天津医药

天津医药 ›› 2016, Vol. 44 ›› Issue (8): 1029-1032.doi: 10.11958/20160162

• 临床研究 • 上一篇    下一篇

不同给药方法治疗细菌性阴道病对阴道微生态环境及免疫因子表达的影响

王芳1 ， 霍彦2 ， 刘艳妍3 ， 尹利荣1△   

  1. 1天津医科大学第二医院妇科 （邮编300211）， 2计划生育科； 3天津华兴医院妇产科
  • 收稿日期:2016-03-14 修回日期:2016-05-29 出版日期:2016-08-15 发布日期:2016-08-22
  • 通讯作者: 尹利荣 E-mail： yinlirongfk@sina.com E-mail:wangfang623@sina.com.cn
  • 作者简介:王芳 （1976）， 女， 主治医师， 博士， 主要从事女性生殖道感染及宫颈肿瘤研究
  • 基金资助:
    天津市卫生局科技基金 （2012KZ094）

Influence of different administration regimens for treatment of bacterial vaginosis on vaginal microflora and the expression of immune factors

WANG Fang1 , HUO Yan2 , LIU Yanyan3 , YIN Lirong1△   

  1. 1 Department of Gynecology, 2 Department of Family Planning, The Second Hospital of Tianjin Medical University, Tianjin 300211,China; 3 Department of Gynecology, Tianjin Huaxing Hospital
  • Received:2016-03-14 Revised:2016-05-29 Published:2016-08-15 Online:2016-08-22
  • Contact: YIN Lirong E-mail： yinlirongfk@sina.com E-mail:wangfang623@sina.com.cn

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摘要： 摘要： 目的 监测细菌性阴道病 （BV） 患者不同给药方法治疗前后阴道微生态恢复情况及局部免疫因子水平， 探索药物选择与疗效转归的关系。方法 选取健康女性 25 例为对照组， BV 患者 100 例为治疗组。治疗组按随机数字表法分为 A～D 组， 每组 25 例。A 组甲硝唑阴道泡腾片； B 组甲硝唑阴道泡腾片+乳杆菌活菌胶囊； C 组硝呋太尔阴道片； D 组硝呋太尔阴道片+乳杆菌活菌胶囊。A、 C 组均每晚给药 1 粒， 共 7 d， B、 D 组两种药物按先后顺序分别每晚 1 粒给药 7 d， 共 14 d。应用微生态评价体系及酶联免疫吸附法比较治疗组与对照组之间及各组 BV 患者治疗前后的临床疗效、 阴道微生态重建及阴道灌洗液中白细胞介素-8 （IL-8）、 Toll 样受体 2 （TLR2）、 肿瘤坏死因子-α （TNF-α） 的水平。结果 与对照组相比， 治疗组均存在阴道菌群紊乱、 pH 值升高和微生态失调现象。治疗前， 治疗组阴道灌洗液中 IL-8 水平与对照组差异无统计学意义， TNF-α及 TLR2 水平均高于对照组 （P＜0.05）， 各治疗组间免疫因子水平差异无统计学意义。治疗后， B、 D 组治疗有效率及阴道微生态恢复率均高于 A、 C 组 （P＜0.05）， IL-8 水平与 A、 C 组差异无统计学意义， TNF-α及 TLR2 水平均低于 A、 C 组 （P＜0.05）。结论 利用微生态评价系统辅助评判不同给药方案治疗 BV 效果证实硝呋太尔阴道片联合乳杆菌活菌胶囊序贯给药方案在临床疗效、 阴道微生态重建及阴道局部免疫恢复方面优于传统甲硝唑单独给药治疗。

关键词: 阴道病, 细菌性, 乳杆菌属, 甲硝唑, 硝呋拉太, 白细胞介素 8, Toll 样受体 2, 肿瘤坏死因子α

Abstract: Abstract: Objective Tracking of the vaginal microflora recovery and the expression of immune factors from untreated and treated patients with bacterial vaginosis (BV) by using different administration regimens and studying the relationship of treatment results and regimen selections. Methods 25 healthy females were selected as a control group and 100 BV patients were randomly divided into 4 groups (n=25/group). Group A: Intravaginal administration of metronidazole (× 7 d), Group B: Continuous intravaginal administration of metronidazole (×7 d) and then live Lactobacillus Capsule (×7 d) , Group C: Intravaginal administration of nifuratel (× 7 d), Group D: Continuous intravaginal administration of nifuratel (× 7 d) and then live Lactobacillus Capsule (×7 d). The microecological assessment system and EILSA were used to compare the clinical efficacy, vaginal microflora recovery and the changes in IL-8, TLR2 and TNF-α of the vaginal lavage fluid in healthy women or patients with bacterial vaginosis before and after treatments by four treatment strategies. Results ① The vaginal microflora imbalance, flora disturbance, pH value increased were presented in BV group compared with the control group.② Compared to the median of IL- 8, TLR2 and TNF- α in vaginal lavage fluids of control group, there was no significant difference in IL-8 level but both TLR2 and TNF-α were significantly increased (P＜0.05) in BV group. The immune factors had no significantly difference in all BV groups.③The therapeutic effect in each BV groups was compared after stopping treatment for 7 days. The cure rate and the vaginal microflora recovery rate were significant higher in group B and D than group A and C (P＜0.05). ④ After treatment there was no significant change in IL- 8 level but there was an obviously decrease in TLR2 and TNF-α (P＜0.05). The decreased levels are more significant in groups B and D than groups A and C (P＜0.05). Conclusion By combining with the microecological assessment system to evaluate the therapeutic effect of BV, our research suggests that the sequence schemes of nifuratel plus live Lactobacillus Capsule is more effective in therapy effect, restoring normal vaginal micro-ecological environment and vaginal local immunity than metronidazole used alone.

Key words:  vaginosis, bacterial, lactobacillus, metronidazole, nifuratel, interleukin- 8, toll- like receptor 2, tumor necrosis factor-alpha