复发性外阴阴道假丝酵母菌病发病危险因素与治疗分析

摘要

目的 调查分析复发性外阴阴道假丝酵母菌病(RVVC)发病的危险因素和相应治疗措施,为临床诊断治疗RVVC提供理论依据.方法 以我院2013年10月至2015年10月期间收治的230例RVVC患者为RVVC组,以同期收治的248例外阴阴道念珠菌病(VVC)为VVC组,对两组患者进行问卷调查.采用Logistic回归分析RVVC发病的相关因素,并比较氟康唑、伊曲康唑、伏立康唑、两性霉素B四种RVVC常规治疗药物的临床疗效及药敏性.结果 与VVC组相比,RVVC组有更高的比例有未控制的糖尿病、阴道病史、流产史、抗生素应用频次高、口服避孕药、应用免疫抑制剂、偏好紧身化纤内裤、长期使用护垫和宫内节育器,且有阴道反复冲洗及长期焦虑抑郁(P<0.05).Logistic回归分析表明,未控制的糖尿病、阴道病史、流产史、和抗生素应用频次高、口服避孕药、免疫抑制剂应用、紧身化纤内裤、护垫长期使用和宫内节育器是RVVC发病的独立危险因素(P<0.05).在临床疗效方面,以两性霉素B最优,且与氟康唑、伊曲康唑、伏立康唑比较差异具有统计学意义(P<0.05);两性霉素B的药敏性最高,且与氟康唑、伊曲康唑、伏立康唑比较差异具有统计学意义(P<0.05).结论 RVVC的易感因素复杂多样,包括疾病史、用药史和不良行为习惯等.RVVC的临床治疗药物应用方案并不一致,但临床医师应重视真菌培养和药敏试验,以针对RVVC发病危险因素对症治疗,从而提高RVVC的治愈率,减少RVVC的致病菌的耐药情况发生.%Objective To investigate the risk factors and corresponding treatment measures of recurrent vul-vovaginal candidiasis (RVVC), and to provide theoretical basis for the clinical diagnosis and treatment of RVVC. Methods From October 2013 to October 2015, 230 patients with RVVC in our hospital were enrolled into the RVVC group, and another 248 cases with vulva vagina candidiasis (VVC) were selected the VVC group. A questionnaire survey was conducted on the two groups. Logistic regression analysis was used to analyze the related factors of RVVC inci-dence, and the clinical curative effect and drug susceptibility of the four RVVC conventional therapy drugs (fluconazole, itraconazole, voriconazole and amphotericin B) were compared. Results Compared with the VVC group, the RVVC group not only had the high proportion of uncontrolled diabetes, vaginal medical history, history of abortion, and high an-tibiotics application frequency, oral contraceptives, and application of immunosuppressant, tight-fitting chemical fiber underpants, long-time use of pads and intrauterine device, but also had repeated vaginal flushing and long-term anxiety and depression (P<0.05). Logistic regression analysis showed that uncontrolled diabetes, vaginal medical history, history of abortion, and high antibiotics application frequency, oral contraceptives, and application of immunosuppressant, tight-fitting chemical fiber underpants, long-time use of pads and intrauterine device were the independent risk fac-tors of RVVC. In the aspect of clinical curative effect, amphotericin B had the best therapeutic effect, which had significant differences compared with fluconazole, itraconazole, voriconazole (P<0.05). Amphotericin B also had the highest susceptibility and significant differences compared with fluconazole, itraconazole, voriconazole (P<0.05). Conclusion The risk factor of RVVC are complex and diverse, including disease history, medication history, bad be-havior habits. Although the clinical therapeutic drug RVVC applications are not consistent, but clinicians should pay at-tention to fungal culture and drug sensitivity test to take targeted symptomatic treatment according to RVVC risk factors, so as to improve the cure rate of RVVC and reduce the drug resistance of pathogenic bacteria of RVVC.