阴道微生态指标在外阴阴道假丝酵母菌病治疗中的应用

Application of vaginal micro ecological index in vulvar and vagina candida diseases treatment

目的通过阴道微生态评价指标,了解外阴阴道假丝酵母菌病(VVC)患者治疗后的阴道微生态被彻底恢复与未被彻底恢复时的差异。方法将169例VVC患者被随机分成A、B两组。A组87例(其中RVVC 12例),B组82例(其中RVVC 9例)。A组治疗至症状消失、体征恢复正常、病原体消失,2次阴道分泌物真菌学检查阴性、阴道菌群密集度Ⅱ~Ⅲ度且乳酸杆菌占明显优势、过氧化氢、唾液酸酶、白细胞酯酶、脯氨酸氨基肽酶、乙酰氨基葡萄糖苷酶等功能指标阴性时停药;B组治疗至症状消失、体征恢复正常、病原体检测结果阴性时停药。A、B两组停药后均随访6个月。结果 A组随访6个月复发率为2.30%、B组复发率为12.20%,两组比较,差异有统计学意义(P<0.05);临床治愈时,部分患者阴道微生态指标仍处于紊乱状态,而恢复微生态指标要比临床治愈困难得多。结论动态监测阴道微生态评价指标,将阴道微生态评价指标作为治愈的标准,能客观指导临床VVC治疗。VVC患者经个体化治疗,积极彻底恢复阴道微生态环境,可明显降低了其远期复发率。

Objective To find out the vaginal microecological differences between the situations of complete recovery and incomplete recovery in the cases of VVC through the evaluation of vaginal microecological index. Methods 169 cases of VVC patients were randomly divided into two groups marked as A and B. 87 cases in group A( 12 cases of which are RVVC),82 cases in group B( 9 cases of which are RVVC). Cases in Group A had been stopped treatment when recovered to the symptoms disappeared,signs back to normal,pathogens disappeared,twice vaginal mycological check showed negative,vaginal flora density around Ⅱ-Ⅲ degrees and lactobacillus showed obvious advantages; Cases in Group B had been stopped treatment when symptoms disappeared,signs back to normal, and pathogen detection results showed negative. Both groups were followed up for 6 months after drug withdrawal. Results The recurrence rate was 2. 30% in group A when were followed up for 6 months,for B group that was 12. 20%,the differences in comparison were significant( P < 0. 05); When reached clinical cure,the vaginal microecological index in part of the patients were still in a state of disorder,and restore the micro ecological index is much more difficult than clinical cure. Conclusion Dynamic monitoring of Vaginal microecological evaluation index and use vaginal micro ecological evaluation index as a standard of cure can objectively guide clinical VVC treatment. Through individualized treatment the VVC patients can completely restore vaginal microecological environment actively,can obviously reduce the long-term recurrence rate.