目的 探讨适合RVVC患者的治疗方案.方法 对45例RVVC患者进行阴道分泌物悬滴法检查和真菌培养法检查,根据药敏结果氟康唑(对氟康唑耐药改用伊曲康唑)口服联合两性霉素B阴道用药强化治疗3个月,再用克霉唑阴道片巩固治疗6个月,停药后定期随访1 a,记录研究对象主诉,并取阴道分泌物进行悬滴法和培养法检查是否存在念珠菌.结果 45例研究对象的阴道分泌物中,白念珠菌39例(86.67％),光滑念珠菌4例(8.89％),克柔念珠菌1例(2.22％),热带念珠菌1例(2.22％).念珠菌对伊曲康唑、氟康唑、伏立康唑、5-氟胞嘧啶和两性霉素B的耐药率分别为28.89％、22.22％、17.78％、8.89％和0.00％.随访1 a中共有4例复发,治疗的有效率为91.11％,无效率为8.89％.结论 RVVC的主要致病菌是白念珠菌.念珠菌对两性霉素B的敏感性高、耐药性低.氟康唑或伊曲康唑口服联合两性霉素B阴道局部用药作强化治疗加克霉唑阴道片巩固治疗,有较高RVVC治疗的有效率.%Objective To explore the suitable treatment for patients with RVVC.Methods Forty-five cases of RVVC patients were examined by vaginal discharge drop method and fungal culture method.According to drug sensitivity results,oral fluconazole (use itraconazole if resistant to fluconazole) combined vaginal administration of amphotericin B vaginal medication intensive treatment 3 months,and then clotrimazole vaginal tablets consolidation treatment for 6 months.After stopping the medication regularly follow-up for a year.Record the patient's chief complaint,and take their vaginal secretions to examined by vaginal discharge drop method and fungal culture method to determine whether the presence of Candida.Results Among the 45 patients,vaginal secretions were found in 39 cases (86.67 ％) of Candida albicans,4 cases (8.89 ％) of smooth Candida,1 case (2.22％) of Candida glabrata,1 case of Candida tropicalis (2.22％).The resistant rates of Candida to itraconazole,fluconazole,voriconazole,5-fluorocytosine and amphotericin B were 28.89 ％,22.22 ％,17.78 ％,8.89 ％ and 0.00 ％,respectively.Follow-up 1 year in 4 cases of recurrence,the effective rate of 91.11％,the rate of 8.89％.Conclusion The main pathogen of RVVC is Candida albicans.Candida is highly sensitive to amphotericin B and has low resistance.Fluconazole or itraconazole oral combination of amphotericin B vaginal topical treatment for intensive treatment,plus clotrimazole vaginal tablets for consolidation therapy,had a higher efficient of RVVC treatment.
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