甲硝唑与制霉菌素联合用药方案治疗滴虫性阴道炎的临床疗效观察

目的探讨甲硝唑联合制霉菌素对滴虫性阴道炎的临床效果,为临床合理用药提供参考。方法选择我院2013年1月~2016年5月收治的滴虫性阴道炎患者92例为研究对象,分为观察组41例和对照组51例。观察组给予甲硝唑+制霉菌素联合用药方案,对照组仅单纯采用甲硝唑治疗,观察比较两组患者阴道炎的疗效、IL-2(血清白介素-2)水平、IL-13(血清白介素-13)水平以及IL-8(血清白介素-8)水平等方面的差异,进行判定甲硝唑与制霉菌素的临床联用价值。结果两组患者的血清IL-2水平、血清IL-13水平以及血清IL-8水平比较,观察组明显低于对照组,差异有统计学意义(P0.05);观察组患者的临床疗效明显高于对照组,差异有统计学意义(P0.05)。结论甲硝唑联合制霉菌素治疗滴虫性阴道炎,可显著降低血清IL-2、血清IL-13以及血清IL-8水平,治疗效果确切,安全性高。     

乳杆菌活菌胶囊在配合治疗产后滴虫性阴道炎中的价值

目的探讨应用乳杆菌活菌胶囊在配合治疗产后滴虫性阴道炎中的作用。方法将90例患滴虫性阴道炎的产后妇女随机分为2组,研究组应用甲硝唑400 mg,每日2次,连服7 d,同时每日晚塞1粒乳杆菌活菌胶囊入阴道,连用10 d;对照组应用甲硝唑400 mg,每日2次,连服7 d。2组患者14 d后复查并检查白带常规,对其临床治愈率、白带清洁度、pH进行比较。30 d后随访检查滴虫性阴道炎复发情况。结果用药后研究组治愈率高于对照组,2组差异有统计学意义(P<0.05);研究组、对照组pH均有降低,但研究组pH低于对照组,2组差异有统计学意义(P<0.05);用药后研究组阴道清洁度I、II度比率高于对照组,研究组复发率低于对照组,差异均有统计学意义(P<0.05)。结论产妇应用乳杆菌活菌胶囊配合治疗滴虫性阴道炎可提高治愈率,改善阴道微环境并降低复发率。     

Nifuratel Compared with Metronidazole in the Treatment of Trichomonal Vaginitis

Nifuratel (Magmilor) was compared with metronidazole (Flagyl) in the treatment of trichomonal vaginitis by a randomized double-blind trial. Only 18 out of 47 patients (38%) treated with nifuratel were found to be cured, whereas 42 out of 49 patients (85%) treated with metronidazole were cured. Severe reactions, necessitating withdrawal of treatment, occurred in three patients treated with nifuratel. There were no serious side-effects with metronidazole. The results of this trial indicate that nifuratel is not a satisfactory substitute for metronidazole in the treatment of trichomoniasis.     

定君生联合甲硝唑治疗滴虫性阴道病的临床疗效观察

目的 通过定君生联合甲硝唑以及单独用药治疗滴虫性阴道病的临床疗效观察,探讨联合用药对滴虫性阴道病的疗效.方法 选择诊断明确的滴虫性阴道病患者150例,随机分为3组,试验组采用甲硝唑联合定君生的治疗,对照组Ⅰ采用定君生单独用药,对照组Ⅱ采用甲硝唑治疗,观察治疗后的症状、体征、滴虫和阴道的pH的变化.结果 3组患者有效率差异有统计学意义(P＜0.05),起效时间和复发率差异有统计学意义(P＜0.01).结论 定君生联合甲硝唑治疗滴虫性阴道病,疗效好,有利于快速恢复阴道的微生物环境的平衡,降低复发率.     

