阶段性使用阴道用乳杆菌活菌胶囊配合普罗雌烯阴道胶囊治疗萎缩性阴道炎老年患者的疗效及安全性分析

Efficacy and safety analysis of treating atrophic vaginitis with periodic use of living preparation of lactobacillus and promestriene vaginal capsules

目的分析阶段性使用阴道用乳杆菌活菌胶囊配合普罗雌烯阴道胶囊治疗萎缩性阴道炎老年患者的疗效及安全性。方法选取2017年10月至2018年12月江南大学附属无锡市第五人民医院诊治的130例萎缩性阴道炎老年患者作为研究对象。按随机数字表法将所选患者分为试验组(n=65)使用普罗雌烯阴道胶囊+甲硝唑+阴道用乳杆菌活菌胶囊治疗,对照组(n=65)使用普罗雌烯阴道胶囊+甲硝唑治疗。治疗结束后1w对受试者进行疗效判定,比较萎缩性阴道炎症状评分、阴道健康评分、阴道pH值,并于治疗结束后3个月和6个月随访,统计患者阴道炎症的复发情况,记录不良反应发生情况,并比较治疗前后试验组阴道菌群结构。结果两组患者治疗过程中均无严重不良反应,试验组治疗痊愈率(50.8%)、总有效率(93.9%)均显著高于对照组(32.3%,76.9%),差异均具有统计学意义(均P<0.05),试验组3个月和6个月复发率(1.5%,12.3%)均显著低于同期对照组(27.7%,53.9%),差异均具有统计学意义(均P<0.05);治疗后两组阴道pH值、萎缩性阴道炎症状评分均较治疗前显著降低,差异均具有统计学意义(均P<0.05),而阴道健康总评分较治疗前显著提高,差异具有统计学意义(P<0.05),与同期对照组比较,试验组变化更明显,差异具有统计学意义(P<0.05);治疗前后试验组4种主要细菌(乳酸杆菌属、奇异菌属、加德纳菌和厌氧性球菌属)的相对丰度比较,差异具有统计学意义(P<0.05)。结论阶段性使用乳酸杆菌配合普罗雌烯阴道胶囊、甲硝唑栓治疗萎缩性阴道炎老年患者,可有效缓解其临床症状和体征,提高临床疗效,降低复发率,安全性高。

Objective To analyze the efficacy and safety of treating atrophic vaginitis with periodic use of living preparation of lactobacillus and promestriene vaginal capsules.Methods A total of 130 elderly patients with atrophic vaginitis who were diagnosed and treated in Wuxi Fifth People's Hospital Affiliated to Jiangnan University from October 2017 to December 2018 were selected as research subjects.According to the random number table method,the selected patients were divided into the control group(n=65)treated with promestriene vaginal capsule+metronidazole,and the experimental group(n=65)treated with promestriene vaginal capsule+metronidazole+living preparation of lactobacillus.The treatment efficacy was determined at a week after treatment,and the atrophic vaginitis symptom scores,vaginal health score and vaginal pH value was compared.The recurrence of vaginal inflammation and incidence of adverse reactions were recorded within 3 months'and 6 months'follow-up,and the vaginal flora structure was compared.Results There were no serious adverse reactions in the two groups.The treatment cure rate and total effective rate in the experimental group(50.8%,93.9%)were significantly higher than those of the control group(32.3%,76.9%),all with statistically significant differences(all P<0.05).The recurrence rate with 3 months and 6 months after treatment in the experimental group(1.5%,12.3%)were significantly lower than those in the control group(27.7%,53.9%),all with statistically significant differences(all P<0.05).The vaginal pH and atrophic vaginitis symptom scores were significantly reduced and vaginal health scores were significantly improved after treatment in the two groups,all with statistically significant differences(all P<0.05),and compared with the control group,changes in the experimental group were more obvious,with statistically significant differences(P<0.05).There were statistically significant differences in the relative abundance of four main bacteria(lactobacillus,xenobacteria,gardiner and anaerobic coccus)in the experimental group between before and after treatment(P<0.05).Conclusions The clinical symptoms and signs of elderly patients with atrophic vaginitis can be effectively alleviated by periodic use of lactobacillus in combination with promestriene vaginal capsule and metronidazole suppository.The clinical efficacy is improved and the recurrence rate is reduced,with high safety.