复发性外阴阴道假丝酵母菌病局部病因调查及治疗

目的 调查复发性外阴阴道假丝酵母菌病(RVVC)的局部病因及探讨其合理有效的治疗方案.方法 选择158例确诊为RVVC的患者,常规行肛周分泌物及性伴侣龟头分泌物真菌培养,另50例非阴道病患者同时行肛周分泌物真菌培养作为对照.158例研究病例随机分3组,A组:口服易启康(依曲康唑)0.1 g,每天2次,连服7 d为一疗程.B组:口服易启康+克霉唑栓0.15 g阴道上药每天1次,共10d为一疗程.C组:在B组基础上再进行维持治疗,克霉唑栓0.15 g阴道上药,每隔3d1次,共3次.3组均每次月经干净后3 d开始重复治疗,连续6个疗程.性伴侣龟头分泌物真菌培养阳性者同时口服抗真菌药物治疗.治疗完成后第4、8、12、24周分别进行临床及真菌观察评定疗效.结果 158例患者肛周分泌物真菌培养阳性率100%(158/158);50例非阴道病患者肛周分泌物真菌培养阳性率8%(4/50),两者差异有统计学意义(P＜0.05).158例性伴侣中有18例有包皮过长或龟头炎,这18例性伴侣其龟头分泌物真菌培养阳性率100%(18/18),另140例性伴侣无龟头炎或包皮过长者,其龟头分泌物真菌培养阳性率为1.43%(2/140),两者差异有统计学意义(P＜0.05).3组治疗4周后有效率差异无统计学意义(P＞0.05);治疗8周后A组有效率显著低于B、C组,差异有统计学意义(P＜0.01);24周后A组复发率显著高于B、C组,差异有统计学意义(P＜0.01).结论 消化道真菌感染可能是RVVC反复发作的病因之一;性伴侣有包皮过长或龟头炎时需同时治疗;小剂量、长时间口服易启康及口服加阴道用药治疗RVVC近期4周内均有较好疗效,但联合用药远期疗效优于单纯口服用药.     

克霉唑栓联合乳酸菌阴道胶囊在治疗复发性外阴阴道假丝酵母菌病中的应用与疗效

目的：分析研究临床在面对复发性外阴阴道假丝酵母菌病患者时,给予其实施克霉唑栓、乳酸菌阴道胶囊联合治疗后的临床效果。方法择取我院妇科在近期内接诊的103例复发性外阴阴道假丝酵母菌病患者,并按照治疗方式的不同将患者分为A组(51例单一实施克霉唑栓治疗)、B组(52例实施克霉唑栓、乳酸菌阴道胶囊)。结果经过治疗后,B组患者的治疗有效率为94.23%,明显高于A组患者(P<0.05);治疗后随访结果显示,B组患者的复发率明显低于A组患者(P<0.05)。结论临床在面对复发性外阴阴道假丝酵母菌病患者时,给予其实施克霉唑栓、乳酸菌阴道胶囊联合治疗后临床效果佳,值得临床推广应用。     

可宝净栓联合伊曲康唑治疗复发性外阴阴道假丝酵母菌病的临床观察

目的观察可宝净栓及伊曲康唑联合治疗复发性外阴阴道假丝酵母菌病的疗效及复发情况。方法选择2003～2004年我院妇科门诊确诊为复发性外阴阴道假丝酵母菌病的患者110例,随机分成3组,A组40例给予可宝净栓阴道上药,日一次,每次1片,连用18d,月经期不间断。B组40例给予可宝净栓阴道上药,用法同A组,同时口服抗真菌药物斯皮仁诺200mg,口服,每日一次,共三次。C组,30例,单纯给予斯皮仁诺200mg口服,每日一次,共3次。用药后1个月复诊,以后随访达半年,观察治疗效果,及有无复发。结果联合用药组疗效最好,且复发率最低。结论可宝净栓联合伊曲康唑治疗RVVC疗效显著,且可明显降低VVC复发率。     

