盆腔炎性疾病致病微生物及治疗方案研究

Investigation of the Pathogens of Pelvic Inflammation Disease and the Effectiveness of Various Treatments

目的：了解中国盆腔炎性疾病（PID）患者的致病微生物及不同治疗方法的疗效。方法：采用前瞻性多中心随机研究方法，对全国49所医院934例盆腔炎性疾病患者随机按照不同治疗方法治疗并随访3次观察疗效，对其中481例患者的分泌物进行细菌培养、衣原体检测、支原体检测和淋菌检查，并根据不同的治疗方法分为A、B、C、D、E组。结果：①衣原体检查477例，阳性95例（19．9％）；宫颈支原体检查454例，阳性147例（32．4％）；淋菌检查445例，阳性50例（11．2％）；行厌氧菌检查308例，阳性77例（25．0％）；373例行细菌培养，最多者为大肠埃希菌25例（6．7％），其次为金色葡萄球菌18例（4．8％），链球菌8例（2．1％），表皮葡萄球菌6例（1．6％）等。②不同治疗方法比较：a、静脉给药组：在第3次随访中，3组疗效差异无统计学意义，第1、2次随访中A与B组疗效差异无统计学意义（P〉0．05），但与C组比较差异均有统计学意义（P〈0．05）。b、非静脉给药组：第1次随访中D组疗效显著好于E组，但在第2、3次随访中，两组疗效差异无统计学意义。③A组副反应发生率明显比B组及C组少（P=0．019）；E组明显少于D组（P=0．048）。结论：盆腔炎性疾病患者的致病微生物中淋菌、沙眼衣原体等STI致病微生物占重要比例，细菌感染时以大肠埃希菌为最常见。按照CDC推荐方案治疗PID，均能取得较好疗效，不同方案间存在着疗效及副反应上的差异。

Objective：To investigate the pathogens of pelvic inflammation disease and the effectiveness of variouse treatments. Methods：A prospective multicenter randomized clinical trial was done in 49 hospitals around the country. 934 cases were treated with different treatments randomly and followed up for three times to evaluate the effectiveness. Bacterial culture, gonococcus culture, tests for mycoplasm and chlamydia were performed for vaginal secretion in 481 patients. Results：①The positive rates for chlamydia test, mycoplasm test, gonococcus, anaerobics were 19.9% （95/477）, 32.4% （ 147/454）, 11.2% （50/445）, 25.0% （77/308）. Bacterial culture were performed in 373 cases, mainly colibacillus 25 （6.7%）, followed by golden staphylococcal bacteria 18（4.8% ）, streptococcus 8 （2.1% ） and staphylococcus epidermidis 6 （ 1.6% ）. ②The comparision between different treatments： a： for venous medication, at the third follow-up, no differ- ences were found among the three groups. At the first and second follow-up, no differences were found between A and B group （ P 〉 0.05）, while differences were significant between A and C （ P 〈 0.05）. b： for non-verous medication, at the first follow-up, the effectiveness of group D was much better than group E. At the second and third follow-up, no differences were found. ③The side effects in group A was much less than group B and C （ P=0.019）, also the side effects in group E was much less than group D （P=0.048）. Con- clusions：The pathogen of PID are mainly gonococcus and chlamydia. Colibacillus is the most common pathogen for bacterial infection. Various treatments recommended by CDC are effective, and there are differ- ences in effectiveness and side effects amono different treatments.