Effect Of Wandai Soup On The Iocai Vaginai Immune In The Patients Of Spleen Dampness Type Recurrent Vulvovaginal Candidiasis

ObjectiveResearch local vaginal immune function of recurrent vulvovaginal candidiasis (RVVC) patients. Explain the pathogenesis of RVVC from vaginal mucosal immunity, vaginal highly sensitized state and Thl/Th2balance, to discuss the efficacy and the regulatory mechanism for vaginal local immune function of Wandai Soup.MethodCollecting64patients met RVVC diagnostic criteria and23patients for healthy control group from the clinic of first affiliated hospital of Guangzhou University of Chinese Medicine in September2012to March2014,46RVVC patients have been completed the consolidation therapy and follow-up. RVVC patients were randomly divided into Wandai Soup consolidated therapy group (n=32) and western medicine consolidated therapy group (n=32), then treated by taking Wandai Soup and oral itraconazole respectively for6months and6months of follow-up after treatment. All patients were reviewed leukorrheal examination and evaluated the efficacy of treatment by filling clinical observated table on the third to seventh days after menstrual clean in the first, third, sixth months of consolidation therapy and first, third, sixth months of follow-up after treatment.Vaginal lavage fluid of patients were collected in acute attack, paracmasis of RVVC and the third to seventh days after menstrual clean in the third, sixth months of consolidation therapy and third months of follow-up after treatment, in addition, collected the vaginal lavage fluid of healthy control group in the physical examination, VVC and BV group were collected in attack. Vaginal lavage fluid were centrifugalized at2000rpm/min for5minutes in refrigerating centrifuge, then absorbed the supernatant and placed in-20℃refrigerator. Enzyme-linked immuno sorbent assay was used to detect the level of slgA, IgE, PGE2, IL-4, IL-12, IFN-γin vaginal lavage fluid. Finally, analyze statistics with SPSS18.0statistical package, experimental data expressed as mean±standard(X±S). Measurement data using t test or ANOVA, pairwise comparisons using LSD test, count data were compared with the x2test.Results1. In the64cases of RVVC patients, the youngest was20years old, the oldest46years old, the average age was32.1±5.3years old. The26-30years of age accounted for the largest proportion, a total of27cases, accounting for42.2%;the age of46-50years old accounted for the least proportion, a total of2cases, accounting for3.1%.2.In Chinese medicine group has completed the consolidation therapy was28cases,9cases were recrudescent during consolidation therapy, the recurrence rate was32.1%,23cases has completed the follow-up, recurrence during the follow-up of4cases, the recurrence rate was17.4%; Completed consolidation treatment in western medicine group with28cases,11cases were recrudescent during consolidation therapy, the recurrence rate was39.3%,23cases has completed the follow-up, recurrence during the follow-up of10cases, the recurrence rate was43.5%. Chi square test resulted P>0.05, was no significant difference.3. After consolidation therapy, Chinese medicine group cure rate was34.8%, markedly effective rate was17.4%; western medicine group cure rate was21.7%, markedly effective rate was26.1%. The chi-square test showed no significant difference (P>0.05).4. The consistency of PGE2, IL-4, IL-12, IFN-γ, IgE in Vaginal lavage fluid was statistically significant (P<0.05) between RVVC patients in acute attack and healthy women, The consistency of IL-4, IgE in vaginal lavage fluid was statistically significant (P<0.05) between RVVC patients in paracmasis and healthy women,; The consistency of sIgA、PGE2、IL-4、IL-12、IFN-γ、IgE in vaginal lavage fluid was statistically significant (P<0.05) between RVVC patients in acute attack and paracmasis. The consistency of sIgA、IL-4IL-12、 IgE in vaginal lavage fluid was statistically significant (P<0.05) between BV patients and RVVC patients in acute attack, had no significant differences in PGE2, IFN-γ(P>0.05); while the consistency of IL-4、IL-12in vaginal lavage fluid of RVVC patients in acute attack were significantly higher than VVC patients (P<0.05), the consistency of IgE in vaginal lavage fluid of BV and VVC patients were significantly increased than healthy women (P<0.05), sIgA, PGE2, IL-4, IL-12, IFN-γ was no statistical significance (P>0.05).5. The Chinese medicine group after consolidation therapy, the consistency of IL-4, PGE2, IgE in vagina were significantly lower than those before therapy (P<0.05), the consistency of IgE in vigina had significant difference (P <0.05) between third month of consolidation therapy and the third month of follow-up, while the consistency of sIgA、IgE、PGE2、IL-4、IL-12in vigina before and after treatment showed no significant difference (P>0.05). The consistency of sIgA, IgE, PGE2, IL-4, IL-12, IFN-γ in vagina between the healthy control group and the third month of follow-up were not significantly different (P>0.05).6. In western medicine group, the consistency of sIgA、 IFN-γ in vagina before the treatment had significant difference (P<0.05) with the third month of follow-up. The consistency of IFN-γ in vagina between the healthy control group and third months of follow-up was significant difference (P<0.05), and there was no significant difference in the consistency of sIgA, IgE, PGE2, IL-4, IL-12.(P>0.05).7. Between Chinese medicine group and western medicine group, the consistency of sIgA, IgE, PGE2, IL-4, IL-12, IFN-γwas no statistically significant (P>0.05) in the third month, sixth months of consolidation therapy and the third month of follow-up after treatment.Conclusion1. Consolidation therapy of Wandai Soup and itraconazole can be obtained similar effects.2. The local vaginal immune of RVVC patients in acute attack was in the excited state, Thl overprevent Candida infection, while enhancing Th2’s effect, both things make vaginal injuried and allergic. VVC, BV patients have no obvious vaginal innate immune deficiency and Thl/Th2imbalance, but still exist vaginal highly sensitized state.3. Consolidation therapy can improve local vaginal immune fuction of RVVC. Wandai Soup can improve vaginal allergic reactions and weaken the Th2’s dominance; itraconazole may improve the deficiency of vaginal innate immune, but did not significantly improve Thl’s over reaction and reduced Th2. Wandai Soup improving ways of vaginal local immune exist differences with itraconazole.