乳酸菌联合氟康唑治疗外阴阴道假丝酵母菌病疗效及对阴道微生态的影响

Efficacy of Lactobacillus combined with fluconazole in patients with vulvovaginal candidiasis and its effect on vaginal microecological balance

目的探讨乳酸菌联合氟康唑在外阴阴道假丝酵母菌病治疗中的效果及其对阴道微生态的影响。方法纳入2017年9月至2018年9月在本院妇科住院治疗的103例外阴阴道假丝酵母菌病患者,应用随机数字表法将患者分为观察组(n=52)和对照组(n=51)。对照组患者给予氟康唑胶囊口服治疗,观察组患者在对照组基础上给予乳酸杆菌阴道胶囊,两组疗程均为14 d。对比治疗前后患者阴道瘙痒感、疼痛感、阴道分泌物及充血水肿情况,评估疗效。测定两组患者治疗后血清C反应蛋白(CRP)、白细胞介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)等炎症因子水平,乳酸脱氢酶(LDH)、分泌型免疫球蛋白A(sIgA)及白细胞介素-1β(IL-1β)等阴道微生态指标水平以及阴道pH值。检测阴道分泌物中乳酸杆菌数量。随访1年,记录复发情况。结果治疗后观察组总有效率为96.15%,高于对照组的82.35%(P<0.05)。治疗后观察组乳酸杆菌阳性率为90.38%,高于对照组的74.51%(P<0.05)。治疗后两组血清CRP、IL-6及TNF-α水平均低于治疗前,且两组治疗后比较,观察组低于对照组(P<0.05)。治疗后,两组阴道pH值和IL-1β水平显著低于治疗前,观察组低于对照组;阴道LDH和sIgA水平高于治疗前,观察组高于对照组(P<0.05)。治疗后观察组复发率为1.92%,低于对照组的15.69%(P<0.05)。结论乳酸菌可显著提高氟康唑的抗炎作用,有效缓解外阴阴道假丝酵母菌病患者炎症反应,改善体征,降低复发率,同时可有效调节患者阴道微生态,具有临床应用价值。

Objective To explore the effect of Lactobacillus combined with fluconazole in the treatment of vulvovaginal candidiasis(VVC) and its effect on vaginal microecology. Methods One hundred and three inpatients with VVC in our hospital from September 2017 to September 2018 were included, and divided into observation group(n=52) or control group(n=51) randomly. The control group received fluconazole capsules, while the observation group received Lactobacillus capsules combined with fluconazole, for 14 days. Thereafter, various indexes were compared between groups. Symptoms including vaginal pruritus, pain, vaginal discharge and congestion and edema were observed to assess the clinical efficacy.The levels of inflammatory factors including serum C-reactive protein(CRP), interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α), vaginal microecological indicators including lactate dehydrogenase(LDH), secretory immunoglobulin A(sIgA) and interleukin-1β(IL-1β) and vaginal pH were measured after treatment. The recurrence was recorded during the one-year follow-up. Results After treatment, the total response rate in observation group was significantly higher than that in control group(96.15% vs 82.35%, P<0.05);the positive rate of Lactobacilli was significantly higher than in control group(90.38% vs 74.51%, P<0.05).The levels of serum CRP, IL-6 and TNF-α in both groups were lower after treatment, and those in the observation group were lower than in the control group, respectively(P<0.05). The vaginal pH and IL-1β levels in the two groups were significantly lower after treatment, and those in the observation group were lower than in the control group;the levels of vaginal LDH and sIgA were higher than those before treatment, and those in the observation group were higher than in the control group(P<0.05). The recurrence rate was 1.92% in observation group, significantly lower than the 15.69% in control group(P<0.05). Conclusion Lactobacillus capsules in the treatment of vulvovaginal candidiasis can significantly improve the anti-inflammatory effect of fluconazole, effectively alleviate the inflammatory response, ameliorate the signs, reduce the recurrence rate, and effectively regulate the vaginal microecological balance of patients, which has clinical application value.