盆腔炎性疾病的发病机制及联合治疗研究进展

doi:10.12280/gjfckx.20250088

摘要/Abstract

摘要：

盆腔炎性疾病（pelvic inflammatory disease，PID）是由沙眼衣原体、淋病奈瑟球菌及厌氧菌等多病原体协同作用引发的上生殖道感染性疾病，其病理特征为慢性炎症反应及输卵管纤维化，可导致不孕、异位妊娠等严重并发症。在发病机制方面，性传播病原体通过免疫逃逸介导初始感染，厌氧菌通过生物膜形成及毒素分泌加剧继发感染，而宿主过度的炎症反应及转化生长因子-β1（transforming growth factor-β1，TGF-β1）/Smad信号通路激活是组织纤维化的关键驱动因素。在治疗策略方面，抗生素联合方案较单药治疗可显著提高治愈率，中成药联合抗生素可降低复发率并减少炎性因子水平；物理治疗及多学科诊疗模式可改善慢性盆腔痛患者的疼痛评分及生活质量。诸多研究证实联合治疗通过覆盖多重病原、抑制炎症级联反应及促进组织修复实现协同增效，但需进一步优化急性期病原学诊断技术及厌氧菌检测体系。未来应结合全基因组测序和基因检测技术，构建个体化分层治疗策略，重点探索抗生素-中药-物理治疗的三联方案对慢性PID的长期疗效，以期为临床提供更精准的诊疗路径。

关键词: 盆腔炎性疾病, 药物疗法, 联合, 中西药合用, 细菌, 厌氧, 发病机制

Abstract:

Pelvic inflammatory disease (PID) is an infectious disease of the upper reproductive tract caused by the synergistic action of multiple pathogens such as Chlamydia trachomatis, Neisseria gonorrhoeae, and anaerobic bacteria. Its pathological features include chronic inflammatory response and fallopian tube fibrosis, which can lead to serious complications such as infertility and ectopic pregnancy. In terms of pathogenesis, sexually transmitted pathogens mediate the initial infection through immune escape, and anaerobic bacteria exacerbate secondary infection through biofilm formation and toxins secretion. The excessive inflammatory response of the host and the activation of the transforming growth factor-β1 (TGF-β1)/Smad signaling pathway are the key driving factors for tissue fibrosis. In terms of therapeutic strategies, the combination of antibiotics can significantly improve the cure rate compared with single-drug therapy. The combination of Chinese patent medicines and antibiotics can reduce the recurrence rate and the levels of inflammatory factors. Physical therapy and the multi-disciplinary treatment model can improve the pain score and quality of life of patients with chronic pelvic pain. Many studies have confirmed that combination therapy achieves synergistic effects by covering multiple pathogens, inhibiting the inflammatory cascade reaction, and promoting tissue repair. However, the etiological diagnostic techniques in the acute phase and the anaerobic bacteria detection system need to be further optimized. In the future, whole-genome sequencing and genetic testing technologies should be combined to construct individualized stratified treatment strategies. The long-term efficacy of the triple combination of antibiotics, traditional Chinese medicine, and physical therapy for chronic PID should be explored, with the aim of providing more precise diagnosis and treatment paths for clinical practice.

Key words: Pelvic inflammatory disease, Drug therapy, combination, Combined application of Chinese medicine and western medicine, Bacteria, anaerobic, Pathogenesis

曾璐璐, 曾俏俏, 张畹晴, 潘颖珊, 原子欣, 刘慧玲, 欧阳美金. 盆腔炎性疾病的发病机制及联合治疗研究进展[J]. 国际妇产科学杂志, 2025, 52(3): 252-256.

ZENG Lu-lu, ZENG Qiao-qiao, ZHANG Wan-qing, PAN Ying-shan, YUAN Zi-xin, LIU Hui-ling, OUYANG Mei-jin. Research Progress on the Pathogenesis and Combination Treatment of Pelvic Inflammatory Disease[J]. Journal of International Obstetrics and Gynecology, 2025, 52(3): 252-256.

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