乳酸杆菌活菌制剂治疗阴道炎效果和安全性分析

目的:探讨乳酸杆菌活菌制剂治疗阴道炎的有效性及安全性。方法:选取344例阴道炎患者随机均分为观察组和对照组,观察组采用甲硝唑联合乳酸杆菌活菌制剂治疗,对照组采用甲硝唑治疗,比较两组临床疗效、不良反应发生及随访期间复发情况。结果:观察组细菌性阴道病、念珠菌性阴道炎及滴虫性阴道炎痊愈率和有效率均明显高于对照组,治疗后3、6、9个月复发率低于对照组,差异具有统计学意义(P0.05);对照组不良反应发生率为4.7%(4/86),观察组仅出现3例轻度不良反应,发生率为3.5%,且治疗前后血尿常规及肝肾功能检查指标均无显著性变化(P0.05),两组不良反应发生率差异无统计学意义(P0.05)。结论:乳酸杆菌活菌制剂治疗阴道炎患者安全有效,可在临床上推广。     

滴虫性阴道炎患者配偶对疾病认知调查结果分析及对策研究

目的:调查分析滴虫性阴道炎患者配偶对疾病认知情况,为提高临床滴虫性阴道炎的治疗效果,降低交叉传染及复发率提高参考。方法:选择2015年10月至2016年3月在我院接受治疗的120例滴虫性阴道炎女性及其丈夫作为研究对象,采用自制滴虫性阴道炎认知调查表对患者配偶进行调查,根据调查结果将患者及其丈夫分为认知合格组(48例)与认知不合格组(72例),比较两组患者配偶滴虫生殖器感染情况;两组患者及其配偶均进行滴虫性感染常规治疗,比较两组患者完成治疗疗程后的临床疗效,感染配偶治疗临床疗效,治疗结束后1个月的复发率及感染配偶复发率。结果:两组患者年龄、病程、对滴虫性阴道炎疾病的认知调查结果、合并疾病比较差异无统计学意义(P0.05),认知合格配偶组生殖器的滴虫感染率10.42%。认知不合格配偶组生殖器滴虫感染率37.50%,认知合格组配偶生殖器滴虫感染率明显低于不合格组,组间差异比较有统计学意义(P0.05)。两组患者经治疗7d后,合格组患者及滴虫感染配偶共计53例,临床总有效率90.57%,1个月后复查滴虫感染复发率9.43%;不合格组患者及感染滴虫配偶共计98例,临床总有效率79.59%,1个月后复查滴虫感染复发率28.57%。认知合格组患者及配偶治疗后临床总有效率明显高于认知不合格组,且复发率低于认识不合格组,组间比较差异均有统计学意义(P0.05)。结论:滴虫性阴道炎患者配偶对疾病的认知情况影响患者的治疗及配偶自身对滴虫感染的预防和治疗效果,加强滴虫性阴道炎患者配偶的治疗及健康宣教是改善滴虫性阴道炎治疗质量的重要途径,临床应引起足够重视。     

