克霉唑治疗轻中度外阴阴道假丝酵母菌病的疗效及对患者依从性的影响

目的 对比分析两种剂型克霉唑在轻中度外阴阴道假丝酵母菌病(VVC)治疗中的临床价值。方法 以随机数字表法,将2019年5月—2020年8月收治的98例轻中度VVC患者予以分组,观察组49例,给予克霉唑乳膏治疗,对照组49例,给予克霉唑阴道片治疗,对两组治疗效果、症状缓解时间、不良反应发生情况及患者依从性予以观察。结果 观察组治疗总有效率为97.96%与对照组93.88%比较差异无统计学意义(χ²=0.2606,P=0.581);观察组外阴肿胀缓解时间比对照组短(2.63±0.51vs2.97±0.65 d,t=2.881,P=0.005),差异有统计学意义;观察组外阴瘙痒缓解时间比对照组短(2.35±0.47vs2.71±0.59 d,t=3.341,P=0.001);观察组阴道分泌物异常缓解时间比对照组短(2.92±0.63vs3.28±0.67 d,t=2.740,P=0.007);观察组不良反应发生率为8.16%,与对照组4.08%比较差异无统计学意义(χ²=0.178,P=0.625),;观察组用药依从率为100.00%稍高于对照组9...     

Photodynamic therapy-mediated hypericin-loaded nanostructured lipid carriers against vulvovaginal candidiasis

Introduction and Aim: The indiscriminate use and adverse effects of the main conventional antifungal agents compromise the effectiveness of treating vulvovaginal candidiasis (VVC), mainly caused by the species Candida albicans. This study evaluated the effectiveness of photodynamic therapy (PDT) and the in vitro and in vivo anti-candida potential of the hypericin (HYP)-loaded nanostructured lipid carriers (NLC). Materials and Methods: Empty NLC and NLC-HYP were characterized by the dynamic light scattering technique and transmission electron microscopy to evaluate the average particle size distribution and its morphologies. The in vitro inhibition photodynamic effect of the systems was tested to reduce the planktonic viability of C. albicans. The therapeutic assay photodynamic of the systems was performed to treat VVC in mice. Results: Empty NLC and NLC-HYP presented values of average hydrodynamic diameter, polydispersity index, and ζ-potential from 136 to 133 nm, 0.16 to 0.22, and -18 to -30 mV, respectively, on day 30. Microscopically, the systems showed spherical morphologies and nanoscale particles. Furthermore, in the in vitro inhibition assay, the treatment of PDT with NLC-HYP (NLC-HYP+) showed a significant reduction of the C. albicans planktonic viability compared to YNB negative control after 5 min of LED light irradiation. In the in vivo therapeutic assay, the antifungal group (vaginal antifungal cream) and NLC-HYP+ evaluated in the dark and by PDT, respectively, had a significant log₁₀ reduction in fungal burden compared to the infected group on day 8 of the VVC treatment. Conclusion: Due to the in vitro and in vivo anti-candida potential, PDT-mediated systems can be an effective strategy in VVC therapy.     

阴道擦洗及微波配合药物治疗外阴阴道假丝酵母菌病疗效分析

目的探讨阴道擦洗及微波理疗配合药物治疗外阴阴道假丝酵母菌病（WC）的临床疗效。方法将本院门诊确诊为单纯性VVC的患者220例随机分为组Ⅰ和组Ⅱ,组Ⅰ115例采取阴道擦洗、微波理疗配合局部用药治疗,组Ⅱ105例采取局部用药治疗,两组进行效果比较。结果两组患者停药后第3天和第7天,组Ⅰ患者的阴道分泌物真菌学转阴率、临床有效率均高于组Ⅱ,差异具有统计学意义。结论阴道擦洗、微波理疗配合局部用药治疗VVC具有较好的临床疗效。     

