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凝结芽孢杆菌活菌片联合甲硝唑栓治疗细菌性阴道病,有效降低复发率

来源:健民 2018-12-28 14:29

细菌性阴道病(Bacterial vaginosis, BV)是育龄期女性常见的下生殖道感染性疾病,发病机制复杂,常见原生乳酸菌被厌氧菌[1-2]或支原体[3]或好氧菌(如致病性大肠杆菌和肠球菌[4])取代。阴道微环境pH值升高,或通过外来微生物定殖[5]或通过它们产生胺生成唾液酸酶,从而产生白色分泌物和鱼腥味[6]。阴道感染会有瘙痒、灼烧和阴道分泌物[7]等症状。如果不及时治疗,会导致盆腔炎[8]、不孕、早产、出生体重过轻等并发症。国内外也有研究表明 BV与 HR-HPV 的感染存在显著的相关性。其他的研究还表明,BV的发病率会增加性传播感染的风险[9]

阴道炎被认为是警告症状,为防止此类并发症的发生,应及时治疗。BV的治疗包括口服或阴道补充抗生素,如甲硝唑或克林霉素。然而,治愈率较低,复发率高[10]。就目前的研究报道可以看出,阴道微生态体系日益受到关注,有大量的国内外研究表明阴道微生态体系的失衡与BV的持续感染是密切相关的,因此恢复微生态体系的平衡至关重要[11-13]

益生菌能产生醋酸、细菌素、过氧化氢等抗菌化合物,从而阻碍病原菌[14]的生长,因此被认为是BV防治的一种替代选择。凝结芽孢杆菌活菌片联合甲硝唑栓治疗细菌性阴道病疗效显著,能降低复发率[15]

有研究表明阴道用乳酸菌制剂可有效调节阴道菌群平衡,但使用不方便,同时目前阴道用乳酸菌疗效差,导致患者依从性不好。Vitali、Reid等[16-17]报道通过口服益生菌可有效增加阴道中乳酸菌的数量,调节阴道菌群平衡,有效防治阴道疾病。Antonio等[18]研究证实肠道中的乳酸菌可持续向阴道补充,促进阴道健康。凝结芽孢杆菌又称有孢子性乳酸菌,属于肠道乳酸菌,具有双歧杆菌、乳酸杆菌所有的特性和功能,同时又具有它们没有的特性,凝结芽孢杆菌能分泌抗菌凝固素抑制多种有害菌,还能分解多糖为低聚糖,促进肠道有益菌增殖,快速恢复肠道菌群平衡[19]。在一项用凝结芽孢杆菌治疗细菌性阴道病的临床研究中,凝结芽孢杆菌治疗组80%患者阴道病症状减轻,与对照组相比,有显著的阳性反应,而对照组只有45%的患者症状减轻[20]。而在另一项研究中,使用凝结芽孢杆菌与甲硝唑栓治疗后半年内,对有效者进行随访,观察组的复发率为14.3%,对照组的复发率为32.5%[15]

 

 

[1] Hillier SL. The complexity of microbial diversity in bacterial vaginosis. New Eng J Med. 2005;353:1886–1887. doi: 10.1056/NEJMp058191

[2] Fredricks DN, Fiedler TL, Marrazzo JM. Molecular identification of bacteria associated with bacterial vaginosis. New Eng J Med. 2005;353:899–1911. doi: 10.1056/NEJMoa043802.

[3] French JI, McGregor JA, Parker R. Readily treatable reproductive tract infections and preterm birth among black women. Am J Obstet Gynecol. 2006;194(6):1717–1726. doi: 10.1016/j.ajog.2006.03.004.

[4] Donder GG, Vereecken A, Bosmans E, Dekeersmaecker A, Salembier G, Spitz B. Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis: aerobic vaginitis. Int J Obstet Gynaecol. 2002;109:34–43. doi: 10.1111/j.1471-0528.2002.00432.x

[5] Cauci S, Guaschino S, Driussi S, Santo D, Lanzafame P, Quadrifoglio F. Correlation of local interleukin-8 with immunoglobulin A against Gardnerellavaginalis hemolysin and with prolidase and sialidase levels in women with bacterial vaginosis. J Infect Dis. 2002;185:1614–1620. doi: 10.1086/340417.

