劉元林,李安信
氟康唑聯(lián)合布替萘芬乳膏治療念珠菌性包皮龜頭炎的療效觀察
劉元林,李安信
目的觀察氟康唑聯(lián)合布替萘芬乳膏治療念珠菌性包皮龜頭炎的臨床療效。方法80例念珠菌性包皮龜頭炎患者隨機(jī)分為對(duì)照組(單用布替萘芬)和治療組(布替萘芬+氟康唑),每組40例。同時(shí)選擇40例配偶以布替萘芬+氟康唑治療,并觀察療效。入組對(duì)象以布替萘芬乳膏外涂(1次/d)或布替萘芬乳膏+氟康唑頓服(150mg/d),連續(xù)用藥14 d。所有患者分別于治療前、治療后第7天及第14天記錄臨床癥狀和體征,并做真菌鏡檢,以判斷療效。結(jié)果用藥第7天時(shí),對(duì)照組和治療組總有效率分別為65%和70%,真菌清除率分別為60%和80%,差異無統(tǒng)計(jì)學(xué)意義(P均>0.05)。用藥第14天時(shí),對(duì)照組和治療組的總有效率分別為70%和95%(P<0.05),真菌清除率分別為85%和90%(P>0.05)。2組均無明顯不良反應(yīng)發(fā)生。配偶組總有效率為100%,真菌清除率為95%。結(jié)論氟康唑聯(lián)合布替萘芬乳膏治療念珠菌性包皮龜頭炎安全有效。
陰莖頭炎;氟康唑;念珠菌屬
念珠菌性包皮龜頭炎是由念珠菌感染引起的包皮龜頭炎癥反應(yīng),主要經(jīng)性接觸傳播,是最常見的性傳播疾病之一。其發(fā)病率逐年上升,多因臨床療程不夠,治療不徹底,加之性伴侶治療不及時(shí),導(dǎo)致病情反復(fù)發(fā)作,對(duì)患者造成極大的生理和心理痛苦。我們應(yīng)用氟康唑聯(lián)合布替萘芬乳膏治療念珠菌性包皮龜頭炎,力求找到規(guī)范化的治療方案?,F(xiàn)將結(jié)果報(bào)道如下。
1.1 對(duì)象入選的80例念珠菌性包皮龜頭炎為我院皮膚科性病門診患者,均有性接觸史,臨床癥狀典型,真菌鏡檢陽性,符合念珠菌性包皮龜頭炎診斷標(biāo)準(zhǔn)[1]。患者就診前1個(gè)月內(nèi)未系統(tǒng)使用過抗真菌藥物和抗生素,無系統(tǒng)疾病史,血常規(guī)和肝、腎功能檢測(cè)正常。將80例隨機(jī)分為對(duì)照組(單用布替萘芬乳膏)和治療組(布替萘芬乳膏┼氟康唑),每組各40例,2組年齡、病程及病情嚴(yán)重程度等方面均衡,具有可比性。同時(shí)隨機(jī)選擇40例配偶入組治療。
1.2 治療方法對(duì)照組用布替萘芬乳膏均勻涂于患處,1次/d;治療組加服氟康唑膠囊(輝瑞制藥)150mg,1次/d。2組均連續(xù)用藥14 d。所有患者分別于治療前、用藥后第7天和第14天記錄臨床癥狀和體征,并做真菌鏡檢。治療期間禁止性生活,配偶組治療方案同治療組。
1.3 療效判定根據(jù)患者皮膚黏膜紅斑、丘疹、糜爛、鱗屑和瘙癢等癥狀,按4級(jí)評(píng)分法進(jìn)行評(píng)分,分別為0分(正常)、1分(輕度)、2分(中度)和3分(重度)。療效指數(shù)=(療前評(píng)分-療后評(píng)分)/療前評(píng)分×100%。真菌鏡檢陰性為正常,陽性為帶菌。配偶組查白帶常規(guī),綜合臨床表現(xiàn)和真菌鏡檢結(jié)果進(jìn)行療效判定。判定標(biāo)準(zhǔn)為①痊愈:臨床癥狀和體征全部消失,療效指數(shù)100%,真菌鏡檢陰性;②顯效:癥狀和體征明顯好轉(zhuǎn),療效指數(shù)≥70%,真菌鏡檢陰性;③無效:癥狀和體征無明顯好轉(zhuǎn),療效指數(shù)≤30%,真菌鏡檢陽性。總有效率=(痊愈┼顯效)/總例數(shù)×100%。
1.4 統(tǒng)計(jì)學(xué)處理所有數(shù)據(jù)應(yīng)用SPSS 10.0軟件處理,2組率的比較用四格表χ2檢驗(yàn)。P<0.05表示差異有統(tǒng)計(jì)學(xué)意義。
2.1 療效比較用藥第7天時(shí),對(duì)照組總有效率為65%,治療組為70%,2組比較差異無統(tǒng)計(jì)學(xué)意義。對(duì)照組和治療組真菌清除率分別為60%和80%,2組比較差異無統(tǒng)計(jì)學(xué)意義。見表1。
表1 2組用藥第7天療效比較[例(%)]Table 1 Comparison of the therapeutic effect between the two groups at 7-day treatment[cases(%)]
用藥第14天時(shí),對(duì)照組和治療組的總有效率分別為70%和95%,對(duì)照組低于治療組(P<0.05),真菌清除率分別為85%和90%,2組比較差異無統(tǒng)計(jì)學(xué)意義。見表2。配偶組總有效率為100%,真菌清除率為95%。
1個(gè)月后隨訪,對(duì)照組和治療組痊愈率分別為85%和95%,2組比較差異無統(tǒng)計(jì)學(xué)意義。見表3。
2.2不良反應(yīng)3組未見明顯的紅腫、滲液及疼痛等不良反應(yīng)發(fā)生,患者耐受性良好。
表3 隨訪1個(gè)月療效觀察[例(%)]Table 3 Therapeutic effect during one month of followup[cases(%)]
念珠菌性包皮龜頭炎主要是由念珠菌屬的白色念珠菌、近平滑念珠菌、克柔念珠菌及熱帶念珠菌等引起的男性生殖器包皮龜頭的炎癥反應(yīng),主要經(jīng)性接觸傳播[1]。布替萘芬屬于烯丙胺類抗真菌藥,可抑制真菌鯊烯環(huán)氧酶及真菌的胞膜麥甾醇的生物合成,濃度為5μg/ml時(shí)有直接損害細(xì)胞膜的作用,具有廣譜抗真菌活性,對(duì)皮膚真菌、小孢子菌屬、毛癬菌屬和念珠菌屬等有抗菌活性[2]。氟康唑?yàn)榉蝾惪拐婢幬?,其高度選擇抑制真菌的細(xì)胞色素P450,使菌細(xì)胞損失正常的甾醇,而14α-甲基甾醇則在菌細(xì)胞中蓄積,起到抑菌作用,對(duì)新型隱球菌、白色念珠菌、其他念珠菌和黃曲菌等有抗菌作用[3]。既往念珠菌性包皮龜頭炎多予以單一外用藥物治療,因療程不規(guī)范,常常不能完全清除病原菌,復(fù)發(fā)率高,導(dǎo)致白色念珠菌耐藥菌株增多[4]。口服氟康唑?qū)χ委熎つw黏膜念珠菌病有較好療效,本研究采用口服氟康唑聯(lián)合外用布替萘芬乳膏治療念珠菌性包皮龜頭炎40例,療程2周,總有效率達(dá)到95%,真菌清除率達(dá)到90%,且患者耐受性良好,提示氟康唑聯(lián)合布替萘芬治療念珠菌性包皮龜頭炎安全有效。
