加味桂芍四妙汤联合中药外洗治疗复发性外阴阴道假丝酵母菌病的临床效果

doi:10.3760/cma.j.issn.1007-1245.2022.13.020

摘要/Abstract

摘要： 目的　探讨加味桂芍四妙汤联合中药外洗治疗复发性外阴阴道假丝酵母菌病的临床效果。方法　选取2019年1月至2020年3月东莞市东部中心医院妇科收治的40例复发性外阴阴道假丝酵母菌病患者为研究对象，随机数字表法分为观察组和对照组，各20例。观察组年龄（36.82±7.56）岁，对照组年龄（36.76±7.59）岁。对照组口服氟康唑胶囊+外用硝酸咪康唑栓治疗，观察组加味桂芍四妙汤联合中药外洗治疗，两组患者皆用药4周。比较两组临床疗效、相关症状消失时间及复发情况。采用独立样本t检验和χ²检验。结果　观察组总有效率高于对照组［95.00%（19/20）比70.00%（14/20），P<0.05］。观察组外阴瘙痒、黏膜红肿、白带异常、尿频尿痛等相关症状消失时间短于对照组［（2.31±0.46）d比（2.87±0.54）d、（2.79±0.56）d比（3.25±0.62）d、（1.38±0.35）d比（2.10±0.43）d、（2.57±0.43）d比（3.16±0.58）d，均P<0.05］。观察组随访6个月、12个月的复发率低于对照组［10.00%（2/20）比40.00%（8/20）、15.00%（3/20）比50.00%（10/20），均P<0.05］。结论　加味桂芍四妙汤联合中药外洗治疗复发性外阴阴道假丝酵母菌病更有利于改善相关临床症状，具有更为显著的临床效果和更低的复发率，值得推广应用。

关键词: 加味桂芍四妙汤, 中药外洗, 复发性外阴阴道假丝酵母菌病, 临床效果

Abstract: Objective　To investigate the clinical effect of modified Guishao Simiao decoction combined with external washing by traditional Chinese medicine in the treatment of recurrent vulvovaginal candidiasis. Methods　Forty patients with recurrent vulvovaginal candidiasis treated at Department of Gynecology, East Dongguan Central Hospital from January 2019 to March 2020 were selected as the study objects, and were randomly divided into an observation group and a control group by the random number table method, with 20 cases in each group. The observation group were (36.82±7.56) years old, and the control group (36.76±7.59). The control group were treated with fluconazole capsules and miconazole nitrate suppository. The observation group were treated with modified Guishao Simiao decoction and externally washed by traditional Chinese medicine. Both groups were treated for 4 weeks. The clinical efficacies, times for the disappearance of related symptoms, and recurrence were compared between the two groups. The independent-sample t and χ² tests were applied. Results　The total effective rate in the observation group was higher than that in the control group [95.00% (19/20) vs. 70.00% (14/20), P<0.05]. The times for the disappearance of pruritus vulvae, mucosal redness, abnormal leucorrhea, and frequent urination and odynuria in the observation group were shorter than those in the control group [(2.31±0.46) d vs. (2.87±0.54) d, (2.79±0.56) d vs. (3.25±0.62) d, (1.38±0.35) d vs. (2.10±0.43) d, and (2.57±0.43) d vs. (3.16±0.58) d; all P<0.05]. The recurrence rates after 6 and 12 months' follow up in the observation group were lower than those in the control group [10.00% (2/20) vs. 40.00% (8/20) and 15.00% (3/20) vs. 50.00% (10/20); both P<0.05]. Conclusions　Modified Guishao Simiao decoction combined with external washing by traditional Chinese medicine in the treatment of recurrent vulvovaginal candidiasis is beneficial to improve related clinical symptoms, and has remarkable clinical effect and a lower recurrence rate, so it is worth being generalized.

Key words: Modified Guishao Simiao decoction, External washing by traditional Chinese medicine, Recurrent vulvovaginal candidiasis, Clinical effect

刘志辉　闫彩霞　陈苑红. 加味桂芍四妙汤联合中药外洗治疗复发性外阴阴道假丝酵母菌病的临床效果[J]. 国际医药卫生导报, 2022, 28(13): 1876-1879.

Liu Zhihui, Yan Caixia, Chen Yuanhong. Clinical effect of modified Guishao Simiao decoction combined with external washing by traditional Chinese medicine in treatment of recurrent vulvovaginal candidiasis[J]. International Medicine and Health Guidance News, 2022, 28(13): 1876-1879.