阶段性使用阴道用乳杆菌活菌胶囊配合普罗雌烯阴道胶囊治疗萎缩性阴道炎老年患者的疗效及安全性分析

目的分析阶段性使用阴道用乳杆菌活菌胶囊配合普罗雌烯阴道胶囊治疗萎缩性阴道炎老年患者的疗效及安全性。方法选取2017年10月至2018年12月江南大学附属无锡市第五人民医院诊治的130例萎缩性阴道炎老年患者作为研究对象。按随机数字表法将所选患者分为试验组(n=65)使用普罗雌烯阴道胶囊+甲硝唑+阴道用乳杆菌活菌胶囊治疗,对照组(n=65)使用普罗雌烯阴道胶囊+甲硝唑治疗。治疗结束后1w对受试者进行疗效判定,比较萎缩性阴道炎症状评分、阴道健康评分、阴道pH值,并于治疗结束后3个月和6个月随访,统计患者阴道炎症的复发情况,记录不良反应发生情况,并比较治疗前后试验组阴道菌群结构。结果两组患者治疗过程中均无严重不良反应,试验组治疗痊愈率(50.8%)、总有效率(93.9%)均显著高于对照组(32.3%, 76.9%),差异均具有统计学意义(均P0.05),试验组3个月和6个月复发率(1.5%,12.3%)均显著低于同期对照组(27.7%, 53.9%),差异均具有统计学意义(均P0.05);治疗后两组阴道pH值、萎缩性阴道炎症状评分均较治疗前显著降低,差异均具有统计学意义(均P0.05),而阴道健康总评分较治疗前显著提高,差异具有统计学意义(P0.05),与同期对照组比较,试验组变化更明显,差异具有统计学意义(P0.05);治疗前后试验组4种主要细菌(乳酸杆菌属、奇异菌属、加德纳菌和厌氧性球菌属)的相对丰度比较,差异具有统计学意义(P0.05)。结论阶段性使用乳酸杆菌配合普罗雌烯阴道胶囊、甲硝唑栓治疗萎缩性阴道炎老年患者,可有效缓解其临床症状和体征,提高临床疗效,降低复发率,安全性高。     

硝酸咪康唑栓联合一次性阴道抑菌吸附器(唯阴康)治疗妊娠期念珠菌性阴道炎患者的效果观察

目的探讨硝酸咪康唑栓联合一次性阴道抑菌吸附器(唯阴康)治疗妊娠期念珠菌性阴道炎的临床疗效及安全性。方法选取2014年10月至2017年9月大连市友谊医院诊治的妊娠期念珠菌性阴道炎患者84例作为研究对象,将其随机分为观察组(n=42)与对照组(n=42)。对照组给予硝酸咪康唑栓治疗,观察组给予硝酸咪康唑栓+一次性阴道抑菌吸附器(唯阴康)治疗,两组均连续治疗7 d,停药3 d后复诊。对比两组临床症状改善情况、临床疗效、治疗期间不良反应发生率,统计对比疗程结束后第4周、第6周两组念珠菌性阴道炎复发率。结果观察组阴道瘙痒、疼痛、阴道充血及阴道分泌物异常改善时间均短于对照组,差异具有统计学意义(P0.05);观察组总有效率[92.86%(39/42)比76.19%(32/42)]高于对照组,差异具有统计学意义(P0.05);治疗期间观察组阴道烧灼感、阴道干燥、局部刺激等不良反应发生率与对照组比较差异无统计学意义(P0.05);观察组治疗后第4周复发率[4.76%(2/42)比9.52%(4/42)]、治疗后第6周[9.52%(4/42)比19.05%(8/42)]复发率与对照组比较差异无统计学意义(P0.05)。结论硝酸咪康唑栓联合一次性阴道抑菌吸附器(唯阴康)治疗妊娠期念珠菌性阴道炎疗效显著,有利于缓解临床症状,但是具有一定复发率。     

