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80例复发性外阴阴道念珠菌病的诊治分析

[Analysis of the diagnosis and treatment of recurrent vulvovaginal candidiasis in 80 cases].

作者信息

Yuan Xin-rong, Li Hong-wei, Yuan Li, Fan Long-zhong

机构信息

Department of Gynecology and Obstetrics, 422 Hospital of PLA, Zhanjiang 524009, China.

出版信息

Nan Fang Yi Ke Da Xue Xue Bao. 2010 Oct;30(10):2413-4, 2416.

Abstract

OBJECTIVE

To investigate the appropriate therapy for 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 fluconazole (0.15 qw after 0.15 q3d for 2 times) or ketoconazole (0.2, bid for 3 days ) or itraconazole (0.2 bid for 3 days ). After Nystain (400 000 unit qn for 7 days ) or clotrimazole(0.1 qn for 7 days) or amphotericin B (0.01 qn for 6 days ) being vaginally used, Living preparation of lactobacillus (0.25 qn for 5 days) was vaginally used. The therapy was continued for 2 to 5 therapy durations after the symptoms disappeared with negative fungal culture.

RESULTS

Among 80 cases of RVVC, C. albicans was mostly detected (74%), C. glabrata was 20%. The susceptivity to candidas of oral agents revealed that the sensitive rare of ketoconazole, fluconazole and itraconazole were (91.3%), (81.3%) and (62.5%), respectively. As for vaginal agents, nystain and amphotericin B were 100% sensitive, clotrimazole was 92.5%sensitive, miconazole was 55.0% sensitive. The remote cure of 3 and 6 therapy durations after discontinuing for 12 months was 78.9% and 90.4%

CONCLUSION

The predominant pathogen in RVVC is C. albicans. The effective measures to cure RVVC are to choose sensitive drugs for individual consolidated, maintenance therapy and restore vaginal acidic environment.

摘要

目的

探讨复发性外阴阴道念珠菌病(RVVC)的适宜治疗方法。

方法

每月根据阴道分泌物真菌培养及抗真菌药敏结果选择个体化巩固及维持治疗,以1个疗程为治疗周期。采用口服与阴道用药联合巩固治疗。口服药物为氟康唑(首剂0.15,之后0.15每周1次,首剂前已0.15每3天1次用2次)或酮康唑(0.2,每日2次,连用3天)或伊曲康唑(0.2,每日2次,连用3天)。阴道用药依次为制霉菌素(40万单位每晚1次,连用7天)或克霉唑(0.1每晚1次,连用7天)或两性霉素B(0.01每晚1次,连用6天),之后阴道用乳酸菌活菌制剂(0.25每晚1次,连用5天)。症状消失且真菌培养阴性后继续治疗2至5个疗程。

结果

80例RVVC患者中,白色念珠菌检出率最高(74%),光滑念珠菌占20%。口服抗真菌药物敏感性显示,酮康唑、氟康唑和伊曲康唑的敏感率分别为(91.3%)、(81.3%)和(62.5%)。阴道用药方面,制霉菌素和两性霉素B的敏感率为100%,克霉唑为92.5%,咪康唑为55.0%。停药12个月后3个疗程及6个疗程的远期治愈率分别为78.9%和90.4%。

结论

RVVC的主要病原菌是白色念珠菌。治愈RVVC的有效措施是选择敏感药物进行个体化巩固、维持治疗并恢复阴道酸性环境。

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