不同5′-硝基咪唑类药物治疗厌氧菌性及滴虫性阴道炎临床疗效比较

Comparison among the clinical curative effects using different 5'-nitroimidazole drugs in treating anaerobic or trichomonal vaginitis

目的观察甲硝唑、替硝唑和奥硝唑治疗厌氧菌性和滴虫性阴道炎的临床疗效和不良反应,了解所分离的厌氧菌和阴道毛滴虫对上述药物的敏感性。方法根据细菌学和寄生虫学实验室检查结果,将290例厌氧菌性和62例滴虫性阴道炎患者各随机分为3组,分别给予甲硝唑、替硝唑和奥硝唑治疗。采用二倍试管平皿稀释法测定厌氧菌分离株对不同药物的最低抑菌浓度(MIC),采用二倍试管稀释法测定阴道毛滴虫分离株对不同药物的最低杀虫浓度(MPC)。结果厌氧菌性阴道炎组中,甲硝唑亚组的有效率为54．6%,明显低于替硝唑亚组的68．8%(P＜0．05)和奥硝唑亚组的74．2%(P＜0．01),后两组的差异无显著性(P＞0．05)。滴虫性阴道炎组中,甲硝唑、替硝唑和奥硝唑亚组的有效率分别为90．5%、100．0%和100．0%,3个亚组间的差异均无显著性(P＞0．05)。甲硝唑不良反应总发生率明显高于替硝唑(P＜0．01)和奥硝唑(P＜0．01),但后两组间不良反应率的差异无显著性(P＞0．05)。甲硝唑、替硝唑和奥硝唑对266株革兰阴性厌氧菌MIC_(90)范围分别为4～8、1～2和1～2μg/mL,甲硝唑、替硝唑和奥硝唑对261株革兰阳性厌氧菌MIC_(90)范围分别为32～64、8～32和8～16μg/mL。甲硝唑、替硝唑和奥硝唑杀灭阴道毛滴虫的MPC分别为25、5和5μg/mL。结论与甲硝唑比较,替硝唑和奥硝唑治疗厌氧菌性阴道炎的疗效高、不良反应少,但甲硝唑的价格低廉。临床厌氧菌株对甲硝唑有较高的耐药率。3种药物抗革兰阴性厌氧菌的作用均明显高于革兰阳性厌氧菌,但革兰阳性厌氧菌对奥硝唑仍有较高的敏感性。

Objective To observe the clinical curative effects and side-effects of metronidazole, tinidazole and ornidazole in treating anaerobic or trichomonal vaginitis, and to analyze the susceptibility of the isolated anaerobes and trichomonads to the three drugs. Methods Based on the bacteriological and parasitological laboratory examination results, 290 anaerobic vaginitis patients and 62 trichomonal vaginitis patients were randomly divided into three groups treated with metronidazole, tinidazole and ornidazole, respectively. Doubling plate dilution method was applied to determine the minimal inhibition concentrations（MIC） of the three drugs in inhibiting the anaerobic isolates, and the same dilution method was performed to detect the minimal parasiticidal concentrations（MPC） of the three drugs in killing the trichomonal isolates. Results The effective rate（54.6 % ）of metronidazole in anaerobic vaginitis was remarkably lower than those of tinidazole （ 68. 8 %, P 〈 0. 05 ） and ornidazole （ 74. 2 %, P 〈0.01）, but they showed no significant difference between the curative rates of tinidazole and ornidazole（ P〉 0.05 ）. The curative rates of the three drugs in trichomonal vaginitis were 90. 5 % , 100 % and 100 % , respectively with no significant differences among the curative rates（ P〉0.05 ）. The total side-effect rate of metronidazole in the treated patients was obviously higher than those of tinidazole （ P 〈0.01 ） and ornidazole （ P 〈0.01 ） , but those of tinidazole and ornidazole were similar（ P〉 0. 05 ）. The MIC90 values of metronidazole, tinidazole and ornidazole against 266 Gram-negative anaerobic isolates were 4～8, 1 ～2 and 1 ～2 μg/mL, and 32～64, 8～32 and 8～ 16μg/mL for 261 Gram-positive anaerobic ones, respectively. The MPC values of met ronidazole, tinidazole and ornidazole in killing trichomonads were 25, 5 and 5 μg/mL, respectively. Conclusion The outcome of comparison with metronidazole, tinidazole and ornidazole for anaerobic vaginitis shows higher curative effects and lower side-effects, but metronidazole is much cheaper. The clinical anaerobic strains have much higher resistance to metronidazole. All three drugs dislay stronger activities against the Gram-negative anaerobes than the Gram-positive ones, however, the gram-negative anaerobes still show higher sensitivity to ornidazole.