目的 觀察苦參凝膠聯(lián)合聚甲酚磺醛治療陰道假絲酵母菌病的臨床療效。方法 納入2021年6月—2022年6月在武漢中西醫(yī)結(jié)合骨科醫(yī)院診治的150例外陰陰道假絲酵母菌病患者，按照數(shù)字表法隨機(jī)分為對(duì)照組和治療組，每組各75例。對(duì)照組患者使用聚甲酚磺醛陰道栓，首先清洗外陰，然后以1∶80～1∶100稀釋的濃縮液沖洗陰道，睡前放入陰道栓1枚，1次/2 d。治療組在對(duì)照組基礎(chǔ)上使用苦參凝膠，睡前推入陰道深處。聚甲酚磺醛栓使用后第2天晚上使用苦參凝膠。兩組患者均連續(xù)治療15 d。觀察兩組患者臨床療效，比較治療前后兩組患者臨床癥狀改善時(shí)間、陰道內(nèi)pH值和菌群密度、陰道內(nèi)細(xì)菌密集度和陰道分泌物炎性因子白細(xì)胞介素-8（IL-8）、IL-6和腫瘤壞死因子-α（TNF-α）水平。結(jié)果 治療后，治療組患者總有效率明顯高于對(duì)照組（96.00% vs 86.67%，P<0.05），復(fù)發(fā)率低于對(duì)照組（5.33%vs 16.00%，P<0.05）。治療后，治療組患者白帶減少、外陰瘙癢、外陰疼痛及陰道黏膜充血癥狀改善時(shí)間短于對(duì)照組（P<0.05）。治療后，兩組陰道內(nèi)pH≤4.5患者例數(shù)高于同組治療前，且治療后治療組患者pH≤4.5患者例數(shù)顯著高于對(duì)照組（P<0.05）。治療后，兩組1級(jí)和2級(jí)細(xì)菌密集度明顯升高，而3級(jí)和4級(jí)明顯降低（P<0.05），且治療組1級(jí)細(xì)菌密集度明顯高于對(duì)照組，2級(jí)明顯低于對(duì)照組（P<0.05）。治療后，兩組陰道分泌物IL-8、IL-6和TNF-α水平明顯降低（P<0.05），且治療組患者炎癥因子水平均低于對(duì)照組（P<0.05）。結(jié)論 苦參凝膠聯(lián)合聚甲酚磺醛治療外陰陰道假絲酵母菌病的臨床效果更好，具有更好的抗菌、抗炎作用，還可改善患者性生活疼痛癥狀，臨床復(fù)發(fā)率低。

Objective To observe the clinical efficacy of Kushen Gel combined with polycresol sulfonaldehyde in treatment of vaginal candida. Methods Patients (150 cases) with vaginal candida in Wuhan Orthopaedic Hospital of Integrated traditional Chinese and Western Medicine from June 2021 to June 2022 were divided into control group and treatment group according to the numerical table method, with 75 cases in each group.. Patients in the control group were treated with Policresulen Vaginal Suppository, firstly, the vulva was washed, and then the vagina was rinsed with a concentrated solution of 1:80-1:100, one vaginal suppository was placed before going to bed, once every 2 d. Patients in the treatment group were administered with Kushen Gel on the basis of the control group, pushed into the depths of the vagina before going to bed, and the gel was used after the Policresulen Vaginal Suppository. Patients in two groups were treated for 15 d. After treatment, the clinical evaluation was evaluated, and the improvement time of clinical symptom, pH value and bacterial population density in vagina, bacterial density in vagina, levels of inflammatory factors IL-8, IL-6 and TNF-α in vaginal secretions in two groups before and after treatment were compared. Results After treatment, the total effective rate of the treatment group was significantly higher than that of the control group (96.00% vs 86.67%, P < 0.05), and the recurrence rate was lower than that of the control group (5.33% vs 16.00%, P < 0.05). After treatment, the improvement time of symptom in the treatment group was earlier than that in the control group (P < 0.05). After treatment, the number of patients with vaginal pH ≤ 4.5 in 2 groups was higher than before, and after treatment, the number of patients with pH ≤ 4.5 in the treatment group was significantly higher than that in the control group (P < 0.05). After treatment, the bacterial concentration of grade 1 and 2 in the two groups was significantly increased, while that of grade 3 and 4 was significantly decreased (P < 0.05), and the bacterial concentration of grade 1 in the treatment group was significantly higher than that of the control group, while that of grade 2 was significantly lower than that of the control group (P < 0.05). After treatment, the levels of IL-8, IL-6 and TNF-α in vaginal secretion in two groups were significantly decreased (P < 0.05), and the level of inflammatory factors in the treatment group was lower than that in the control group (P< 0.05). Conclusion Kushen Gel combined with policresulen in treatment of vaginal candida has better clinical effect in the treatment of vulvovaginal candidiasis, with better antibacterial and anti-inflammatory effects, but also can improve the symptoms of sexual pain, and the clinical recurrence rate is low.

R984