目的 探討苦參凝膠聯(lián)合雙唑泰陰道凝膠治療霉菌性陰道炎的臨床療效。方法 選取2016年7月-2018年7月來(lái)鄭州大學(xué)第三附屬醫(yī)院治療的80例霉菌性陰道炎患者，將所有患者隨機(jī)分為對(duì)照組和治療組，每組各40例。對(duì)照組患者每天晚上將陰道清洗干凈之后給予雙唑泰陰道凝膠，1支/次；治療組患者在對(duì)照組治療的基礎(chǔ)上陰道給予苦參凝膠，1支/次，1次/d。兩組患者連用7 d，停藥后第1次月經(jīng)凈后再重復(fù)連用7 d。觀察兩組患者臨床療效和復(fù)發(fā)情況，比較治療前后兩組患者臨床癥狀緩解時(shí)間、臨床癥狀評(píng)分和陰道灌洗液中細(xì)胞因子水平。結(jié)果 經(jīng)過(guò)治療后，對(duì)照組、治療組的總有效率分別為77.50%、95.00%，治療組總有效率顯著較高（P<0.05）。對(duì)照組、治療組的復(fù)發(fā)率分別為20.00%、2.50%，治療組復(fù)發(fā)率顯著低于對(duì)照組（P<0.05）。治療后，治療組外陰瘙癢消失時(shí)間、白帶減少時(shí)間、黏膜充血消失時(shí)間、外陰陰道疼痛消失時(shí)間均明顯短于對(duì)照組（P<0.05）。治療后，兩組患者灼痛感評(píng)分、外陰瘙癢評(píng)分均顯著降低，同組治療前后比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）；且治療組臨床癥狀評(píng)分降低較多，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組患者白細(xì)胞介素1β（IL-1β）、腫瘤壞死因子-α（TNF-α）、單核細(xì)胞趨化蛋白-1（MCP-1）水平均顯著降低，同組治療前后比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）；并且治療組細(xì)胞因子水平降低較多，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 苦參凝膠聯(lián)合雙唑泰陰道凝膠治療霉菌性陰道炎具有較好的臨床療效，改善患者的臨床癥狀，降低陰道灌洗液中細(xì)胞因子水平，復(fù)發(fā)率低，安全性好，值得臨床推廣應(yīng)用。

Objective To investigate clinical efficacy of Kushen Gels combined with Metronidazole, Clotrimazole and Chlorhexidine Acetate Vagina Gels in treatment of mycotic vaginitis. Methods Patients (80 cases) with mycotic vaginitis in Third Affiliated Hospital of Zhengzhou University from July 2016 to July 2018 were randomly divided into control (40 cases) and treatment (40 cases) groups. Patients in the control group were given Metronidazole, Clotrimazole and Chlorhexidine Acetate Vagina Gels after cleaning the vagina every night, 1 tube/time. Patients in the treatment group were given Kushen Gels on the basis of the control group, 1 tube/time. Patients in the two groups were treated for 7 d, and repeated for 7 d after the first menstruation. After treatment, the clinical efficacy and recurrence rate was evaluated, and clinical symptom remission time, clinical symptom score, and cytokine level in vaginal lavage fluid in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control group was 77.50%, which was significantly lower than 95.00% in the treatment group, but recurrence rate in the control group was 20.00%, which was significantly higher than 2.50% in the treatment group, and there were differences between two groups (P < 0.05). After treatment, the disappearance times of pruritus, leucorrhea, mucosal congestion and vulvovaginal pain in the treatment group were significantly shorter than those in the control group, and there was difference between two groups (P < 0.05). After treatment, burning sensation score and vulvae pruritus score in two groups were significantly decreased (P < 0.05). And the scores in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P < 0.05). After treatment, the levels of IL-1β, TNF-α, and MCP-1 levels in vaginal lavage fluid in two groups were significantly decreased, and the difference was statistically significant in the same group (P < 0.05). And the serum levels of inflammatory factors in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P < 0.05). Conclusion Kushen Gels combined with Metronidazole, Clotrimazole and Chlorhexidine Acetate Vagina Gels has clinical curative effect in treatment of mycotic vaginitis, can improve the clinical symptoms of patients, reduce the level of cytokines in the vaginal lavage fluid and recurrence rate with good safety, which has a certain clinical application value.

R984

河南省醫(yī)學(xué)科技攻關(guān)計(jì)劃項(xiàng)目（201403114）