乳酸杆菌活菌制剂用于治疗老年性阴道炎合并细菌性阴道病临床探讨

目的探讨乳酸杆菌活菌制剂用于治疗老年性阴道炎合并细菌性阴道病的临床疗效。方法对118例老年性阴道炎合并细菌性阴道病患者随机分3组,分别予以乳酸杆菌活菌制剂局部用药和（或）口服甲硝唑,进行疗效比较。结果乳酸杆菌活菌制剂和甲硝唑联合应用对治疗老年性阴道炎合并细菌性阴道病疗效显著高于单一用药的疗效,组间差异具有显著性（P〈0.05）;复发率低于单一用药。结论乳酸杆菌活菌制剂与甲硝唑联合治疗老年性阴道炎合并细菌性阴道病有比较好的治疗效果,不易复发。     

Monilial and Trichomonal Vaginitis—Topical Treatment with Povidone-Iodine Preparations

A regimen of treatment for vaginitis combining the use of a povidone-iodine solution for swabbing, a povidone-iodine vaginal gel for application at night and a povidone-iodine douche for use in the morning, was evaluated in 93 courses of treatment in 87 patients with monilial or trichomonal vaginitis or a combination of both.In monilial vaginitis, symptoms were cleared and negative laboratory results obtained in one to three weeks in all 74 courses of treatment. These results were obtained within one week in 52 cases and within two weeks in another 17.In four of five patients with trichomonal vaginitis, symptoms were cleared within three weeks. In the fifth, negative laboratory results were obtained but a mild discharge persisted at the end of the fourth week.In 14 courses for combined infections, symptoms were cleared within three weeks in 13, and the pathogens were absent in those patients within four weeks. In one patient the disease did not respond.     

甲硝唑、欧维婷联合乳杆菌活菌胶囊治疗老年性阴道炎疗效观察

目的研究甲硝唑、欧维婷联合乳杆菌活菌胶囊治疗老年性阴道炎临床疗效。方法将45例老年性阴道炎患者分为对照组23例和治疗组22例,对照组采用甲硝唑治疗,治疗组采用甲硝唑、欧维婷联合乳杆菌活菌胶囊治疗,治疗1个疗程后,观察1个月。结果治疗组临床症状明显改善,与对照组比较,差异有统计学意义(P<0.05)。治疗组外阴阴道外观改善明显。结论甲硝唑、欧维婷联合乳杆菌活菌胶囊治疗老年性阴道炎能有效改善阴道健康状态,安全有效,建议临床推广使用。     

乳杆菌活菌制剂联合可宝净治疗老年性阴道炎疗效观察

目的探讨乳杆菌活菌制剂联合可宝净治疗老年性阴道炎的效果。方法将2006年6月至2008年4月在大连医科大学附属二院确诊为老年性阴道炎的患者随机分为3组。A组：76例,使用乳杆菌活菌胶囊（定君生）与可宝净联合用药;B组：78例,单纯使用甲硝唑泡腾片;C组77例,单纯使用可宝净。结果有效率：A组为92．11％,B组为83．33％,C组为85．71％;复发率：A组为15．79％,B组为39．74％,C组为41．56％,B组、C组差异无显著性（P〈0．05）。结论使用乳杆菌活菌胶囊（定君生）与可宝净联合用药治疗老年性阴道炎是一种有效、安全的方法。     

乳杆菌制剂在不同阴道炎治疗中的作用分析

目的探讨微生态疗法在女性不同阴道炎症治疗中的临床价值,为临床使用微生态制剂治疗阴道炎症,提供新的方法和理论基础。方法以2013年3月至2013年8月在沈阳医学院附属第二医院妇科门诊就诊的阴道炎患者共计892例,作为研究对象,在治疗上采取抗（真）菌药＋乳杆菌制剂,比较各组的治疗效果（7d及14d治愈率）。结果治疗效果比较（7d和14d治愈率）：单纯外阴阴道假丝酵母菌病（VVC）：分别为91．34％和99．10％,P〈0．01,差异有统计学意义;单纯细菌性阴道病（BV）：分别为98．50％和100％,P〉0．05,差异无统计学意义;单纯滴虫性阴道炎（TV）：分别为98．41％和100％,P〉0．05,差异无统计学意义;混合感染：分别为88．12％和99．01％,P〈0．01,差异有统计学意义。结论乳杆菌制剂配合抗（真）菌药在治疗不同阴道炎中的效果不同,疗程不同。     

