of recurrent candida vulvovaginitis and intestinal homologous candida infection. Methods：Collect and identify vulva vaginal secretion and anal swab strains of recurrent candida vulvovaginitis patients in June 2009 to March 2013 in obstetrics and gynecology clinic, for double-positive patients, determine the homology of candida mycoderma bacteria got by separating secretion and anal swab strains by the method of PCR, divide the patients into two types of homologous patients and non homologous patients. Two types were respectively assigned to four groups randomly. Group A （homologous systemic treatment group） and group B （non homologous systemic treatment group） were treated with oral fluconazole, group C （homologous local treatment group） and group D （non homologous local treatment group） were treated with external using Miconazole Nitrate Suppositories at least 6 months. And the patients of group A and B should be consolidation therapy at least 6 months. Follow up 1 year after four groups patients recovered （Curative effect evaluation in the result of candida microscopic examination and culture were negative）, to observe the relapse of four groups patients. Results：Total 160 patients were enrolled in RVVC patients, covered 110 cases of RVVC homology patients and 50 cases of patients with non homologous. Follow up the treatment effect, group A showed that the recurrence rate of the patients with a minimum of 10.7%, recurrence rate of C, D are high with 70.4% and 69.2%. In the fact of first time to relapse and recurrence degree, group A is better than the other three groups, while group C and D are relatively worse. In addition, homology test of double positive and part of double positive patients with recurrent showed that the effect of systemic treatment is better than local treatment. Conclusions：Further confirmed that strains transition between recurrent candida vulvovaginitis and intestinal homologous candida infection probably has the close relationshit） with the reason whv Mart of RVVC natients last lone illness.