恢复阴道微生态在细菌性阴道病个体化治疗中的价值分析

Value of Vaginal Microecology Recovery in the Inividualized Treatment of Bacterial Vaginosis

目的:探讨在个体化对症治疗细菌性阴道病(BV)中积极恢复阴道微生态,以降低BV复发的效果。方法:147例BV患者,其中复发性BV(RBV)50例,被随机分成A、B两组。A组67例,其中RBV21例;B组80例,其中RBV29例。两组均接受个体化治疗并维持3个月。A组治疗至临床症状消失、Amsel正常后,继续调节阴道微生态至Nugent评分≤3分、AV评分≤2分、阴道菌群密集度Ⅱ～Ⅲ度且乳杆菌占明显优势、H2O2≥2μmol/L时停药;B组治疗至临床症状消失、Amsel正常时即停药。两组停药后均随访3个月。统计两组3个月后复发率及A组在治疗过程中继发外阴阴道假丝酵母菌病(VVC)、需氧菌性阴道炎(AV)及阴道微生态恢复情况。结果:A组5例因治疗不规范被剔除。A组随访3个月复发率16.13%、B组46.25%,差异有统计学意义(P<0.05)。个体化治疗过程中,A组继发AV17例(27.42%)、继发VVC24例(38.71%)。A组BV患者经甲硝唑、奥硝唑及克林霉素个体化治疗,继发VVC及AV的患者经唛咪康帕、克林霉素个体化治疗9疗程后,阴道微生态均得到完全恢复。结论:个体化对症治疗中动态监测并消除继发感染和积极恢复阴道微生态,可明显降低BV复发率。

Objective： To investigate the efficiency of vaginal microecology recovery in the inividualized treatment of bacterial vaginosis（BV） and decreasing of the relapses of BV. Methods.147 BV patients（including 50 cases of recurrent BV） were randomized into group A of 67 patients including 21 RBV patients and groups B of 80 patients including 29 RBV patients. Both groups were individually treated for 3 months. The treatment of A group was discontinued when Amsel normal, AV score ≤2, nugent score ≤3, vaginal flora intensity Ⅱ～Ⅲ degrees, lactobacillus dominated and H202 I〉2 wmoVL while group B was stop treatment when Amsel was normal. Two groups were followed up for 3 months. BV recurrence rate and the condition of sec ondary infections （ including VVC and AV） and vaginal ecosystem were observed and compared between these two groups. Results：5 cases of group A were deleted for the substandard treatment. The 3 months recurrence rate of group A （16. 13% ） was significantly lower than that of group B （46.25%） （ P 〈 0. 05）. Secondary infection of AV and VVC in the individualized treatment of stage in group A were 27. 42% and 38. 71% respectively. The BV patients in group A were individually treated with metronidazole, ornidazole or clindamycin,their econdary infection（ including VVC and AV） were individually treated with Label mi compaq and clindamycin. Vaginal microecology was recovered completely when patients were treated in accordance with individualized treatment plan. Conclusions.The long term recurrence rate of BV Patients could be reduced effectively if vaginal microecology unbalance were complete repaired and case history or the secondary infection were treated actively.