[6] Hapsari ED, Hayashi M, Matsuo H. Clinical characteristics of vaginal discharge in bacterial vaginosis diagnosed by Nugent’s criteria. Clin Exp Obstet Gynecol. 2006;33:5–9.

[7] Anukam KC, Osazuwa E, Osemene GI, Ehigiagbe F, Bruce AW, Reid G. Clinical study comparing probiotic lactobacillus GR-1 and RC-14 with metronidazole vaginal gel to treat symptomatic bacterial vaginosis. Microbes Infect. 2006;8:2772–2776. doi: 10.1016/j.micinf.2006.08.008.

[8] Ness RB, Kip KE, Soper DE, Stamm CA, Rice P, Richter HE. Variability of bacterial vaginosis over 6- to 12-month intervals. Sex Trans Dis. 2006;33(6):381–385. doi: 10.1097/01.olq.0000204748.89222.33.

[9] Myer L, Denny L, Telerant R, Souza M, Wright TC, Kuhn L. Bacterial vaginosis and susceptibility to HIV infection in South African women: a nested case-control study. J Infect Dis. 2005;192:372–1380. doi: 10.1086/462427.

[10] Bradshaw CS, Morton AN, Hocking J, Garland SM, Morris MB, Moss LM, Horvath LB, Kuzevska I, Fairley CK. High recurrence rates of bacterial vaginosis over the course of 12 months after oral metronidazole therapy and factors associated with recurrence. J Infect Dis. 2006;193:1478–1486. doi: 10.1086/503780.

[11] Collins S, Beigi R, Mellen C, et al. The effect of pessaries on the vaginal microenvironment[J]. American Journal of Obstetrics & Gynecology, 2015, 212(1):60.e1-60.e6.

[12] Doncel G F, Anderson S, Zalenskaya I. Role of semen in modulating the female genital tract microenvironment--implications for HIV transmission.[J]. American Journal of Reproductive Immunology, 2014, 71(6):564-574.

[13] Guo H Y, Hu X M, Han D D, et al. Lipid peroxidation and antioxidant status in vagina microenvironment of patients with several common vaginitis.[J]. Clinical & Experimental Obstetrics & Gynecology, 2013, 40(3):331-6.

[14] Ya W , Reifer C , Miller L E . Efficacy of vaginal probiotic capsules for recurrent bacterial vaginosis: a double-blind, randomized, placebo-controlled study[J]. American Journal of Obstetrics & Gynecology, 2010, 203(2):1200-120000000.

[15] 翟新茹, 刘欣舒, 陈炜, et al. 凝结芽孢杆菌活菌片联合甲硝唑栓治疗细菌性阴道病的临床观察[J]. 中国微生态学杂志, 2016, 28(7).

[16] Vitali B , Cruciani F , Baldassarre M E , et al. Dietary supplementation with probiotics during late pregnancy: outcome on vaginal microbiota and cytokine secretion[J]. BMC Microbiology,12,1(2012-10-18), 2012, 12(1):236.

[17] Reid G, Charbonneau D, Erb J, et al. Oral use of Lactobacillus rhamnosus GR-1 and L. fermentum RC-14 significantly alters vaginal flora: randomized, placebo-controlled trial in 64 healthy women[J]. Fems Immunology & Medical Microbiology, 2003, 35(2):131-134.

[18] Antonio M A D, Rabe L K, Hillier S L. Colonization of the Rectum by Lactobacillus Species and Decreased Risk of Bacterial Vaginosis[J]. Journal of Infectious Diseases, 2005, 192(3):394-398.

[19] 崔云龙, 闫述翠, 万阜昌. 凝结芽胞杆菌TBC 169株对肠道致病菌的抑菌作用[J]. 中国微生态学杂志, 2005, 17(5):333-334.

[20] Ratna Sudha M , Yelikar K A , Deshpande S . Clinical Study of Bacillus coagulans Unique IS-2 (ATCC PTA-11748) in the Treatment of Patients with Bacterial Vaginosis[J]. Indian Journal of Microbiology, 2012, 52(3):396-399.

 

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