黄体酮联合抗生素治疗子宫内膜炎患者的效果及其对炎症因子水平的影响

目的观察黄体酮联合头孢曲松钠和甲硝唑二联抗生素治疗子宫内膜炎的临床效果,及其对患者炎症因子水平的影响。方法选取2016年2月至2017年2月首都医科大学附属北京友谊医院诊治的188例子宫内膜炎患者为研究对象。按照随机数字表,将188例患者平均分为研究组和对照组,每组94例患者。研究组患者在对照组治疗的基础上,增加黄体酮胶囊口服治疗;对照组患者予以头孢曲松钠和甲硝唑行二联抗生素静脉滴注治疗。观察两组患者治疗期间药物不良反应发生情况,统计患者子宫内膜炎临床症状消失时间,比较两组患者子宫内膜炎疗效水平,记录患者18个月内子宫内膜炎复发情况。结果治疗后,两组患者血清MMP-9和促炎因子IL-4含量水平均比治疗前显著下降,其差异均具有统计学意义(均P0.05);而抑炎因子IL-2和IL-10水平均比治疗前显著上升,其差异均具有统计学意义(均P0.05);且研究组患者血清MMP-9、IL-4含量的下降幅度和IL-2、IL-10水平的上升幅度均比对照组更为显著,其差异均具有统计学意义(均P0.05);研究组患者下腹坠痛和阴道分泌物增多及性状改变症状消失时间[(9.59±1.96)d和(13.81±3.15)d]均显著短于对照组患者水平[(15.29±3.56)d和(21.05±4.43)d],其差异均具有统计学意义(均P0.05)。研究组患者子宫内膜炎治疗总体有效率(95.7%)显著高于对照组患者(86.2%),其差异具有统计学意义(χ~2=5.238,P0.05)。治疗后18个月内,研究组患者子宫内膜炎复发率(5.3%)与对照组患者复发率(7.5%)比较,其差异无统计学意义(χ~2=0.334,P0.05)。治疗期间,研究组患者药物不良反应发生率(12.8%)与对照组患者(10.6%)比较,其差异无统计学意义(χ~2=0.206,P0.05)。结论与单纯抗生素治疗相比,黄体酮联合抗生素可以显著缓解子宫内膜炎患者炎症反应程度,促进临床症状消退,增强子宫内膜炎治疗效果,药物不良反应没有增加,值得临床借鉴。     

复方甲硝唑栓联合结合雌激素软膏治疗老年性阴道炎疗效分析

目的:探讨复方甲硝唑栓联合结合雌激素软膏治疗老年性阴道炎的临床疗效及对患者血清激素水平的影响。方法:截选2012年2月至2014年10月80例老年性阴道炎患者,按照随机数字表法分为对照组(甲硝唑栓)与观察组(复方甲硝唑栓联合结合雌激素软膏),各40例;观察两组患者治疗前后临床症状及性激素水平变化、临床疗效及不良反应,随访3个月,统计两组治愈患者复发情况。结果:治疗后,两组患者临床症状、E_2、FSH水平均较治疗前明显改善,且观察组诸项指标均优于对照组(P0.05);观察组临床治疗总有效率为97.5%,明显高于对照组的65.0%(P0.05);两组患者不良反应率无显著差异(P0.05);随访3个月,观察组复发率明显低于对照组(P0.05)。结论:应用复方甲硝唑栓联合结合雌激素软膏治疗老年性阴道炎疗效显著且稳定。     

点阵激光联合中药浸泡治疗多发性跖疣30例临床观察

目的探讨点阵激光联合中药浸泡治疗多发性跖疣的疗效。方法选择2015年1月-2016年6月在皮肤科门诊治疗的多发性跖疣患者60例,随机分为对照组和观察组,每组30例,观察组采用点阵激光联合自拟中药方浸泡治疗,对照组采用火针联合自拟中药方浸泡治疗,每2周为1个疗程,两组患者均治疗4个疗程,比较两组患者在第1、第2、第3、第4个疗程后行走、压迫时的疼痛情况,治疗有效率及不良反应,并随访3个月,比较两组患者的复发率。结果治疗前两组患者的疼痛评分差异无统计学意义(P0.05),治疗后观察组患者随着疗程的增多疼痛评分均明显降低,差异有统计学意义(P0.05),且在第1、第2、第3、第4疗程后观察组患者的疼痛评分均明显低于对照组,差异有统计学意义(P0.05);第1、第2疗程后两组患者治疗有效率比较差异无统计学意义(P0.05),自第3疗程后,观察组患者的有效率为83.33%明显高于对照组的43.33%,差异有统计学意义(P0.05),第4疗程后,观察组患者的有效率为93.33%明显高于对照组的73.33%,差异有统计学意义(P0.05);随访3个月,对照组共复发5例(22.73%),观察组无复发病例,两组比较具有统计学意义(P0.05)。结论点阵激光联合中药浸泡治疗多发性跖疣能够迅速改善症状,减轻疼痛,不良反应少,效果显著,复发率低。     