外阴阴道假丝酵母菌病与阴道局部免疫的研究进展

阴道假丝酵母菌病感染后,阴道上皮局部介导的先天免疫在抗假丝酵母菌病中开始发挥重要作用,局部Th1与Th2细胞及其细胞因子形成局部免疫网络相互调控、彼此抑制,调节免疫应答引起阴道上皮局部免疫改变,决定了机体对致病菌的易感性。本文就VVC与Th1/Th2介导的阴道局部免疫相关研究进行阐述。     

臭氧治疗外阴阴道假丝酵母菌病的临床观察

目的观察臭氧对外阴阴道假丝酵母菌病（VVC）的治疗效果。方法将102例VVC患者随机分为观察组（51例）和对照组（51例）,观察组接受臭氧治疗,对照组接受达克宁硝酸咪康唑栓治疗。两组于治疗后第3天进行临床和真菌学疗效分析。结果治疗结束后第3天,观察组治愈42例（82．3％）、显效6例（11．8％）、有效3例（5．3％）,总有效率为100％;对照组治愈28例（55．0％）、显效12例（23．5％）、有效6例（11．8％）、总有效率为90．3％。两组治愈率差异有统计学意义（P〈0．01）。结论臭氧治疗外阴阴道假丝酵母菌病效果显著,不良反应发生率低。     

抗真菌药联合转移因子治疗复发性外阴阴道假丝酵母菌病的疗效观察

目的 观察抗真菌药联合转移因子治疗复发性外阴阴道假丝酵母菌病的疗效.方法 将160例确诊为复发性外阴阴道假丝酵母菌病的患者随机分为两组,治疗组80例,给予抗真菌药联合转移因子治疗,对照组80例,单纯给予抗真菌药物治疗.观察两组停药后1w、1个月、3个月、6个月的情况.结果 治疗6个月后停药,两组治愈率无明显差异(P＞005);停药1个月、3个月、6个月后治疗组的复发率明显低于对照组(P＜0.05).结论 抗真菌药联合转移因子治疗复发性外阴阴道假丝酵母菌病,疗效显著,复发率低,值得推广使用.     

雌激素影响外阴阴道假丝酵母菌病的发生发展

白假丝酵母菌是外阴阴道假丝酵母菌病的主要条件致病菌,高水平的雌激素与外阴阴道假丝酵母菌病的高发病率密切相关。雌激素对菌体和宿主均有影响。雌激素通过结合白假丝酵母菌的雌激素结合蛋白增加1型菌丝壁蛋白、分泌型天冬氨酸蛋白酶和磷脂酶的表达,促进形态转换和热休克蛋白90的表达,从而增强白假丝酵母菌对宿主组织的粘附、入侵和环境适应力。同时雌激素通过与宿主的雌激素受体结合影响阴道的pH,抑制阴道上皮细胞和吞噬细胞介导的先天性抗假丝酵母菌免疫以及T细胞和B细胞介导的获得性抗假丝酵母菌免疫。雌激素是建立外阴阴道假丝酵母菌病动物模型的关键因素。此文章总结了在外阴阴道假丝酵母菌病的发生发展中雌激素对假丝酵母菌和宿主产生的影响。     

复发性外阴阴道念珠菌病危险因素分析

目的探讨复发性外阴阴道念珠菌病（RVVC）发病的危险因素。方法采用念珠菌镜检和培养的方法将160例患者中阳性者分为外阴阴道念珠菌病（WC）组和RVVC组,分析各种危险因素在3组中的差异。结果使用抗生素、阴道冲洗、口服避孕药、妊娠与RVVC的发生有关。结论使用抗生素、阴道冲洗、口服避孕药、妊娠是RVVC的危险因素。     

