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目的:探讨重度外阴阴道假丝酵母菌病的有效治疗方法。方法:将136例重度外阴阴道假丝酵母菌患者随机分为A、B、C三组,A组给予制霉菌素片阴道用药,每次50万U,每晚1次,共14d;B组给予咪康唑栓阴道用药,每次400mg,每晚1次,共6d;C组给予两种药物同时阴道用药,剂量同A、B组,共6d,再继续给予单一制霉菌素片阴道用药,共4天。各组均同时口服伊曲康唑,每次200mg,每日2次,共1d。分别于停药4～7d、停药1个月复诊,行临床症状体征评分及真菌学检查,并进行疗效判定及不良反应评估。结果:停药4～7d后复诊,A、B、C组临床治愈率分别为65.0%、59.6%、88.6%,C组明显高于A、B组,差异均有显著性意义(P<0.05)。停药1个月后复诊,A、B、C组临床治愈率分别为70.0%、70.2%、93.2%,C组明显高于A、B组,差异具有显著性意义(P<0.05)。两次复诊A、B、C组总有效率均分别为95.0%、93.6%、97.7%,各组间差异无统计学意义(P>0.05)。停药4～7d后,阴道分泌物真菌学镜检治愈率A、B、C组分别为75.0%、74.5%、97.7%,C组明显高于A、B组,差异具有显著性意义(P<0.05)。停药1个月后复诊,A、B、C组复发率分别为18.7%、20.0%、2.3%,C组明显低于A、B组,差异具有显著性意义(P<0.05)。各组不良反应发生率均低,组间差异无显著性(P>0.05)。结论:制霉菌素片加咪康唑栓联合阴道用药治疗重度外阴阴道假丝酵母菌病临床效果优于各药单独用药,是一种安全且更为有效的治疗方法。
Objective: To explore the effective treatment of severe vulvovaginal candidiasis. Methods: 136 cases of severe vulvovaginal Candida were randomly divided into three groups (A, B and C). Group A was treated with nystatin tablets vaginally at 500,000 U per night for 14 days. Group B Given miconazole suppository vaginal medication, each 400mg, 1 night, a total of 6d; C group given two drugs at the same time vaginal medication, the same dose with the A, B group, a total of 6d, and then continue to give a single nystatin tablets vaginal medication, a total of 4 days. Each group also oral itraconazole, 200mg each time, 2 times a day, a total of 1d. Respectively in the withdrawal 4 ~ 7d, withdrawal 1 month follow-up, clinical signs and symptoms score and mycological examination, and efficacy evaluation and adverse reaction assessment. Results: After 4 to 7 days of withdrawal, the clinical cure rates in groups A, B and C were 65.0%, 59.6% and 88.6%, respectively, which were significantly higher in group C than in groups A and B (P <0.05 ). The clinical cure rates of group A, B and C were 70.0%, 70.2% and 93.2% respectively after one month’s withdrawal from treatment. The difference between the two groups was statistically significant (P <0.05). The total effective rates of A, B and C in the two referrals were 95.0%, 93.6% and 97.7% respectively, with no significant difference between the two groups (P> 0.05). After 4 to 7 days of withdrawal, the cure rate of vaginal secretions was 75.0%, 74.5% and 97.7% in group A, B and C, respectively, which was significantly higher in group C than in group A and B (P <0.05). The relapse rates in group A, B and C were 18.7%, 20.0% and 2.3% respectively after one month’s withdrawal from treatment. The recurrence rates in group A and B were significantly lower than those in group A and B (P <0.05). The incidence of adverse reactions in each group was low, no significant difference between groups (P> 0.05). Conclusion: Nystatin tablets plus miconazole suppository combined with vaginal drug treatment of severe vulvovaginal candidiasis clinical effect is superior to the drug alone, is a safe and more effective treatment.