米非司酮联合宫瘤消胶囊对子宫肌瘤患者细胞因子和性激素水平影响研究

目的:研究米非司酮联合宫瘤消胶囊对子宫肌瘤患者细胞因子和性激素水平影响。方法:选取2013年10月至2014年10月收入我院妇科并存在手术指征的子宫肌瘤患者100例,随机数表分为治疗组和对照组,每组各50例。治疗组使用米非司酮联合宫瘤消胶囊治疗;对照组仅使用米非司酮口服治疗。并对两组疗效、子宫体积、最大肌瘤体积及细胞因子和性激素水平进行比较。结果:治疗组总有效率为94.0%,显著高于对照组的76.0%,组间比较差异有统计学意义(χ~2=6.256,P0.05)。治疗前,两组子宫体积及最大肌瘤体积差异无统计学意义(P0.05),治疗后,两组子宫体积及最大肌瘤体积较显著减小,组内比较差异具有统计学意义(P0.05),且治疗组子宫体积及最大肌瘤体积显著小于对照组,差异有统计学意义(P0.05)。治疗前,两组血清IL-22,TNF2α水平差异无统计学意义(P0.05),治疗后,与对照组相比治疗组血清IL-22水平显著升高,TNF2α水平显著降低,差异具有统计学意义(P0.05)。治疗前两组FSH、LH、E_2、P水平比较差异均无统计学意义(P0.05),治疗后两组E_2、P水平均显著降低,组内比较差异具有统计学意义(P0.05),治疗后治疗组E_2、P水平显著低于对照组,组间比较差异具有统计学意义(P0.05)。治疗期间,治疗组4例患者出现潮热,3例患者出现恶心呕吐,无其他不良反应;对照组6例患者出现潮热,5例患者出现恶心呕吐,无其他不良反应,两组不良反应较轻,未影响治疗,治疗结束后恢复,治疗前后两组均检查血常规及肝肾功能,无异常,两组不良反应发生率无无统计学差异(χ~2=1.118,P0.05)。结论:米非司酮联合宫瘤消胶囊治疗子宫肌瘤效果较好,并可调节患者内分泌功能,不良反应发生率低,值得临床推广应用。     

雷公藤多苷联合复方甘草酸苷治疗湿疹的临床研究

目的探讨雷公藤多苷联合复方甘草酸苷治疗湿疹的有效性与安全性。方法 118例湿疹患者随机分为2组。对照组口服复方甘草酸苷片2片,3次/d;试验组在对照组治疗的基础上增加雷公藤多苷片20 mg口服,3次/d。疗程均为3周,疗程结束后,观察2组患者的临床疗效,白细胞介素(IL)-2、IL-6、C-反应蛋白(CRP)水平,及不良反应发生情况。结果试验组患者治疗后总有效率显著高于对照组,差异有统计学意义(P0.05)。2组患者IL-2、IL-6、CRP水平较治疗前均显著下降,差异有统计学意义(P0.05);其中试验组各指标下降更明显(P0.05)。2组均无明显不良反应。结论雷公藤多苷联合复方甘草酸苷治疗湿疹的疗效显著优于单用复方甘草酸苷,且安全性较好。     

