细菌性阴道病和念珠菌性阴道炎的临床分析

摘要

目的探讨女性下生殖道细菌性阴道病(BV)、念珠菌性阴道炎(VVC)单纯感染与混合感染之间治疗后复发率和易复发率的差别,以寻求有效的治疗和预防措施.方法以阴道分泌物半定量法、湿片法和培养法对临床药物治疗状态进行综合分析.结果7 595例外阴阴道炎病例中单纯BV、单纯VVC和BV-VVC混合感染的患病率为56.6%(4 295/7 595)、30.68%(2 330/7 595)和12.77%(970/7595);复发率分别为4.07%(175/7 595)、7.89%(184/7 595)和48.56%(471/7 595),前二者与后者间差异有显著性P＜0.01.830例复发病例中,BV、VVC单纯感染和混合感染的易复发率分别为1.7%(3/175),4.89%(9/84)和10.19%(48/471),前二者与后者间差异有显著性P＜0.05.结论BV、VVC混合感染导致VVC复发率、易复发率明显增高;VVC合并BV是VVC复发的一个重要因素,应引起临床高度关注及有效的系统治疗.%[Objective] To evaluate the benefit of BV treatment with regard to VVC reoccurrence among women who live in the Northeast region of China. [Methods] 7595 women presenting vaginitis-related symptoms were enrolled between age 18 and 74, with a median of 36, in Shenyang. Microscopic examination of wet mount was carried out for all vaginal specimens. BV was diagnosed by the BVBLUE(R) test (Gryphus Diagnostics, USA), a sialidase-based rapid diagnostic kit for BV. VVC was diagnosed initially on the wet mount by microscopic examination, and in follow-up cases of recurrent VVC by the Vitek 2 system (bioMerieux, France) after vaginal culture. Treatment of BV was provided by metronidazole, and VVC by imidazoles. [Results] Treatment of BV cases by metronidazole and VVC cases by imidazole was generally effective. The recurrent rate was very low in the single infection cases (175/4295, 4.07%, for BV; and 184/2330, 7.89%, for VVC). Significant differences were observed in the recurrent rate of BV and VVC when compared with the recurrent rate of concurrent BV and VVC infection. A total of 970 cases were diagnosed for having both VVC and BV. The recurrent rate was 48.56% (471/970) among these patients despite of treatment of BV and VVC with metronidazole and imidazole, respectively. The rate of high recurrent incidences (≥4episodes per year) was also higher (10.19%, 48/471) in patients with BV and VVC compared to those who had only BV (2.94%, 5/175) or VVC (4.89%, 9/184). [Conclusions] The study indicated that the recurrent rate of BV and VVC is dramatically increased if patients have both BV and VVC in comparison with those who have only BV or VVC. It is therefore beneficial to correctly diagnose BV and VVC in each case, and prescribe treatment for both diseases concurrently.