妊娠期外阴阴道假丝酵母菌病症状与妊娠结局分析

目的：研究妊娠期外阴阴道假丝酵母菌病(VVC)症状与妊娠结局的关系。方法选取我院收集的136例妊娠>35 w患者阴道分泌物假丝酵母菌涂片阳性诊断VVC,其中有症状者60例作为观察组,无症状者76例作为对照组。观察两组妊娠结局及不良妊娠结局情况。结果观察组胎膜早破、产褥感染和剖宫产率与对照组比较差异有统计学意义(<0.05);而胎儿窘迫和新生儿感染率比较差异无统计学意义(>0.05)。结论妊娠期有症状VVC可致胎膜早破、剖宫产率等不良妊娠结局增高,早期诊断和治疗十分必要。     

纳米银抗菌凝胶联合氟康唑治疗外阴阴道假丝酵母菌疗效观察

目的：探讨纳米银抗菌凝胶联合氟康唑治疗外阴阴道假丝酵母菌病疗效。方法选择门诊确诊的外阴阴道假丝酵母菌患者58例随机分为治疗组和对照组,治疗组氟康唑单次口服150mg,纳米银抗菌凝胶连用6d。对照组纳米银抗菌凝胶连用6d,对比疗效。结果两组停药后7d总有效率为93.3%和82.1%,两组在下次月经干净后总有效率为93.3%和78.6%。结论纳米银抗菌凝胶联合氟康唑治疗外阴阴道假丝酵母菌具有较好的疗效。     

复发性外阴阴道念珠菌病患者及性伴侣带菌情况分析

目的 研究复发性外阴阴道念珠菌病(RWC)复发相关因素.方法 选择55例RVVC患者及其中45位患者性伴侣,取阴道、肛门、口腔及龟头分泌物分离念珠菌,采用ITS1区单链构型多态性(SSCP)分析和大亚基26S rDNA基因D1/D2区序列分析相结合的方法进行菌种鉴定,应用微卫星CAI位点的SSCP和基因扫描分析相结合的...     

Quantitative system for diagnosis of vulvovaginal candidiasis

IntroductionVaginal infections are one of the most common reason for gynecological consultations. Many of them are the result of overgrowth of resident microorganisms. The clinical symptoms of vulvovaginal candidiasis are nonspecific and an accurate diagnosis is a problem that often leads to inadequate treatment or delays in treatment. The lack of an exact and practical diagnostic method is a common cause of misdiagnosis.AimTo create a complex, quantitative method for the diagnosis of vulvovaginal candidiasis which to enables differentiation from vaginal fungal colonization.Material and methodsA total of 2306 vaginal samples were examined. Clinical, microbiological, epidemiological methods and statistical models are used.Results and discussionThe proposed score system is a specific, sensitive and inexpensive method to routinely diagnose vulvovaginal candidiasis. Statistical processing of the obtained data shows the impact of the individual components on which the method is based: the presence of vaginal discharge, pruritus, direct microscopy and assessment of the fungal growth. The data analysis reveals good sensitivity (71%) and high specificity (98%) of the method. This allows accurate interpretation of the result of the clinical and microbiological examination of each patient.ConclusionThe system for diagnosing vulvovaginal candidiasis is complex and based on quantitative indicators. The method can be used to differentiate vulvovaginal candidiasis from vaginal fungal colonization (the cut-off value is 5.5 points) and to more accurately interpret a Candida positive result from quantitative real-time PCR in asymptomatic patients or in women with mixed vaginal infection.     

复方沙棘籽油栓治疗复发性念珠菌外阴阴道炎的临床观察

目的观察并评价阴道应用复方沙棘籽油栓治疗复发性念珠菌外阴阴道炎（RVVC）的疗效。方法对500例RVVC患者阴道应用复方沙刺籽油栓每晚一粒，每月用12天，共6个月，观察疗效及副反应。结果①第一次复诊时治愈率为93．20％，第二次复诊时97．40％。②患者满意和较满意在第一次复诊可达90％，第二次复诊时达98％。③无严重不良反应发生。结论阴道应用复方沙棘籽油栓治疗复发性念珠菌外阴阴道炎（RVVC）有效、安全且依从性好。     