5%咪喹莫特乳膏联合CO_2激光治疗在女性尖锐湿疣中的应用

目的:探讨5%咪喹莫特乳膏联合CO_2激光治疗在女性尖锐湿疣中的临床应用价值。方法:选择2014年4月至2016年6月济宁市皮肤病防治院收治的尖锐湿疣患者80例,按照随机数字法分为两组,每组40例,对照组使用二氧化碳激光治疗,观察组则在对照组基础上局部涂抹5%咪哇莫特乳膏,连续治疗30天为1疗程,连续治疗3个疗程为1治疗周期,比较两组治疗后相关炎症性细胞因子水平,两组治疗后整体复发情况、整体疗效及出现的不良反应。结果:治疗后观察组IL-6、TNF-α、IL-1及hs-CRP水平显著低于治疗后对照组(P0.05),观察组治疗后3个月内、3个月以上和1年内整体复发率均显著低于对照组,其差异具有统计学意义(P0.05),观察组整体有效率显著高于对照组,其差异具有统计学意义(P0.05);比较两组发生红斑、瘙痒、灼热及糜烂的整体比例,差异无统计学意义(P0.05)。结论:针对女性尖锐湿疣患者使用5%咪喹莫特乳膏联合CO_2激光治疗,能显著降低机体炎症反应,减少复发率、提高临床治疗效果,且安全性高。     

Dermatology in private practice in France in 2000

OBJECTIVES: Data regarding French dermatological practice are scarce. Our objective was to identify the skin disorders most commonly diagnosed by office-based dermatologists. We also documented the severity of these skin disorders, as reflected by the repercussions on patient's everyday life, and the way physicians managed patients. DESIGN: We carried out a one-day survey of visits to a randomly selected sample of 900 French office-based dermatologists. The randomization was stratified according to the five French different dialing area codes. RESULTS: Office-based dermatologists saw 6411 patients with 7839 skin disorders during the survey. The daily number of visits to French dermatologists was estimated at 47 000 and the annual number between 12 and 14 millions. Office-based dermatologists mostly managed warts, acne, nevus, dermatitis, malignancies and pre-malignancies, fungal infection and psoriasis. Repercussions on patients'everyday life were assessed by physicians as important or very important in 28 p. 100 of cases. Half of the patients received topical treatment, 20.5 p. 100 a systemic drug and 40 p. 100 a minor surgical procedure (including cryotherapy). CONCLUSION: Although dermatologists frequently see benign skin disorders such as warts or nevus, more severe diseases represent an important part of their activity.     

Decrease in neutrophils observed in vivo in psoriatics after PUVA therapy

Summary In 56 patients leucocyte and differential counts were done before and at weekly intervals during PUVA treatment of chronic recalcitrant psoriasis. A statistical significant (P<0.01) decrease in the percentage of neutrophils was observed during the first week of the PUVA therapy. This observation could be closely related to the clinical clearing of psoriasis (P=0.02).The effect of PUVA therapy in psoriasis may be due to a decrease in the number of immunocompetent neutrophils demonstrated in psoriatic lesions.     

37例麻风患者的家庭集聚性调查分析

目的:明确麻风家庭感染者的发病情况。方法:利用全国麻风病防治信息管理系统(LEPMIS)数据库,描述性分析麻风家庭感染者的发病情况。结果:符合条件的共17户家庭37例麻风患者,其中多菌型患者33例,少菌型4例;密切接触5年内发病4例(10.81%),5~10年发病者11例(29.73%),超过10年发病者13例(35.14%),不明时间者9例(24.32%);其中因父母子女关系感染17例(45.95%)、祖孙关系5例(13.51%)、兄弟关系2例(5.41%)。结论:多菌型麻风是家庭传染者的主要传染源。     

Progress in Malassezia Research in Korea

Yeasts of the genus Malassezia are part of the normal flora of human skin. However, they are also associated with various skin diseases. Since the introduction of Malassezia to the Korean Dermatologic Society two decades ago, remarkable progress has been made in our knowledge of this genus. In this paper, we review recent developments in Malassezia research, including taxonomy and methods for species identification, recent genome analyses, Malassezia species distribution in healthy conditions and in specific skin diseases, trials investigating the mechanisms underlying Malassezia-related diseases, as well as therapeutic options. This review will enhance our understanding of Malassezia yeasts and related skin diseases in Korea.     

