复发性外阴阴道假丝酵母菌病的菌群分析与治疗

目的:了解复发性外阴阴道假丝酵母菌病(recurrent vulvovaginal candidiasis,RVVC)的致病菌群情况,探讨时RVVC的治疗.方法:对108例RVVC患者进行阴道分泌物假丝酵母菌培养并做药敏试验,选择敏感药物进行有效的半年巩固治疗,治疗第3月结束、治疗第6月结束时进行假丝酵母菌涂片检查.结果:RVVC患者中81例(75.0%)为白色假丝酵母菌,19例(17.6%)为光滑假丝酵母菌,4例(3.7%)为近平滑假丝酵母茵,2例(1.9%)为热带假丝酵母菌,2例(1.9%)为克柔假丝酵母菌.药物敏感试验显示,在108例RVVC患者中80.6%、66.7%、65.74%、57.4%、8.3%、6.5%分别对制霉菌素、克霉唑、咪康唑、氟康唑、酮康唑、伊曲康唑敏感;7.4%的假丝酵母茵对所有列出的药物均已耐药.治疗3个月、6个月结束时症状体征评分都比初诊时有明显好转(P<0.0001).治疗3个月结束时假丝酵母茵转阴率为76.2%(80/105),治疗6个月结束时假丝酵母茵转阴率为64.8%(68/105).结论:①非白色假丝酵母菌的比例在RVVC患者中增高,可以占到25.00%,而其中17.6%的RWC是由于光滑假丝酵母菌造成的.②在治疗RVVC时,要根据假丝酵母菌培齐、药敏实验结果以及以往患者的用药经验及发作特点选择用药.

Investigate the Pathogen Flora and the Treatment of Recurrent Vulvovaginal Candidiasis

Objective:To investigate the pathogen flora of recurrent vulvovaginal candidiasis(RWC),and to discuss its treatment. Methods: Fungal culture and susceptibility tests of vaginal discharge from 108 RWC patients were performed. Sensitive drugs were selected for effective consolidating treatment for half year. Fungal smears were examined at the 3rd and 6th months after the treatment respectively. Results:①Among RWC patients,there were 81 cas es of Candida albicans(75.0%), 19 cases of C. Glabrata(17.6%), 4 cases of C. Parapsilosis(3.7%) ,2 cases of C.tropicalis (1.9%) and 2 cases of M. Krusei (1.9%). The drug susceptibility test showed that 80.6% of these 108 patients were sensitive to nystatin; 66.7% were sensitive to clotrimazole; 65.7% were sensitive to miconazole; 57.4% were sensitive to fluconazole;8.3% were sensitive to ketoconazole;6.5% were sensitive to itraconazole; 7.4% were resistant to all of the above drugs.②The score of symptom and sign was significantly improved compared with the first visit at the 3rd and 6th month after the treatment( P<0.0001). The negative rate was 76.2%(80/105) at the 3rd month after the treatment and 64.8%(68/105)at the 6th month after the treatment. Conclusions:①The rate of non Candida albicans is increased to 25% in RWC patients, and 17.60% is Candida glabrata.②During the treatment of RWC, the drugs should be selected according to fungal culture, results of susceptibility test, medication experience of patients,and attack character. The research of immune abnormality of the local vagina will be helpful to improve the cure rate of RWC.