产后42天产妇阴道感染发生情况调查

目的调查产后42天产妇阴道感染发生情况。方法选取2013年1月至2013年3月期间大兴区医院产后42天复检产妇188例,采用白带常规镜检方法对产后42天复检产妇进行常规筛查。结果检出：需氧菌阴道炎患者21例（占受检人数的11.17%）,细菌性阴道病患者29例（占受检人数的15.43%）,滴虫性阴道炎患者7例（占受检人数的3.72%）,外阴阴道假丝酵母菌病患者5例（占受检人数的2.67%）,共计62例（占受检人数的32.98%）。结论产后42天产妇阴道感染以细菌性阴道感染为主。     

TRICHOMONAL VAGINITIS—The Problem of Chronic or Recurring Infection

In general practice and in gynecology, vaginal trichomoniasis is a frequent and troublesome problem. However, the trichomonas vaginalis organism is frequently found in an apparently healthy vagina, indicating that symptoms, recurrences, or exacerbations may depend on local changes in secretions, probably due in part to emotional stress. Therapy must, therefore, include not only the topical use of an effective trichomonacidal drug, but also sympathetic and considerate listening by the physician.The combination of furazolidone and nifuroxime in vaginal suppositories and vaginal insufflation powder was found to be an effective trichomonacidal compound. A total of 56 patients with trichomonal, monilial and nonspecific bacterial vaginitis was treated with this nitrofuran combination with good results.In topical therapy, powders seem more effective, probably because a dry environment is unfavorable to the flagellates. The patient should be instructed to insert two vaginal suppositories daily for the first week, then to decrease the dosage gradually as indicated by the physician after clinical examination and microscopic examination of vaginal secretions each week. Of great importance is the fact that some patients may need long-term maintenance therapy—one or two suppositories weekly—especially if the emotional difficulties appear to be insurmountable.     

Trichomonal vaginitis; the problem of chronic or recurring infection

In general practice and in gynecology, vaginal trichomoniasis is a frequent and troublesome problem. However, the trichomonas vaginalis organism is frequently found in an apparently healthy vagina, indicating that symptoms, recurrences, or exacerbations may depend on local changes in secretions, probably due in part to emotional stress. Therapy must, therefore, include not only the topical use of an effective trichomonacidal drug, but also sympathetic and considerate listening by the physician. The combination of furazolidone and nifuroxime in vaginal suppositories and vaginal insufflation powder was found to be an effective trichomonacidal compound. A total of 56 patients with trichomonal, monilial and nonspecific bacterial vaginitis was treated with this nitrofuran combination with good results. In topical therapy, powders seem more effective, probably because a dry environment is unfavorable to the flagellates. The patient should be instructed to insert two vaginal suppositories daily for the first week, then to decrease the dosage gradually as indicated by the physician after clinical examination and microscopic examination of vaginal secretions each week. Of great importance is the fact that some patients may need long-term maintenance therapy-one or two suppositories weekly-especially if the emotional difficulties appear to be insurmountable.     