在療效觀察過程中發(fā)現(xiàn),治療第7天時(shí)對(duì)照組與治療組總有效率分別為65%和70%,2組差異無統(tǒng)計(jì)學(xué)意義,第14天時(shí)分別為70%和95%,2組間差異有統(tǒng)計(jì)學(xué)意義。提示治療念珠菌性包皮龜頭炎療程須在2周以上,才能取得較好的療效。
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(2013-05-16收稿 2013-06-04修回)
(責(zé)任編委 王永怡 本文編輯 陳玉琪)
Therapeutic effect of fluconazole combined w ith butenafine cream in patientsw ith candidal balanoposthitis
LIU Yuan-lin,LIAn-xin
Department of Dermatology,Navy General Hospital,Beijing 100048,China
Objective Toobserve clinicaleffectsof flucoanzole combined with butenafine cream in treatmentof candidalbalanoposthitis.Methods A total of 80 patients with candidal balanoposthitis were randomized into a control group(given butenafine cream only)and a treatment group(given butenafine cream plus fluconazole),with 40 patients in each group.Forty spouses(spouse group)were selected and given butenafine cream plus fluconazole.Butenafine cream was for external use one time per day,and fluconazole was used orally 150 mg per day,for 14 days.The clinical signs and symptoms were recorded before treatment,and at the 7th and 14th day of treatment,respectively.Microscopic examination of fungi was performed for determining therapeutic effects. Results At the 7th day of treatment,the total effective rates of the control group and the treatment group were 65%and 70%,fungi clearance rates of the control group and the treatment group were 60%and 80%,respectively,and the differences were not significant between the two groups(P>0.05).At the 14th day of treatment,the total effective rates of the control group and the treatment group were 70%and 95%,and the difference was significant between the two groups(P<0.05);fungi clearance rates of the control group and the treatmentgroup were 85%and 90%,respectively,and the differencewasnotsignificant between the two groups(P>0.05). No obvious adverse reactions were found in the control group and the treatment group.The total effective rate was 100%and fungal clearance rate was 95%in the spouse group.Conclusion Flucozanole combined with butenafine cream is safe and effective in treatment of candidal balanoposthitis.
balanitis;fluconazole;Candida
R697.13
A
1007-8134(2014)01-0043-02
解放軍海軍總醫(yī)院出國人員創(chuàng)新培育基金(2012010)
100048北京,解放軍海軍總醫(yī)院皮膚科(劉元林);100039北京,解放軍第三〇二醫(yī)院皮膚性病科(李安信)