【作者】 刘宇倩；

【导师】 池凤好；

【作者基本信息】 广州中医药大学 ， 中西医结合临床， 2010， 硕士

【摘要】 研究目的：初步探索中药香莲外洗液对40例白色念珠菌阴道分离株的最低抑菌浓度值(MIC值)和最低杀菌浓度值(MFC值)范围；并分析所收集的40例外阴阴道念珠菌病(Vulvovaginal Candidiasis,简称VVC)患者的病史资料,对VVC疾病的临床概况、诊断治疗的发展等方面总体上进行客观地探讨了解。研究方法：实验方面,参照1997年CLSI(美国临床和实验室标准化协会)颁布的《肉汤稀释法酵母菌抗真菌药物敏感性试验参考方法》(M27-A方案),采用微量液基稀释法分别测定香莲外洗液和氟康唑对40例白色念珠菌阴道分离株的MIC值及香莲外洗液对该菌临床株的MFC值,质控菌株为克柔念珠菌ATCC6258。临床方面,对纳入病源标准的40例VVC患者进行病史采集,分析采集结果,认识VVC疾病的临床概况并探讨该疾病在诊断治疗方面的发展以对VVC疾病的临床特征、诊治规范等各信息作一番大致了解。研究结果：1.实验结果,质控菌株克柔念珠菌ATCC6258在M27-A方案的质控MIC结果范围内。40株白色念珠菌的香莲外洗液MIC范围为3.20±2.83mg/ml,MFC范围为31.25-62.5mg／ml；氟康唑MIC范围为4.00±2.94μg／ml；两药物的抑菌作用的差异无显著性(P>0.05)。2.临床方面,病史采集结果,40例VVC患者年龄为32.4±10.15(20～55岁),均有性生活史,其中,复发患者合计占20%(8／40)；患者就诊的主要症状体征是外阴／阴道瘙痒(28／40,70%),外阴／阴道潮红(30／40,75%),宫颈轻度糜烂(14／40,35%),其次为白带增多(22／40,55%),阴道分泌物粘稠呈豆渣样(20／40,50%)；治疗上选用香莲外洗液52.5%(21／40),咪唑类药物者占82.5%(33／40),制霉菌素糊27.5%(11／40)；单纯阴道纳药治疗者占45%(18／40),外用联合口服治疗者占55%(22／40),中西医结合治疗者占87.5%(35／40)。研究结论：体外抗真菌药敏试验证实香莲外洗液在一定浓度范围内对白色念珠菌有较满意的抑杀作用,其抑菌作用和氟康唑差别不大。外阴阴道念珠菌病(VVC)是我院妇科和皮肤性病门诊的常见病和多发病,是仅次于细菌性阴道炎的常见生殖道感染性疾病,影响大多数妇女的身心健康和正常生活工作,好发于育龄期妇女,性行为是VVC疾病发生交叉感染的重要途径之一,白色念珠菌仍为本病主要的致病菌。病史采集结果发现咪唑类药物(如达克宁等)、多烯类药物(如制霉菌素糊等)和香莲外洗液是我院用以治疗VVC的常用药物,阴道纳药法、内外合治法以及中西医结合法是我院妇科和皮肤性病门诊治疗VVC患者的首选疗法。更多还原

【Abstract】 Objectives:To priliminarily research into the range of both the minimum inhibitory concentration (MIC) and the minimum fungi cidal concentration (MFC) of Xianglian lotion against 40 strains of Candida Albicans in vaginal isolates. And analyze the medical history data of 40 patients with Vulvovaginal Candidiasis (called VVC for short). Thereby to totally and objectively comprehend and probe into various aspects of general clinical situations as well as diagnosis and therapy on the VVC disease.Methods:In the experimental respect, the MICs of both fluconazole and Xinaglian lotion as well as its MFCs against 40 strains of C. albicans in vaginal isolates were all measured by broth microdilution method according to document《Re-ference Method for Broth Dilution Susceptibility Testing of Yeast》(M27-A Document) published by the American National Institution for Clinical Lab-oratory Standards(CLSI) in 1997. The Candida strain of quality control(QC) is Candida krusei ATCC6258. In the clinical respect, collect the clinical history of 40 patients with VVC who conformed to the subsumption standard of etiology. Then analyze the results by the collection. Afterwards know about the general clinical situations of VVC disease and probe into the aspect on its development of diagnosis and therapy, in order to roughly understand va-rious VVC information on the clinical characters and guidelines of diagnosis and treatment.Result:1. The experiment result is that the Candida strain of QC, Candida krusei ATCC6258, is under the control of the MICs range according to the document M27-A. The MICs range of 40 Candida strains are:Fluconazole 4.00±2.94μg/ml, Xinaglian lotion 3.20±2.83mg/ml. The MFCs range of Xianglian lotion is 31.25～62.5mg/ml. Besides, there’s no prominent difference between the bacteriostatic effects of these two med-ications (P>0.05).2. On the clinical aspect, the results of patients’history collection are: The ages of 40 patients with VVC disease, all of whom have the life history, are 32.4±10.15 (20～55 years old); 20% people in total for subsequent visits. The main symptoms of patients are pruritus of vulva and vagina (28/40,70 %), erubescent on the vulva and vagina (30/40,75%), cervical lightly erosion (14/40,35%). Second are leucorrhea increase (22/40,55%), bean curd residue alike of the stiff excretions in vagina (20/40,50%). Medicine choices si-tuation is that Xianglian lotion 52.5%(21/40), imidazole class medicines 82.5%(33/40), mycetin cataplasma 27.5%(11/40), the purely medicine law ac-ception of the vagina 45%(18/40), external use integrated oral treatment 55% (22/40), Chinese integrated western medicine 87.5%(35/40).Conclusion:The susceptibility tests of antifungal agents in vitro proved that Xiang-lian lotion in some concentration range has its own approving inhibitory and fungicidal effects against C. albicans and, in comparision with fluco-nazole and Xianglian lotion, there’s few difference of the bacterio-static effects between them two. The WC is, after the bacterial vaginosis, the second common disease of genital tract infection, which affects a majority of women’s phy-sical and psychology health a lot and mainly occurs among women of child-bearing age. Sexual behavior is one of the important ways of the Cross infection on the WC disease. C. albicans is still the main pathogenic fungus. The results of patients’history collection shows that imidazole class medicines (as Miconazole Nitrate Cream)、polyene medicines (as mycetin cataplasma) and Xianglian lotion are in common use to treat WC in our hospital. The medicine law acception of the vagina、external use integrated oral treatment and the way of Chinese integrated western medicine are the first choices of therapies for WC patients in the outpatients of the gynecology and the dermatology & venereology departments of our hospital.更多还原