| Background:Bacterial vaginosis(Bacterial Vaginosis,BV)is a common lower genital tract infection in women of childbearing age.It is mainly infected by Gardnebacterium,Vibrio campylobacter,Bacteroides and other genital tract mycoplasma.The number of Lactobacillus vaginalis decreased significantly and even disappeared directly.Bacterial vaginosis was more common in females aged 15 to 44 years.Most of the patients were caused by various pathogenic anaerobes.The incidence of bacterial vaginosis was significantly higher than that of trichomoniasis and mycosis.Female vaginal microecology imbalance,vaginal local immune environment difficult to recover and bacterial Vaginosis patient’s condition repeats,easy to relapse has the high correlation.At present,the main clinical treatment of bacterial vaginosis is vaginal local administration and oral administration,among which nitroimidazole,clindamycin,ampicillin are the most commonly used drugs.However,there are great differences in the efficacy of different drug delivery methods or drug regimens.It is of great significance to study the safe and efficient treatment methods to improve the therapeutic effect of bacterial vaginosis.At the same time,it is the research focus of clinical gynecology for bacterial vaginosis drug therapy in recent years.Objective:The differences of vaginal microecological environment and immune internal environment of patients with bacterial vaginosis before and after treatment were analyzed by taking different drug treatment schemes and combining with the observation results of female population in the control group.To study the effective drug therapy for bacterial vaginosis.Method:From January 2016 to December 2017,200 patients with bacterial vaginosis were selected as treatment group,and 50 healthy women were selected as control group.Two hundred patients with bacterial vaginosis in the treatment group were randomly divided into two groups: group A(n = 50)and group D(n = 50).Group A was treated with intravaginal nifurotrel vaginal tablets,250 mg each time,placed at the posterior fornix of the vagina,1 tablet per night for 7 days,and group B treated with tinidazole vaginal effervescent tablets,200 mg each time,placed at the posterior fornix of the vagina,1 tablet per night.For 7 days,group C was treated with nifutrel vaginal tablets combined with Lactobacillus capsule.The two drugs were put into the posterior vagina fornix in sequence,and 1 tablet was given for7 days each night for 14 days.Group D tinidazole vaginal effervescent tablets combined with Lactobacillus capsule,two drugs in sequence,respectively,placed in the vaginal posterior fornix,every One tablet in the evening was given for 7 days,for a total of 14 days.The changes of vaginal microecology and immune environment before and after treatment were compared among the four groups,and the results were compared with those in the control group,and the effectiveness of different drug treatment schemes was analyzed.Result:The main differences in clinical manifestations and vaginal microecology between patients with bacterial vaginosis and healthy women were as follows: BV patients had vaginal itching,thin leucorrhea,fishy smell,vaginal PH > 4.5,cleanliness degree Ⅰ or Ⅱ,positive amines test.All the clue cells were positive,the vaginal secretion Gram staining showed that Gardnerella vaginalis was dominant,the density increased to grade Ⅳ,Lactobacillus occasionally appeared or lacking.The vaginal PH values of healthy women were lower than 4.5.Lactobacillus was the dominant bacteria in secretion smears,and the microflora density was grade Ⅱ ~ Ⅲ.There was significant difference in the curative effect between BV group and control group before and after treatment(P < 0.05).The effective rate of group C was better than that of group A(P < 0.05).There was no significant difference between group C and group D(P < 0.05).In other words,the clinical symptom improvement of Nifurotael vaginal tablet combined with Lactobacillus capsule or tinidazole vaginal effervescent tablets combined with Lactobacillus capsule was better than that of Nifurotalr vaginal tablet or tinidazole vaginal effervescent tablets alone.There was no significant difference between group A and group B alone and between group C and group D(P > 0.05).The recovery rate of vaginal microecology in BV group was 41 cases(85.4%),B group(40 cases)(85.1%),C group,47 cases(95.7%)and 43 cases(89.5%),respectively).The recovery rate of BV D group was higher than that of AC group(P< 0.05),A and B group).There was no significant difference between group C and group D(P > 0.05 P).The combination of Nifurotael vaginal tablets with Lactobacillus capsule or tinidazole vaginal effervescent tablets combined with Lactobacillus capsule in the treatment of vaginal flora diversity,microflora density,the recovery rate of enzyme activity was higher than that of single nifutrel vaginal tablet or tinidazole vaginal effervescent tablets,and there was no significant difference between the two groups(P > 0.05).Compared with the control group,there was no significant difference in the concentration of IL-8(P=0.25)in the BV group before treatment,but the levels of TNF-α(P < 0.001),TLR2(P < 0.001)and TLR4(P < 0.001)were higher than those in the control group.There was no significant difference between the two groups.There was no significant difference in the levels of IL-8,TNF-α and TLR-2,TLR4 between the two groups(P > 0.05),but the levels of TNF-α and TLR2,TLR4 in the four groups were significantly lower than those before treatment.The improvement effect of TNF-α and TLR2,TLR4 in group D was significantly better than that in group B(P < 0.05).The level of TNF-α and TLR2,TLR4 in group D was significantly better than that in group D(P < 0.05).No serious adverse reactions or complications occurred in the four groups during and after treatment.Conclusion:A sequential regimen was used to treat bacterial vaginosis with Nifuroterol vaginal tablet combined with Lactobacillus capsule or tinidazole combined with Lactobacillus capsule in the treatment of bacterial vaginosis in the recovery of vaginal microecology and vaginal immune environment.The clinical efficacy was better than that of single drug administration. |
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