Real-time PCR分析滴虫性阴道炎患者微生物组成的变化

目的探寻滴虫性阴道炎患者阴道微生物组成的特点,为临床诊治及减少疾病的复发提供参考依据。方法选取2016年5-6月复旦大学附属华东医院妇科门诊45岁以下确诊为滴虫性阴道炎的育龄期患者16例,以同期18例45岁以下育龄期健康女性为对照,采集患者和健康人上阴道壁1/3处的分泌物,进行常规临床分析和革兰染色,并以21种常见的阴道细菌的特异引物进行Real-time PCR检测,分析并比较这些细菌在滴虫性阴道炎患者和健康人阴道内的组成及变化。结果在18例健康人中,其中13例的阴道微生物组成以乳酸杆菌(Lactobacillus)为优势菌,3例的阴道微生物组成无明显优势菌群或者优势菌不为检测的21种常见阴道微生物,2例的阴道微生物组成以加德纳菌为优势菌;在16例滴虫性阴道炎患者中,只有2例患者的阴道微生物菌群以乳酸杆菌为优势菌,14例以厌氧菌如普雷沃属(Prevotella)、纤毛菌(Leptotrichia)和斯尼思菌(Sneathia)为优势菌。经Metastats进行组间差异分析,结果表明Lactobacillus crispatus、Leptotrichia amnionii、Eggerthella sp.和Peptostreptococcus sp.在两组之间差异有统计学意义(P≤0.05)。PCoA主成分析结果亦显示滴虫性阴道炎患者的阴道常见21种微生物组成与健康人有显著差别。结论滴虫性阴道炎患者阴道内微生物组成的多样性增加,普雷沃属、纤毛菌及斯尼思菌的明显增高可能滴虫性阴道炎的炎症发生有关,此结果对于临床治疗滴虫性阴道炎的及减少复发提供新的方向,具有一定的指导意义。     

乳酸杆菌细胞裂解物对家兔实验性阴道炎的治疗作用

目的观察乳杆菌DM8909裂解物及发酵物在体内对大肠埃希菌、金黄色葡萄球菌的抑制效果,探索一种替代活菌制剂的生态制剂。方法用阿莫西林和甲硝唑接种家兔建立脱污染模型,再用大肠埃希菌和金黄色葡萄球菌的混合液接种,建立实验性感染模型后,随机分为5组,分别用乳杆菌裂解物原液、裂解物稀释液、发酵上清液、乳杆菌活菌制剂及生理盐水(对照组)进行治疗,分析和考察阴道菌群变化。结果德氏乳酸杆菌裂解物具有治疗实验性家兔细菌性阴道炎的效果,其疗效与活菌制剂相近。结论德氏乳酸杆菌裂解物可作为乳酸杆菌活菌制剂的替代物。     

青海高原地区7325例 藏族妇女阴道分泌物五联检测

目的了解青海高原地区藏族妇女阴道分泌物病原体感染情况。方法对本院2016年7月至2016年12月妇科门诊就诊的7 325例患者阴道分泌物五联检测结果进行回顾性分析。结果 7 325例阴道分泌物样本中过氧化氢阳性占82.8%,唾液酸苷酶阳性占53.5%,白细胞酯酶阳性占74.6%,β-葡萄糖醛酸苷酶阳性占75.9%,凝固酶阳性占70.5%。阴道分泌物样本中乳杆菌少或无占82.8%,其检出病原菌5 771例,阳性检出率为78.8%。各种阴道炎的构成比中需氧菌性阴道炎(AV)占25.4%,细菌性阴道炎(BV)占17.8%,念珠菌性阴道炎(VVC)占11.5%,滴虫性阴道炎(TV)占9.3%,混合性感染占36.0%。结论青海高原地区藏族妇女阴道病比较常见的是AV、BV、VVC,TV也多发,广大妇女应该给予重视,定期进行阴道分泌物常规检查,以便及时发现疾病,采取有效的防治措施,避免性传播疾病感染扩散。     

