萆苓止带片治疗脾虚湿盛证外阴阴道假丝酵母菌病的临床疗效及对生殖道微生态的作用机制

Clinical efficacy of Biling Zhidai Tablets in vulvovaginal candidiasis in syndrome of spleen deficiency and dampness excess and mechanism on the microecology of the genital tract

目的:观察萆苓止带片治疗脾虚湿盛证外阴阴道假丝酵母菌病(VVC)患者的疗效,并从生殖道微生态和炎症因子探讨其作用机制。方法:将2021年11月—2022年9月就诊于广东省中医院的单纯性VVC患者分为治疗组(47例)和对照组(44例)。对照组与治疗组均予克霉唑栓剂外用,治疗组联用萆苓止带片口服,疗程7 d,分别观察治疗前、治疗7 d和停药7 d时患者真菌转阴率、阴道清洁度、中医证候积分、舒适度评分,并检测生殖道微生态和血清人单核细胞趋化蛋白1、人细胞间黏附分子1和人肿瘤坏死因子α表达情况。结果:治疗组在治疗7 d和停药7 d时真菌转阴率显著高于对照组(P<0.05),治疗组中医证候及舒适度评分较对照组改善更显著(P<0.05)。VVC患者生殖道微生态α多样性等与健康组存在差异,以Pseudomonas(属)和Lactobacillus iners(种)变化最显著,治疗组治疗后可恢复部分生殖道微生态。结论:萆苓止带片治疗脾虚湿盛证VVC疗效显著,可显著提高真菌转阴率、改善症状和舒适度,对生殖道微生态的调节作用可能是其作用机制之一。

Objective:To evaluate the effectiveness of Biling Zhidai Tablets in treating patients with vulvovaginal candidiasis(VVC) in syndrome of spleen deficiency and dampness excess and to explore its mechanisms of action through reproductive tract microecology and inflammatory markers.Methods:From November 2021 to September 2022,patients with uncomplicated VVC visiting the Guangdong Provincial Hospital of Chinese Medicine were divided into a treatment group(47 cases) and a control group(44 cases).Both groups received topical clotrimazole suppositories,with the treatment group additionally taking Biling Zhidai Tablets orally for a seven-day course.The study assessed the fungal clearance rates,vaginal cleanliness,traditional Chinese medicine syndrome scores,comfort ratings before treatment,after seven days of treatment,and seven days post-treatment.Furthermore,reproductive tract microecology and serum levels of MCP-1,ICAM-1,and TNF-αwere measured.Results:The treatment group showed significantly higher rates of fungal clearance both during and after treatment compared to the control group(P<0.05).Additionally,reductions in traditional Chinese medicine symptom scores and improvements in comfort were more improved in the treatment group(P<0.05).Differences in the α-diversity of reproductive tract microecology between patients and healthy controls were noted,particularly with significant changes in Pseudomonas and Lactobacillus iners.Post-treatment,the treatment group showed partial restoration of reproductive tract microecology.Conclusion:Biling Zhidai Tablets significantly improve fungal clearance rates,symptoms,and comfort in VVC patients in syndrome of spleen deficiency and dampness excess.Modulation of reproductive tract microecology may be one of its mechanisms of action.