中西医结合治疗妊娠期外阴阴道假丝酵母菌病临床观察

目的观察中西药结合治疗妊娠期外阴阴道假丝酵母菌病的临床疗效。方法 96例患者随机分成两组。治疗组48例,中药局部用药加克霉唑栓阴道上药。对照组48例,2%碳酸氢钠局部用药加克霉唑栓阴道上药,7 d为1疗程,连用2个疗程。观察比较两组疗效和治愈者1个月后的复发率。结果治疗效果和复发率两组比较差异均有统计学意义。治疗组总有效率达97.9%,治愈后复发率仅2.7%,对照组总有效率达89.6%。治愈后复发率15.6%。两组临床表现改善情况与治疗前比较,差异有统计学意义,且治疗组疗效显著优于对照组。两组真菌检测率,远期真菌检测优于近期疗效,治疗组优于对照组,差异有统计学意义。结论中西医结合治疗妊娠期外阴阴道假丝酵母菌病,症状改善明显,复发少,值得临床推广。     

Sexual behavior of women with repeated episodes of vulvovaginal candidiasis

One hundred and two women with a history of a median of six episodes of vulvovaginal candidiasis (VVC) and 204 age-matched controls participated in a structured in-depth interview on sexual behavior. Mean and median ages of the two groups were 26.7 and 26 years, respectively. Sexual characteristics, associated with VVC in crude analyses, were adjusted in multifactorial analyses for coital frequency, experience of casual sex, vaginal irritation, smoking, alcohol habits, and having a steady partner. In addition, education, as a measure of socioeconomic status, was added in the multifactorial analyses. VVC was not associated with multiple sexual partners or ever-experience of causal sex. Sexual variables that remained significant or were of borderline significance after adjustment were: age at first intercourse (p=0.001), casual sex partners the previous month (odds ratio (OR)=3.1), sex during menstruation (OR=1.7), regular oral sex (OR=2.4), experience of anal intercourse ever (OR=2.4), oral intercourse the last month (OR=3.1), and frequency of oral intercourse (p=0.02). Thus, the study indicates that certain sexual activities are associated with repeated episodes of VVC.     

复发性外阴阴道念珠菌病患者的病原菌分析

目的了解复发性外阴阴道念珠菌病患者的念珠菌菌种分布。方法采集外阴阴道念珠菌病患者的标本,用CHROMagarCandida显色培养基及生物梅里埃API20CAUX酵母菌鉴定系统鉴定念珠菌的菌种。结果289例患者的阴道分泌物标本中,共检出念珠菌224株,检出率为77．51％。其中复发性外阴阴道念珠菌病患者的分泌物标本89例,检出72株。临床分离的念珠菌以白念珠菌居多共168株,占75．00％;其次为近平滑念珠菌19株（8．48％）,克柔念珠菌11株（4．91％）,其他为热带念珠菌、光滑念珠菌等。结论复发性外阴阴道念珠菌病患者以白念珠菌感染占明显优势,其他有近平滑念珠菌、克柔念珠菌感染等     

Evaluating the accuracy and diagnostic value of CFW and a new fluorescent reagents,fluorescent brightener 85, for the diagnosis of vulvovaginal candidiasis

BackgroundVulvovaginal candidiasis (VVC) is a common vaginitis in females. The commonly used diagnostic method, 10% potassium hydroxide (KOH) smear microscopy, makes it not very easy to recognize fungi.MethodsVaginal secretions were collected from clinically suspected VVC patients and divided into four groups and examined using KOH, CFW (Calcofluor White), FB 85(fluorescent brightener 85), and culture. The data were statistically analyzed.ResultsIn total, 110 patients with suspected VVC were recruited. The positive rates of KOH, CFW, FB 85, and the culture method were 68.2%, 64.5%, 61.8%, and 77%, respectively. According to the McNemar test, there was no statistically significant difference between the KOH, CFW, and the FB 85 methods (p > 0.05). However, CFW had a shorter diagnosis time than the KOH method and had a statistically significant difference (p < 0.001). Moreover, CFW has the highest sensitivity, specificity, and accuracy. In morphological recognition, it was easier to recognize fungal structures with CFW and FB 85 than with the KOH.ConclusionsThe fluorescent method is a good method for the diagnosis of VVC. And the fungi can be found more quickly. Similar to CFW, FB 85 is also a potential good fluorescent reagent for the diagnosis of VVC and has potential value for application in clinical fungal infection diseases.     

