目的 探讨苦参凝胶联合硝酸咪康唑栓治疗外阴阴道假丝酵母菌病的临床疗效。方法 纳入2023年3月—2024年12月承德市中心医院收治的外阴阴道假丝酵母菌病患者98例，按随机数字表法平均分为对照组和治疗组，每组各49例。对照组给予硝酸咪康唑栓，每晚睡前阴道深处放入1枚栓剂，1次/d。在对照基础上，治疗组联合苦参凝胶，苦参凝胶缓慢推入阴道内，1支/次，1次/d。两组患者疗程7 d。对比两组患者临床疗效、真菌转阴率和症状消失时间，比较治疗前后舒适状况量表（GCQ）、症状自评量表（SCL-90）、36项健康调查简表（SF-36）评分及阴道微生态指标和阴道灌洗液中高迁移率族蛋白1（HMGB1）、白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）水平。结果 治疗后，治疗组总有效率和真菌转阴率分别为95.92%和97.96%，均明显高于对照组的79.59%和83.67%（P＜0.05）。治疗后，治疗组白带异常、外阴瘙痒、外阴阴道疼痛等各项症状的消失时间均短于对照组（P＜0.05）。治疗后，两组GCQ、SF-36评分增加，而SCL-90评分显著减少（P＜0.05），且治疗组GCQ、SCL-90和SF-36评分均明显优于对照组（P＜0.05）。治疗后，阴道pH值、清洁度Ⅲ～Ⅳ度占比显著降低（P＜0.05），阴道乳酸杆菌计数增加（P＜0.05），且治疗组患者阴道微生态指标明显优于对照组（P＜0.05）。治疗后，两组阴道灌洗液中HMGB1、IL-1β和IL-6水平显著下降（P＜0.05），且治疗组阴道灌洗液因子水平明显低于对照组（P＜0.05）。结论 苦参凝胶联合硝酸咪康唑栓治疗外阴阴道假丝酵母菌病，能有效促进真菌转阴和症状缓解，改善患者的舒适程度、心理状态和生活质量，并可进一步调节阴道微生态平衡及减轻炎症损伤。

Objective To investigate the clinical efficacy of Kushen Gel combined with Miconazole Nitrate Suppositories in treatment of vulvovaginal candidiasis. Methods A total of 98 patients with vulvovaginal candidiasis admitted to Chengde Central Hospital from March 2023 to December 2024 were enrolled and equally divided into a control group and a treatment group using a random number table method, with 49 cases in each group. The control group received Miconazole Nitrate Suppositories, with one suppository inserted deep into the vagina every night before bedtime, once daily. On the basis of the control regimen, the treatment group was additionally administered Kushen Gel, with one tube slowly injected into the vagina once daily. Both groups were treated for 7 consecutive days. Clinical efficacy, fungal negative conversion rate, and time to symptom disappearance were compared between the two groups. The scores of General Comfort Questionnaire (GCQ), Symptom Checklist-90 (SCL-90), and 36-Item Short-Form Health Survey (SF-36), as well as vaginal microecological indicators and the levels of high mobility group box 1 protein (HMGB1), interleukin-1β (IL-1β), and interleukin-6 (IL-6) in vaginal lavage fluid were evaluated before and after treatment. Results After treatment, the total effective rate and fungal negative conversion rate in the treatment group were 95.92% and 97.96%, respectively, which were significantly higher than 79.59% and 83.67% in the control group (P < 0.05). The time to disappearance of abnormal leucorrhea, vulvar pruritus, vulvovaginal pain and other symptoms in the treatment group was shorter than that in the control group (P < 0.05). After treatment, the GCQ and SF-36 scores were increased while the SCL-90 score was significantly decreased in two groups (P < 0.05), and the scores in the treatment group were significantly better than those in the control group (P < 0.05). After treatment, vaginal pH value and the proportion of cleanliness grade Ⅲ-Ⅳ were significantly decreased (P < 0.05), and the count of vaginal Lactobacillus was increased (P < 0.05), the vaginal microecological indicators in the treatment group were significantly better than those in the control group (P < 0.05). After treatment, the levels of HMGB1, IL-1β and IL-6 in vaginal lavage fluid were significantly decreased in both groups (P < 0.05), and which in the treatment group were significantly lower than in the control group (P < 0.05). Conclusion Kushen Gel combined with Miconazole Nitrate Suppositories is effective in the treatment of vulvovaginal candidiasis. It can effectively promote fungal negative conversion and symptom relief, improve patient comfort, psychological status and quality of life, further regulate vaginal microecological balance, and alleviate inflammatory injury.

R984

承德市社会科学发展研究课题（20253083）