目的 探讨苦参凝胶联合双唑泰阴道凝胶治疗霉菌性阴道炎的临床疗效。方法 选取2016年7月-2018年7月来郑州大学第三附属医院治疗的80例霉菌性阴道炎患者，将所有患者随机分为对照组和治疗组，每组各40例。对照组患者每天晚上将阴道清洗干净之后给予双唑泰阴道凝胶，1支/次；治疗组患者在对照组治疗的基础上阴道给予苦参凝胶，1支/次，1次/d。两组患者连用7 d，停药后第1次月经净后再重复连用7 d。观察两组患者临床疗效和复发情况，比较治疗前后两组患者临床症状缓解时间、临床症状评分和阴道灌洗液中细胞因子水平。结果 经过治疗后，对照组、治疗组的总有效率分别为77.50%、95.00%，治疗组总有效率显著较高（P<0.05）。对照组、治疗组的复发率分别为20.00%、2.50%，治疗组复发率显著低于对照组（P<0.05）。治疗后，治疗组外阴瘙痒消失时间、白带减少时间、黏膜充血消失时间、外阴阴道疼痛消失时间均明显短于对照组（P<0.05）。治疗后，两组患者灼痛感评分、外阴瘙痒评分均显著降低，同组治疗前后比较差异具有统计学意义（P<0.05）；且治疗组临床症状评分降低较多，两组比较差异有统计学意义（P<0.05）。治疗后，两组患者白细胞介素1β（IL-1β）、肿瘤坏死因子-α（TNF-α）、单核细胞趋化蛋白-1（MCP-1）水平均显著降低，同组治疗前后比较差异具有统计学意义（P<0.05）；并且治疗组细胞因子水平降低较多，两组比较差异有统计学意义（P<0.05）。结论 苦参凝胶联合双唑泰阴道凝胶治疗霉菌性阴道炎具有较好的临床疗效，改善患者的临床症状，降低阴道灌洗液中细胞因子水平，复发率低，安全性好，值得临床推广应用。

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

河南省医学科技攻关计划项目（201403114）