促效疗法治疗慢性复发性口腔念珠菌感染的疗效:一项随机对照临床试验

Y. Makedonova, L. Gavrikova, S. Dyachenko, D. Dyachenko
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Examination and treatment of patients was performed at the Department of Dentistry of Volgograd State Medical University and at Volgograd Regional Clinical Dental Polyclinic (Volgograd, Russia). Study timeline: September 2020 — November 2022. Patients were divided into 2 groups depending on the antimycotic drug used: in the main group, patients took voriconazole, in the control group — fluconazole. In addition to etiotropic therapy, patients of both groups were prescribed complex treatment aimed at stimulating the immune protection of the body, restoring vitamin and mineral deficiency, and correcting the imbalance of the oral ecosystem. The patients underwent local symptomatic therapy: antiseptic treatment with 0.06% chlorhexidine bigluconate solution, anesthesia with 15% lidocaine gel, and 3.44% retinol oil solution to stimulate epithelization. Oral sanitation and professional hygiene were recommended for patients to prevent oral candidiasis. 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Analysis of the quantitative characteristics of Candidaspp. using bacterial culture test revealed a high and moderate number of Candidaspp. CFU in most clinical isolates before treatment, and no such cases in patients of the main group after treatment. The susceptibility test of yeast fungi to fluconazole and itraconazole showed the presence of isolates with dose-dependent susceptibility, and the resistance of individual samples C. krusei to fluconazole and C. glabrata (16.7% and 60%, respectively) and to itraconazole (33.3% and 100%, respectively). All Candidaspp. isolates were found to be highly susceptible to voriconazole. The efficacy of the combined treatment of an episode with voriconazole is 95.4%. Continued suppressive therapy with voriconazole resulted in relapse prevention in 98.3% of patients. Etiotropic therapy with voriconazole provided a stable clinical effect (92.7%) after a year of follow-up.Conclusion. 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引用次数: 0