乳杆菌活菌胶囊配合制霉菌素治疗外阴阴道假丝酵母菌病的临床研究

目的：探讨乳杆菌活菌胶囊（商品名：定君生）配合制霉菌素治疗外阴阴道假丝酵母菌病（VVC）的疗效。方法：把120例VVC患者随机分为治疗组（60例）和对照组（60例）。治疗组先给予制霉菌素（50万U/片）治疗,阴道上药,1片/次,1次/d,连续用药10 d,接着给予定君生1粒,阴道上药,1次/d,连续5 d;第2、3个月月经干净后继续给予制霉菌素、定君生,阴道上药,方法和剂量同前。对照组仅用制霉菌素（50万U/片）1片,阴道上药,1次/d,连续10 d;第2、3个月月经干净后继续给予制霉菌素,阴道上药,方法和剂量同前。两组治疗3个疗程后观察其疗效。结果：治疗组总有效率为96.7%,对照组总有效率为73.3%,治疗组疗效优于对照组,两组比较差异有统计学意义（P〈0.05）。结论：定君生配合制霉菌素治疗外阴阴道假丝酵母菌病疗效明显。     

健康妇女和外阴阴道假丝酵母菌病患者阴道乳杆菌对阴道假丝酵母菌抑制作用的实验研究

目的:探讨正常健康和外阴阴道假丝酵母菌病(VVC)妇女阴道分泌物中分离的乳杆菌对假丝酵母菌生长的抑制。方法:健康正常(正常组)和VVC初发(VVC组)妇女各30名,通过定量采集阴道分泌物培养乳杆菌,观察阴道乳杆菌数量及菌种分布情况,并将获得的乳杆菌及VVC患者阴道分泌物中假丝酵母菌分离纯化及鉴定后,采用牛津杯法观察乳杆菌对假丝酵母菌生长的抑制作用,同时比较VVC组和正常组乳杆菌产H2O2能力的差异。结果:①乳杆菌检出率及菌种分布组间无统计学差异(P>0.05);②VVC组阴道乳杆菌数量的平均对数值与正常组相比显著减少(P<0.01);③阴道内乳杆菌BV试剂盒检测为阴性者,正常组显著高于VVC组(P<0.01);④正常组阴道分离的乳杆菌与VVC组比较,对白色和热带假丝酵母菌的生长抑制有统计学差异(P<0.05),对克柔假丝酵母菌的抑制无统计学差异(P>0.05);正常组分离的嗜酸乳杆菌与VVC组的比较,对白色和热带假丝酵母菌的生长抑制均有统计学差异(P<0.01,P<0.05),对克柔假丝酵母菌的生长抑制无统计学差异(P>0.05);但是正常组和VVC组分离的詹氏乳杆菌对上述3种假丝酵母菌的生长抑制均无统计学差异(P>0.05)。结论:①正常妇女与VVC患者阴道内乳杆菌检出率、菌种分布相似,均以嗜酸、詹氏乳杆菌为优势菌种;②VVC患者阴道乳杆菌的数量显著减少;③VVC组产生H2O2的能力下降,可能与VVC发生相关;④正常状态下阴道乳杆菌对假丝酵母菌抑制作用优于VVC感染状态,其中以嗜酸乳杆菌的抑菌作用最为明显。     

常用抗假丝酵母菌药物对阴道常见乳杆菌生长影响的研究

目的:探讨治疗外阴阴道假丝酵母菌病(VVC)的药物对阴道常见乳杆菌生长的影响。方法:VVC患者随机分为3组,分别应用咪康唑(咪康唑组)、伊曲康唑(伊曲康唑组)、制霉菌素栓(制霉菌素组)进行治疗,治疗前、后分别进行乳杆菌Nugent评分,治疗后观察患者症状缓解时间、阴道pH值、乳杆菌数量及H2O2阳性乳杆菌的检出率等。结果:患者症状缓解时间、总有效率3组间差异无统计学意义(P>0.05)。3组乳杆菌Nugent评分均较治疗前有所降低,且伊曲康唑组乳杆菌Nugent评分显著高于咪康唑组和制霉菌素组,差异有统计学意义(P<0.05)。咪康唑组、伊曲康唑组、制霉菌素组中H2O2阳性的乳杆菌分别占30.0%、60.0%和25.0%,差异有统计学意义(P<0.05),伊曲康唑组H2O2阳性的乳杆菌的检出率显著高于其余2组,差异有统计学意义(P<0.05)。结论:伊曲康唑治疗VVC疗效确切,对阴道乳杆菌生长的影响较小,有助于维护阴道正常菌群,是一种治疗VVC较理想的抗真菌药物。