参考文献

[1] 许莹莹,刘萍,冯勤梅. 复发性外阴阴道假丝酵母菌病的免疫机制及免疫治疗[J]. 中国生育健康杂志,2021,32(1):85-87. DOI:10.3969/j.issn.1671-878X.2021.01.022.
[2] 常军卫,王利,王欣. 乳酸菌阴道胶囊联合常规西医药物对复发性外阴阴道假丝酵母菌病的疗效及对阴道分泌物炎性指标的影响[J]. 贵州医药,2021,45(10):1530-1531. DOI:10.3969/j.issn.1000-744X.2021.10.006.
[3] 朱玉平,华馥. 复发性外阴阴道假丝酵母菌病的危险因素及阴道局部免疫状态分析[J]. 中国妇幼健康研究,2021,32(8):1206-1211. DOI:10.3969/j.issn.1673-5293.2021.08.024.
[4] 杨涵,安红梅,邓继红,等. 克霉唑阴道片与阴道用乳杆菌联合治疗复发性外阴阴道假丝酵母菌病[J]. 昆明医科大学学报,2020,41(7):140-143. DOI:10.3969/j.issn.1003-4706. 2020.07.028.
[5] 郑利,周玲,魏红萍. 氟康唑、三维制霉素栓及乳酸菌阴道胶囊序贯治疗复发性外阴阴道假丝酵母菌病的疗效观察[J]. 检验医学与临床,2020,17(18):2723-2724. DOI:10.3969/j.issn.1672-9455.2020.18.043.
[6] 李赛男,祁文瑾,黄蓉,等. 复发性外阴阴道假丝酵母菌病药物敏感性与耐药基因表达的相关性分析[J]. 现代妇产科进展,2021,30(5):350-354,359. DOI:10.13283/j.cnki.xdfckjz.2021.05.005.
[7] 陈秋珍,严少梅,黄丽婷,等. 克霉唑阴道片治疗复发性外阴阴道假丝酵母菌病疗效分析[J]. 中国实用妇科与产科杂志,2021,37(3):384-387. DOI:10.19538/j.fk2021030125.
[8] 杨涵,安红梅,邓继红,等. 阴道用乳杆菌联合克霉唑阴道片治疗"二孩"生育需求女性复发性外阴阴道假丝酵母菌病的效果[J]. 中国妇幼保健,2021,36(24):5725-5727. DOI:10.19829/j.zgfybj.issn.1001-4411.2021.24.037.
[9] 秦晓林,段纯,胡艺琳,等. 复发性外阴阴道假丝酵母菌病患者病原菌分布和耐药性研究[J]. 热带医学杂志,2021,21(10):1339-1342. DOI:10.3969/j.issn.1672-3619. 2021.10.023.
[10] 陈娟,李卫. 乳酸菌阴道胶囊联合常规用药治疗复发性外阴阴道假丝酵母菌病的作用[J]. 中国临床医生杂志,2018,46(4):482-484. DOI:10.3969/j.issn.2095-8552. 2018.04.037.
[11] Fukazawa EI, Witkin SS, Robial R, et al. Influence of recurrent vulvovaginal candidiasis on quality of life issues [J]. Arch Gynecol Obstet, 2019, 300(3): 647-650. doi: 10.1007/s00404-019-05228-3.
[12] 刘辉煌. 乳酸菌阴道胶囊联合克霉唑治疗复发性外阴阴道假丝酵母菌病的疗效与安全性分析[J]. 中国微生态学杂志,2020,32(2):207-210. DOI:10.13381/j.cnki.cjm. 202002019.
[13] 张展,白会会,王风娟,等. 复发性外阴阴道假丝酵母菌病患者反复发作期阴道分离菌株的同源性及耐药性分析[J]. 中华妇产科杂志,2020,55(3):177-182. DOI:10.3760/cma.j.cn112141-20191210-00665.
[14] 范爱萍,王履,薛凤霞. 复发性外阴阴道假丝酵母菌病发病机制及诊治研究进展[J]. 中国妇产科临床杂志,2018,19(2):174-177. DOI:10.13390/j.issn.1672-1861.2018.02.028.
[15] Collins LM, Moore R, Sobel JD. Prognosis and long-term outcome of women with idiopathic recurrent vulvovaginal candidiasis caused by Candida albicans [J]. J Low Genit Tract Dis, 2020, 24(1):48-52. DOI: 10.1097/LGT.0000000000000496.