摘要

背景有效治疗口腔念珠菌感染尤其重要,因为Candidaspp数量的增加导致口腔复发性真菌病变的患者增加。抗真菌药物难治菌株。本文介绍了对慢性复发性口腔念珠菌感染患者进行促效治疗的临床疗效研究结果。客观的评估利他主义治疗慢性复发性口腔念珠菌感染的有效性。方法。一项随机对照临床试验在56名年龄在45至74岁的慢性复发性口腔念珠菌感染患者中进行。患者的检查和治疗在伏尔加格勒国立医科大学牙科系和伏尔加格勒地区临床牙科综合诊所(俄罗斯伏尔加格勒)进行。研究时间:2020年9月至2022年11月。根据使用的抗真菌药物,患者被分为两组:主组患者服用伏立康唑,对照组患者服用氟康唑。除了营养不良治疗外,两组患者都接受了复杂的治疗,旨在刺激身体的免疫保护,恢复维生素和矿物质缺乏,并纠正口腔生态系统的失衡。患者接受了局部症状治疗:0.06%氯己定双葡糖酸盐溶液进行防腐治疗,15%利多卡因凝胶麻醉,3.44%视黄醇油溶液刺激上皮化。建议患者进行口腔卫生和职业卫生,以预防口腔念珠菌感染。为了恢复咀嚼功能,患者接受了口腔修复治疗。本研究的主要参考点是通过临床标准和细菌培养试验结果评估治疗的有效性,以记录Candidaspp的数量、种类和易感性。治疗结束后3周、6个月和12个月的菌株。结果:口腔念珠菌慢性复发最常见的病原菌为白色念珠菌(69.6%),其次为非白色念珠菌(10.7%),热带C.tropicalis(10.7%)和光滑C.glabrata(8.9%)。Candidaspp的数量特征分析。使用细菌培养试验显示Candidaspp的数量较高和中等。大多数临床分离株在治疗前均存在CFU,而主要组患者在治疗后无此类病例。酵母真菌对氟康唑和伊曲康唑的药敏试验显示,存在具有剂量依赖性药敏的分离株,个别样品克鲁塞氏菌对氟康唑、光滑念珠菌的耐药性(分别为16.7%和60%)和对伊曲康唑(分别为33.3%和100%)。所有Candidaspp。发现分离株对伏立康唑高度敏感。伏立康唑联合治疗一次发作的疗效为95.4%。持续的伏立康唑抑制治疗可预防98.3%的患者复发。经过一年的随访,伏立康唑的利他性治疗提供了稳定的临床效果(92.7%)。结论。研究结果证实了伏立康唑利他性疗法治疗慢性口腔念珠菌感染并复发的有效性,尤其是在检测到非白色念珠菌或氟康唑和伊曲康唑耐药的白色念珠菌的情况下,或者如果不可能识别病原体。
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Effiectiveness of Etiotropic Therapy in Patients with Chronic Recurrent Oral Candidiasis: a Randomized Controlled Clinical Trial
Background. Effective treatment of oral candidiasis is especially relevant due to the increase in patients with recurrent fungal lesions of the oral cavity caused by the growing number of Candidaspp. strains refractory to antimycotic drugs. The paper presents the results of the study on the clinical efficacy of etiotropic therapy in patients with chronic recurrent course of oral candidiasis.Objective. To assess the effectiveness of etiotropic therapy in patients with chronic recurrent oral candidiasis.Methods. A randomized controlled clinical trial was conducted in 56 patients with chronic recurrent oral candidiasis aged 45 to 74 years. Examination and treatment of patients was performed at the Department of Dentistry of Volgograd State Medical University and at Volgograd Regional Clinical Dental Polyclinic (Volgograd, Russia). Study timeline: September 2020 — November 2022. Patients were divided into 2 groups depending on the antimycotic drug used: in the main group, patients took voriconazole, in the control group — fluconazole. In addition to etiotropic therapy, patients of both groups were prescribed complex treatment aimed at stimulating the immune protection of the body, restoring vitamin and mineral deficiency, and correcting the imbalance of the oral ecosystem. The patients underwent local symptomatic therapy: antiseptic treatment with 0.06% chlorhexidine bigluconate solution, anesthesia with 15% lidocaine gel, and 3.44% retinol oil solution to stimulate epithelization. Oral sanitation and professional hygiene were recommended for patients to prevent oral candidiasis. In order to restore chewing function, patients were referred to prosthodontic treatment. The main reference point of the study was to assess the effectiveness of the therapy, both by clinical criteria and by evaluating the results of bacterial culture test in order to record the quantitative, species and susceptibility profile of Candidaspp. strains in 3 weeks, 6 and 12 months after the end of treatment. Analysis and statistical processing of the obtained data were performed using Excel program to MS Windows 10 (Microsoft Corp., USA).Results. The most common pathogenic agent of chronic recurrent forms of oral candidiasis is C. albicans (69.6%), followed by C. non-albicans species — C. krusei (10.7%), C. tropicalis (10.7%) and C. glabrata (8.9%). Analysis of the quantitative characteristics of Candidaspp. using bacterial culture test revealed a high and moderate number of Candidaspp. CFU in most clinical isolates before treatment, and no such cases in patients of the main group after treatment. The susceptibility test of yeast fungi to fluconazole and itraconazole showed the presence of isolates with dose-dependent susceptibility, and the resistance of individual samples C. krusei to fluconazole and C. glabrata (16.7% and 60%, respectively) and to itraconazole (33.3% and 100%, respectively). All Candidaspp. isolates were found to be highly susceptible to voriconazole. The efficacy of the combined treatment of an episode with voriconazole is 95.4%. Continued suppressive therapy with voriconazole resulted in relapse prevention in 98.3% of patients. Etiotropic therapy with voriconazole provided a stable clinical effect (92.7%) after a year of follow-up.Conclusion. The results of the study confirm the effectiveness of etiotropic therapy with voriconazole for chronic oral candidiasis complicated by a recurrent course, especially in case of detected C. non-albicans or fluconazole- and itraconazole-resistant C. albicans, or if it is impossible to identify the pathogenic agent.
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