细菌性阴道病复发原因及阴道微生态评价指标对治疗细菌性阴道病的影响

The causes of relapse of bacterial vaginal disease and the effects of vaginal micro ecological evaluation index on the treatment of bacterial vaginal disease

目的 探讨细菌性阴道病（BV）复发的原因及阴道微生态评价指标对治疗BV的影响。方法 选取2013年1月至2014年6月接收的经临床症状、体征及细菌学检查结果确诊的170例BV患者为研究对象,根据入院顺序随机均分为两组。对照组患者治疗至症状消失、Amsel正常停药;观察组在对照组基础上治疗至阴道菌群密集度为Ⅱ-Ⅲ度且乳酸杆菌占明显优势,H2O2浓度〉2 nmol/ml。随访6个月,观察比较两组患者复发率。回顾性分析复发患者的临床资料,总结BV复发的原因。结果 观察组复发率显著低于对照组（14.12%比55.29%,χ^2=31.799,P=0.000）。170例BV患者出现复发59例（34.71%）,单因素分析结果提示年龄、文化程度、流产史均不是复发的危险因素（P〉0.05）,内裤换洗方式及次数、性生活次数、洗浴方式、非经期使用护垫均是其危险因素（P〈0.05）。logistic多因素分析提示内裤与其它衣物同洗、盆浴、性生活频率〉3次/周、非经期使用护垫是BV复发的独立危险因素（P〈0.05）,内裤换洗次数〈4次/周为非独立危险因素（P〉0.05）。结论 阴道微生态可以作为指导BV治疗的指标,而BV复发与诸多因素有关,临床应加强相关因素预防,降低复发发生率。

Objective To investigate the causes of elapse of bacterial vaginal disease （BV） and the effects of vaginal micro ecological evaluation index on the treatment of vaginal bacterial disease （BV）. Methods The 170 cases diagnosed with BV through clinical symptoms, signs and the results of bacteriological examinations from January 2013 to June 2014 were selected and randomly divided into two groups according to the order of admission. Patients in the control group were treated until the symptoms disappeared and the medicine was withdrawn until Amsel appeared normal. The patients in the observation group were treated until the intensity of the vagina bacterium group reached degree II -III and Lactobacillus was obvious （ the concentration of H2O2 〉 2 nmol/ml）, based on the therapy of the control group. After 6 months of follow - up, the recurrence rate was compared between the two groups , the clinical data of relapsing patients were retrospectively analyzed and the reasons of recurrence of BV were summarized. Results The recurrence rate （14. 12% ） in the observation group was significantly lower than that （55.29%,χ^2 =31. 799, P =0. 000） of the control group. In 170 cases of patients with BV, 59 cases showed recurrence, accounting for 34. 71%. The results single factor analysis suggested that age, degree of education and the history of abortion were not the risk factors of recurrence （ P 〉 0. 05 ）. But logistic multi factors analysis suggested that the way of underwear changed and times, times of sexual life, way of bathing and pads used in the non menstrual were the main risk factors （ P 〈 0. 05 ）. Multivariate logistic analysis showed that the underwear washed with other clothes, bathtub, the frequency of sexual life （more than 3 times per week） , pads used in non menstrual were independent risk factors for recurrence of BV （P 〈0. 05）. But the times of underwear changed （ less than 4 times per week） were the independent risk factor （ P 〉 0. 05 ）. Conclusion The vaginal micro ecology can serve as a guide for the BV treatment indicator, and the recurrence of BV is related to many factors. So clinical factors related to prevention should be strengthened to reduce the recurrence rate.