Hard cornification in reptilian epidermis in comparison to cornification in mammalian epidermis

The structure of reptilian hard (beta)-keratins, their nucleotide and amino acid sequence, and the organization of their genes are presented. These 13-19 kDa proteins are basic, rich in glycine, proline and serine, and different from cytokeratins. Their mRNAs are expressed in beta-cells. The central part of beta-keratins (this region has been previously termed 'core-box' and is peculiar of all sauropsid proteins) is composed of two beta-folded regions and shows a high identity with avian beta-keratins. This central part present in all beta-keratins, including feather keratins, is the site of polymerization to build the framework of beta-keratin filaments. Beta-keratins appear cytokeratin-associated proteins. Their central region might have originated in an ancestral glycine-rich protein present in stem reptiles from which beta-keratins evolved and diversified into reptiles and birds. Stem reptiles of the Carboniferous period might have possessed glycine-rich proteins derived from exons/domains corresponding to the variable, glycine-rich region of cytokeratins. Beta-keratins might have derived from a gene coding for small glycine-rich keratin-associated proteins. The glycine-rich regions evolved differently in the lineage leading to modern reptiles and birds versus that leading to mammals. In the reptilian lineage some amino acid regions produced by point mutations and amino acid changes might have given rise to originate the central beta-pleated region. The latter allowed the formation of filamentous proteins (beta-keratins) associated with intermediate filament keratins and replaced them in beta-keratin cells. In the mammalian lineage no beta-pleated region was generated in their matrix proteins, the glycine-rich keratin-associated proteins. The latter evolved as glycine-tyrosine-rich, sulphur-rich, and ultra-sulphur-rich proteins that are used for building hairs, horns and nails.     

Experimental approaches to lymphocyte migration in dermatology in vitro and in vivo

Lymphocyte trafficking through the dermal compartment is part of the physiological surveillance process of the adaptive immune system. On the other hand, persistent or recurrent lymphocyte infiltrates are hallmarks of both types of chronic inflammatory skin diseases, Th1-type such as psoriasis or Th2/allergic-type like atopic dermatitis. A better understanding of the mechanisms underlying lymphocyte movements is one of the key prerequisites for developing more effective therapies. In this review, we introduce a range of simple-to-sophisticated experimental in vitro and in vivo approaches to analyze lymphocyte migration. These methods start from static in vitro adhesion and chemotaxis assays, include dynamic endothelial flow chamber, intravital dual photon, and transcutaneous live-video microscopy, and finally encompass specific genetically deficient or engineered animal models. Discussing pros and cons of these assay systems hopefully generates both state-of-the-art knowledge about the factors involved in most common chronic skin diseases as well as an improved understanding of the limitations and chances of new biologic pharmaceuticals that are currently introduced into clinical practice.     

Formaldehyde‐releasers in cosmetics in the USA and in Europe

Background: Frequencies of sensitization to formaldehyde among US patients patch tested for suspected contact dermatitis are higher than in Europe. Cosmetics are an important source of contact with formaldehyde. Objectives: To acquire data on the frequency of use of formaldehyde‐releasers in cosmetics sold in the USA and Europe and their use concentrations. To assess whether any observed differences may contribute to the discrepancies in sensitization rates. Methods: Enquiries with Food and Drug Administration (FDA), the European Cosmetics Association, and the Dutch Cosmetics Association. Reading the labels of skin care cosmetics in a local drugstore. Results: The FDA provided data on the presence of formaldehyde and releasers. Nearly one fifth of all cosmetics contain a releaser. In 25% of 496 examined skin care products, releasers were present. In comparable FDA data categories, the percentage was 24. No data were found on use concentrations of the releasers in cosmetics in either the USA or Europe. Conclusions: The percentages of stay‐on skin care products containing a formaldehyde‐releaser are virtually identical in the USA (FDA data) and our local drugstore sample. However, this does not necessarily imply that cosmetics play no part in the differences in formaldehyde sensitization rates.