复发性外阴阴道假丝酵母菌病的治疗  

A Recurrent Vulvovaginal Candidiasis and Drug Resistance:Analysis and Therapy

作　　者：祝建军[1] 蒋琰瑛[2] 吴展[2] 刘霞[2] 李英龙[2] 叶金艳 杜玉海[1] 

机构地区：[1]嘉兴市妇幼保健院检验科,浙江嘉兴314000 [2]嘉兴市妇幼保健院妇科,浙江嘉兴314000

出　　处：《中华医院感染学杂志》2008年第7期965-967,共3页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科学研究基金项目(2004B189);浙江省嘉兴市科研计划项目(2004015)

摘　　要：目的了解引起复发性外阴阴道假丝酵母菌病(RVVC)的主要病原菌及其耐药性,寻求RVVC的理想治疗方案。方法将诊断为RVVC的病例,进行真菌学培养及药敏试验,选择敏感抗真菌药物,确定个体化的强化治疗和巩固治疗方案进行疗效观察,并对治愈停药后1、3、6、9、12个月回访调查分析。结果67例RVVC病例白色假丝酵母菌感染占68.4%,光滑假丝酵母菌感染占26.4%;在口服用药中酮康唑敏感率最高(91.04%),特比奈芬敏感率最低(34.33%),在阴道用药中制霉菌素和两性霉素B敏感率最高(100.00%),克霉唑次之(91.00%),咪康唑敏感率最低(53.73%);RVVC的治愈率为随访治愈后1个月95.52%、3个月83.58%、12个月72.22%。结论RVVC的主要病原菌是白色假丝酵母菌和光滑假丝酵母菌,治疗RVVC必须根据药敏结果选择抗真菌药物,根据病程和随访复发情况延长强化治疗和巩固治疗时间是治愈RVVC的有效措施,在无药敏结果时首选酮康唑、制霉菌素、克霉唑。OBJECTIVE To comprehend the main pathogenic bacteria of recurrent vulvovaginal candidiasis （RVVC）, and to analyze the drug resistance of pathogenic bacteria in order to seek the best therapeutic regimen. METHODS Samples extracted from the cases which were diagnosed RVVC were cultured and susceptibility test was carried out. To select sensitive antifungals and ascertain individualized intensification therapy and after treatment regimen and observe curative effect, at the same time, return visit and analyze curative effect after discontinuation for 1, 3, 6, 9, and 12 months. RESULTS The Candida albicans （68. 4%）, and C. glabrata （26.4 %） were found out from 67 RVVC cases. For oral administration, the susceptibility to KCZ was 91.04 M, to terbinafine was 34.33 %. For pro vagin medication, the susceptibility to mycostatin and amphotericin B were 100% ,to clotrimazole was 91.0%. RVVC cure rate at 1,3,and 12 months after recovery were 95.52%, 83.58%, and 72.22%, respectively. CONCLUSIONS C. albicans and C. glabrata are the main pathogens which induce RVVC, so fungus culture and susceptibility test must be done. Mycostatin, KCZ and clotrimazole are first choices for RVVC therapy. To extend intensification therapy and after treatment is modus operandi on the basis of course of disease and recurrence condition. KCZ, mycostatin and clotrimazole should be selected if susceptibility test was not done.

关 键 词：复发性外阴阴道假丝酵母菌病 白色假丝酵母菌 抗真菌药物 耐药性 治疗 

分 类 号：R379[医药卫生—病原生物学]