加味萆薢渗湿汤联合阴洁康洗液坐浴治疗湿热下注型外阴阴道假丝酵母菌病临床研究

Clinical Study on Modified Bixie Shenshi Tang and Chinese Herbal Bath with Yinjiekang Lotion for Vulvovaginal Candidiasis of Damp-Heat Pouring Downward Type

目的:观察加味萆薢渗湿汤联合阴洁康洗液坐浴治疗湿热下注型外阴阴道假丝酵母菌病(VVC)的临床疗效及对患者阴道微生态的影响。方法:选取96例湿热下注型VVC患者,按随机数字表法分为A组、B组、C组,每组32例。A组给予克霉唑阴道片治疗,B组给予加味萆薢渗湿汤内服联合阴洁康洗液坐浴治疗,C组给予加味萆薢渗湿汤内服、阴洁康洗液坐浴联合克霉唑阴道片治疗,3组均随访3个月。比较3组治愈率、总有效率、复发率及不良反应;比较3组治疗前后阴道微生态指标。结果:A组、B组、C组治愈率分别为62.5%、40.6%、90.6%,总有效率分别为90.6%、71.9%、96.9%。C组治愈率高于B组、A组(P<0.05);C组总有效率高于B组(P<0.05)。随访3个月,C组复发率低于A组(P<0.05)。治疗后、随访3个月,B组、C组乳酸杆菌分级均优于A组(P<0.01)。治疗后、随访3个月,C组阴道pH值达标率、菌群密集度Ⅱ~Ⅲ级比率、菌群多样性Ⅱ~Ⅲ级比率、过氧化氢(H2O2)阳性率、清洁度Ⅰ级比率、白细胞酯酶阴性率均高于A组(P<0.05);C组菌群密集度Ⅱ~Ⅲ级比率、菌群多样性Ⅱ~Ⅲ级比率、白细胞酯酶阴性率均高于B组(P<0.05);B组阴道pH值达标率、H2O2阳性率、清洁度Ⅰ级比率均高于A组(P<0.05)。治疗期间,B组未出现不良反应,C组有1例患者出现阴道干涩,A组有1例患者出现外阴水肿、1例患者出现阴道灼痛,均未经处理自行缓解。结论:加味萆薢渗湿汤联合阴洁康洗液坐浴能有效调节湿热下注型VVC患者失衡的阴道微生态,与克霉唑阴道片联用可提高临床疗效、降低复发率。

Objective:To observe the clinical effect of modified Bixie Shenshi tang and Chinese herbal bath with Yinjiekang lotion on vulvovaginal candidiasis(VVC)of damp-heat pouring downward type and its effect on vaginal microecology of patients.Methods:A total of 96 VVC patients of damp-heat pouring downward type were selected and divided into group A,group B and group C by random number table method,32 cases in each group.group A was treated with clotrimazol vaginal tablets only,group B was treated with oral administration of modified Bixie Shenshi tang and Chinese herbal bath of Yinjiekang lotion,group C was treated with oral administration of modified Bixie Shenshi tang,Chinese herbal bath of Yinjiekang lotion and clotrimazol vaginal tablets.All groups were followed up for three months.The cure rate,total effective rate,recurrence rate,adverse reactions and the vaginal microecological indexes before and after treatment were compared among the three groups.Results:The cure rates in group A,B and C were 62.5%,40.6%,90.6%,and the total effective rates were 90.6%,71.9%,96.9%,respectively.The cure rate in group C was higher than that in group B and A(P<0.05);the total effective rate in group C was higher than that in group B(P<0.05).After three-month follow-up,the recurrence rate in group C was lower than that in group A(P<0.05).After treatment and follow-up for three months,the grade of lactobacillus in groups B and C was better than that in group A(P<0.01).After treatment and follow-up for three months,the rate of vaginal p H value reaching standard,the rate of microflora concentration of gradeⅡtoⅢ,the rate of microflora diversity of gradeⅡtoⅢ,the positive rate of H2 O2,the rate of cleanliness of gradeⅠand the negative rate of leukocyte esterase in group C were all higher than those in group A(P<0.05);the rate of microflora concentration of gradeⅡtoⅢ,the rate of microflora diversity of gradeⅡtoⅢ,and the negative rate of leukocyte esterase in group C were all higher than those in group B(P<0.05);the rate of vaginal p H value reaching standard,the positive rate of H2 O2 and the rate of cleanliness of gradeⅠin group B were all higher than those in group A(P<0.05).During the treatment,there was no adverse reactions in group B;there was one patient in group C who developed vaginal dryness;there was one patient in group A who developed vulvar edema and one patient who developed vaginal burning pain;and all of them were spontaneously relieved without treatment.Conclusion:Modified Bixie Shenshi tang and Chinese herbal bath with Yinjiekang lotion could effectively regulate the imbalance of vaginal microecological status in VVC patients of damp-heat pouring downward type,and the combination with clotriazole vaginal tablets could improve clinical effect and reduce recurrence rate.