Drug resistance in the sexually transmitted protozoan Trichomonas vaginalis

Trichomoniasis is the most common, sexually transmitted infection.It is caused by the flagellated protozoan parasite Trichomonas vagina/is. Symptoms include vaginitis and infections have been associatedwith preterm delivery, low birth weight and increased infant mortality, as well as predisposing to HIV/AIDSand cervical cancer. Trichomoniasis has the highest prevalence and incidence of any sexually transmitted infection. The 5-nitroimidazole drugs, of which metronidazole is the most prescribed, are the only approved,effective drugs to treat trichomoniasis. Resistance against metronidazole is frequently reported and cross-resistance among the family of 5-nitroimidazole drugs is common, leaving no alternative for treatment, withsome cases remaining unresolved. The mechanism of metronidazole resistance in T. Vagina/is from treatment failures is not well understood, unlike resistance which is developed in the laboratory under increasingmet ronidazole pressure. In the latter situation, hydrog enosomal function which is involved in activationof the prodrug, metronidazole, is down-regulated. Reversion to sensitivity is incomplete after removal ofdrug pressure in the highly resistant parasites while clinically resistant strains, so far analysed, maintaintheir resistance levels in the absence of drug pressure. Although anaerobic resistance has been regarded asa laboratory induced phenomenon, it clearly has been demonstrated in clinical isolates. Pursuit of both approaches will allow dissection of the underlying mechanisms. Many alternative drugs and treatments have been tested in vivo in cases of refractory trichomoniasis, as well as in vitro with some successes including the broad spectrum anti-parasitic drug nitazoxanide. Drug resistance incidence in T. Vagina/is appears to be on the increase and improved surveillance of treatment failures is urged.     

乳杆菌制剂对非特异性阴道炎的治疗及其机制的研究

本文对３２例非特异性阴道炎患者以乳杆菌进行治疗,比较用药前后阴道分泌物ｐＨ及阴道常见的乳杆菌、葡萄球菌、肠杆菌、酵母菌的定量变化,同时观察其临床治疗效果。结果表明：治疗后阴道分泌物ｐＨ明显降低,乳杆菌数量明显增多,葡萄球菌、肠杆菌、酵母菌数量明显减少。治疗后阴道炎的症状、体征明显好转。     

Effect of metronidazole on spermatogenesis and FSH, LH and testosterone levels of pre-pubertal rats

Metronidazole, a 5-nitroimidazole drug has been reported to decrease testicular weight, testicular and epididymal spermatid counts and causes abnormal sperm morphology with degeneration of seminiferous tubules with 6 weeks treatment of metronidazole (400 mg/kg, day). In contrast to DNA flow cytometry (FCM), the histological and gravimetric parameters do not allow a rapid, sensitive, objective and multiparameteric evaluation of reproductive toxicants on spermatogenesis. Moreover, the exact mechanisms for such an effect are not entirely clear. The present study was therefore undertaken to assess the effects of intraperitoneal (i.p.) administration of metronidazole 400 mg/kg daily for 30 days on testicular germ cell changes assessed by DNA (FCM) and hormone levels of testosterone, FSH and LH in pre-pubertal rats. A significant reduction in the haploid cell population in metronidazole treated groups as compared to saline treated controls was observed. The mean serum FSH, LH and testosterone value were also lowered in treated animals. Thus, the spermatotoxic effects of metronidazole were probably mediated by decrease in the circulating hormones responsible for spermatogenesis.     

微生态治疗老年性阴道炎的临床观察

目的探讨采用乳杆菌活菌胶囊治疗老年性阴道炎的临床效果。方法将50例绝经妇女诊断为老年性阴道炎患者随机分成两组,研究组26例每晚清洁外阴后,阴道深部放置乳杆菌活菌胶囊500mg,连续10d。对照组24例每晚阴道内置人甲硝唑500mg,连续10d。两组均在停药后第3-7天复查比较其治愈率、总有效率。两组治愈者均于停药后90d复查,比较其复发率。结果研究组治愈率为73．07％,总有效率为96．14％。对照组治愈率为62．50％,总有效率为91．66％,两组差异无显著性（P〉0．05）。研究组复发率为0,对照组复发率为20．83％,两组差异有显著性（P〈0．05）。结论乳杆菌活菌阴道胶囊恢复阴道微生态平衡,增加阴道黏膜抵抗力。与抗生素药物比较复发率低,又无毒副作用,是治疗老年性阴道炎首进药物。