[16] 黄树芬. 阴道分泌物标本五联检验对阴道炎病原体及白带清洁度的临床诊断价值分析[J]. 国际医药卫生导报,2018,24(15):2295-2297. DOI:10.3760/cma.j.issn.1007-1245. 2018.15.021.
[17] 许晓芬,曹馨宇,于艳红,等. 清热除湿止带汤治疗复发性外阴阴道假丝酵母菌病28例[J]. 河南中医,2018,38(7):1070-1073. DOI:10.16367/j.issn.1003-5028.2018. 07.0286.
[18] 徐玲华,金燕,金丽萍,等. 布拉氏酵母菌联合阴道用药治疗复发性外阴阴道假丝酵母菌病的临床疗效及安全性[J]. 中国微生态学杂志,2018,30(11):1330-1332, 1338. DOI:10.13381/j.cnki.cjm.201811021.
[19] Brand SR, Degenhardt TP, Person K, et al. A phase 2, randomized, double-blind, placebo-controlled, dose-ranging study to evaluate the efficacy and safety of orally administered VT-1161 in the treatment of recurrent vulvovaginal candidiasis [J]. Am J Obstet Gynecol, 2018, 218(6):624.e1-624.e9. DOI: 10.1016/j.ajog.2018.03.001.
[20] 张芳芳,巨宇叶,田蕾,等. 外阴阴道假丝酵母菌病的治疗现状与展望[J]. 国际妇产科学杂志,2021,48(4):425-428,433. DOI:10.12280/gjfckx.20201006.
[21] 杜惠兰,宋亚静,陈静. 苦参凝胶联合抗真菌药治疗外阴阴道假丝酵母菌病的Meta分析[J]. 中草药,2021,52(16):4973-4985. DOI:10.7501/j.issn.0253-2670.2021.16.022.
[22] 费霖莉,张忠良,章利晨. 加味萆薢渗湿汤联合阴洁康洗液坐浴治疗湿热下注型外阴阴道假丝酵母菌病临床研究[J]. 新中医,2021,53(20):18-22. DOI:10.13457/j.cnki.jncm. 2021.20.005.
[23] 宋桂红,唐赛赛,崔敏. 中草药治疗复发性外阴阴道假丝酵母菌病临床分析研究[J]. 中国药理学通报,2021,37(3):后插2. DOI:10.3969/j.issn.1001-1978.2021.03.026.
[24] 邱海霞,王庆伟. 桂芍四妙汤和苦参凝胶对外阴阴道假丝酵母菌病阴道清洁度及pH值的影响[J]. 辽宁中医药大学学报,2021,23(6):213-216. DOI:10.13194/j.issn.1673- 842x. 2021.06.046.
[25] 王治霞. 中药熏洗联合中医护理在治疗霉菌性阴道炎患者中的效果分析[J]. 首都食品与医药,2020,27(14):177. DOI:10.3969/j.issn.1005-8257. 2020.14.157.
[26] 李玲. 中西医结合治疗霉菌性阴道炎护理观察[J]. 光明中医,2020,35(14):2248-2250. DOI:10.3969/j.issn. 1003- 8914.2020.14.053.
[27] 熊娜. 中药熏洗治疗复发性霉菌性阴道炎临床观察[J]. 光明中医,2020,35(9):1343-1345. DOI:10.3969/j.issn. 1003-8914.2020.09.025.
[28] 宋桂红,唐赛赛,崔敏. 中草药治疗复发性外阴阴道假丝酵母菌病临床分析研究[J]. 中国药理学通报,2021,37(2):后插2. DOI:10.3969/j.issn.1001-1978.2021.02.028.
[29] 苏庆华,李国正,吴利利. 加味桂芍四妙汤联合中药外洗治疗复发性霉菌性阴道炎临床观察[J]. 光明中医,2019,34(15):2348-2350. DOI:10.3969/j.issn.1003-8914. 2019.15.030.
[30] 吴媚. 中西医结合治疗复发性阴道假丝酵母菌病的临床疗效研究[J]. 西南国防医药,2018,28(5):480-482.DOI:10.3969/j.issn.1004-0188. 2018.05.033.