复发性外阴阴道假丝酵母菌病69例诊治分析  

Analysis of diagnosis and treatment of recurrent vulvovaginal candidiasis(RVVC) in 69 cases

作　　者：祝建军[1] 蒋琰瑛[1] 吴展[1] 叶金艳 沈雪群 

机构地区：[1]嘉兴市妇幼保健院,浙江嘉兴314000

出　　处：《中国实用妇科与产科杂志》2009年第10期769-771,共3页Chinese Journal of Practical Gynecology and Obstetrics

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

摘　　要：目的探讨治疗复发性外阴阴道假丝酵母菌病（RVVC）的合适方法。方法2004年1月至2006年7月嘉兴市妇幼保健院，根据阴道分泌物真菌培养＋药敏结果选择个体化强化＋巩固治疗方案；每月1个疗程，口服＋阴道用药强化治疗。口服用药：伊曲康唑0．1g每日2次，连用5d或酮康唑0．2g每日2次，连用5d或氟康唑150mg1次或150mg每3日1次，连用2次后150mg/周；配伍阴道用药：制霉菌素阴道栓每晚40万单位，连用7d或克霉唑阴道栓每晚0．1g，连用7d或凯妮汀0．5g/周或两性霉菌B泡腾片每晚10mg，连续6d。症状消失伴真菌学转阴后再巩固治疗2～10个疗程。结果（1）RVVC发生率占外阴阴道假丝酵母菌病（VVC）的4．4％。（2）69例RVVC以白色假丝酵母菌感染为主占73．9％，光滑假丝酵母菌感染占21．7％。（3）药敏结果显示口服药中酮康唑敏感率为94．2％，氟康唑75．4％，伊曲康唑62．3％，特比奈芬仅43．5％；阴道用药中制霉菌素和两性霉菌B敏感率为100．0％，克霉唑94．2％敏感，咪康唑53．6％敏感。（4）治疗有效率91．3％。停药后3、6、12个月远期治愈率为81．2％、73．9％和69．6％。结论RVVC主要病原菌是白色假丝酵母菌，选择敏感药物强化＋巩固治疗是治愈RVVC有效措施。Objective To investigate the appropriate therapy of treating recurrent vulvovaginal candidiasis （RVVC）. Methods Individual consolidated and maintenance therapy were chosen according to fungal culture of vaginal secretion and antifungal drug sensitivity per month as one therapy duration. Drugs were used orally and vaginally together to consolidate the therapy. Oral drugs were itroconazole （0. 1, bid for 5days） or ketoconazole （0. 2,bid for 5days） or fluconazole （ 0. 15 for one time or 0. 15 qw after 0. 15 q3d for 2 times ）. Nystatin（400 000 unit qn for 7 days ） or clotrimazole（0. 1 qn for 7 days ） or clotrimazole（0. 5 qw ） or amphotericin B（0. 01qn for 6days） was vaginally used. The therapy was continued for 2 to 10 therapy durations after the symptoms disappeared with negative fungal culture. Results （ 1 ） The incidence of RVVC was 4. 4% that of VVC, （2）Among 69 cases of RVVC, C. albicans was mostly detected （73.9%）, C. glabrata was 21.7%. （3）The susceptivity to candidas of oral agents revealed that the sensitive rate of ketoconazole, fluconazole, itroconazole and terbinafine were respectively 94. 2% ,75.4% ,62. 3% and 43.5%. As for vaginal agents , nystatin and amphotericin B were 100% sensitive, clotrimazole was 94. 2% sensitive, miconazole was 53.6% sensitive. （4） The effective rate of individual strengthening and solid therapy was 91.3% , the remote cure rate after discontinuing for 3 months,6 months and 12 months was respectively 81.2% ,73.9% and 69. 6% ,respectively. Conclusion The predominant pathogen in RVVC is C. albicans. The effective measures to cure RVVC are to choose sensitive drugs for individual consolidated and maintenance therapy.

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 治疗 

分 类 号：R71[医药卫生—妇产科学]