Cellular immunity in recurrent vulvovaginal candidiasis

Impaired T cell function has been reported to predispose women to recurrent vulvovaginal candidiasis, but conflicting results have been noted in the literature. Most clinical episodes occur in the late luteal phase, suggesting hormonal influence on host resistance. The present study assesses the cellular immune responses of 28 women with recurrent vaginal candidiasis (patients) and 25 control women (controls), noting results in relation to whether the women were in the follicular or luteal phase of the menstrual cycle at the time of sampling. Candida-stimulated peripheral blood lymphocyte proliferation was significantly reduced in patients compared with controls. Interferon-gamma (IFN-γ) production in response to both Candida and purified protein derivative (PPD) stimulation was significantly lower in patients compared with controls. Skin test responses were comparable in both groups. A significant reduction in Candida-stimulated IFN-γ production was seen in patients but not controls in the follicular phase compared with those in the luteal phase. There was also a trend towards lower proliferation in response to Candida in patients but not controls in the follicular phase compared with patients in the luteal phase. These results suggest that there is a partial T cell dysregulation in recurrent vaginal candidiasis which may be exacerbated by the hormonal balance present during the follicular phase, correlating with the risk of clinical infection.     

妊娠期妇女生殖道假丝酵母菌病与妊娠不良结局分析

目的探讨妊娠期妇女生殖道假丝酵母菌病对妊娠不良结局的影响。方法回顾性分析2011年1月-2014年2月在我院住院孕产妇共2500例,进行阴道分泌物细菌培养,对白色念珠菌培养阳性组与正常对照组的妊娠结局进行分析,以探讨妊娠合并生殖道假丝酵母菌病与围产期并发症的关系。结果在2500例围产期妇女中,无致病菌组（对照组）为1300例,假丝酵母菌培养阳性组（感染组）为350例,总患病率为14%,其中有症状组200例（57.14%）,无症状组为150例（42.86%）。有症状感染组、无症状感染组、对照组的胎膜早破的发生率分别为22.5%、9.33%、8.15%,早产率分别为9.5%、4%、3%,绒毛膜羊膜炎率分别为23%、8.67%、7.38%,产褥感染率分别为7.5%、4%、3.54%,新生儿黄疸的发生率分别为21%、10.67%、11.54%,新生儿窒息率分别为2%、2.67%、2.31%,低体重儿的发生率分别为1.5%、1.33%、1.92%。有症状的妊娠期妇女生殖道假丝酵母菌病与无症状组及对照组相比较,胎膜早破、早产、绒毛膜羊膜炎、产褥感染、新生儿黄疸的发生率均有显著升高,新生儿窒息率及低体重儿的发生率无显著性差异。结论孕期对有症状的生殖道假丝酵母菌病的治疗是有重要意义的。     

Immunopathogenesis of recurrent vulvovaginal candidiasis.

Recurrent vulvovaginal candidiasis (RVVC) is a prevalent opportunistic mucosal infection, caused predominantly by Candida albicans, which affects a significant number of otherwise healthy women of childbearing age. Since there are no known exogenous predisposing factors to explain the incidence of symptomatic vaginitis in most women with idiopathic RVVC, it has been postulated that these particular women suffer from an immunological abnormality that prediposes them to RVVC. Because of the increased incidence of mucosal candidiasis in individuals with depressed cell-mediated immunity (CMI), defects in CMI are viewed as a possible explanation for RVVC. In this review, we attempt to place into perspective the accumulated information regarding the immunopathogenesis of RVVC, as well as to provide new immunological perspectives and hypotheses regarding potential immunological deficiencies that may predispose to RVVC and potentially other mucosal infections by the same organism. The results of both clinical studies and studies in an animal model of experimental vaginitis suggest that systemic CMI may not be the predominant host defense mechanism against C. albicans vaginal infections. Rather, locally acquired mucosal immunity, distinct from that in the peripheral circulation, is now under consideration as an important host defense at the vaginal mucosa, as well as the notion that changes in local CMI mechanism(s) may predispose to RVVC.