包括乳酸在内的细菌性阴道病替代治疗策略: 抗生素耐药性问题的潜在解决方案
- 作者: Minakova A.D.1, Dzhibladze T.A.1, Zuev V.M.1, Khokhlova I.D.1
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隶属关系:
- I.M. Sechenov First Moscow State Medical University
- 期: 卷 12, 编号 1 (2025)
- 页面: 84-91
- 栏目: Original study articles
- URL: https://journal-vniispk.ru/2313-8726/article/view/310011
- DOI: https://doi.org/10.17816/aog633449
- ID: 310011
如何引用文章
详细
背景。细菌性阴道病(BV, Bacterial Vaginosis)是一种常见的非炎症性阴道感染,可增加性传播感染的风险,对围产期结局产生不良影响,并降低整体生活质量。由于抗菌治疗在长期管理中的效果有限,并且抗生素治疗相关的复发率和不良反应较高,因此迫切需要寻找BV的替代治疗方法。
目的。 评估采用克林霉素或地喹氯铵联合乳酸的两阶段综合治疗方案在育龄期女性中的疗效和耐受性。
材料与方法。本研究为一项开放性随机临床试验,共纳入93名18-45岁、符合Amsel标准确诊的BV女性患者。患者被随机分为三组:第一组(n=31)接受乳酸治疗;第二组(n=31)接受克林霉素联合乳酸治疗;第三组(n=31)接受地喹氯铵联合乳酸治疗。在治疗结束后14天,依据Amsel标准评估治疗效果。在治疗后三个月评估患者症状并测量阴道分泌物pH值。
结果。研究显示,在治疗结束两周后,细菌性阴道病症状仍持续存在于第一组3例(9.7%)患者,第二组1例(3.2%)患者。阴道分泌物pH值在所有研究组中均呈现积极变化,且该变化在治疗结束两周及三个月后仍保持稳定。三个月后,第一组1例患者、第二组1例患者、第三组2例患者仍报告阴道分泌物异常。乳酸单一治疗的有效率在治疗后14天为90.3%,三个月后为96.4%。克林霉素联合乳酸的两阶段治疗有效率分别为96.8%(14天)和96.7%(三个月)。地喹氯铵联合乳酸治疗的有效率在14天时为100.0%,三个月后为93.3%。此外,在第二组随访中发现1例治疗后三个月出现外阴阴道念珠菌病的病例。
结论。本研究证实了两阶段治疗方案在短期及长期均具有较高的疗效。尽管乳酸单一治疗的初始效果较低,但其远期疗效与其他方案相当,突出了乳酸在细菌性阴道病综合治疗中的重要性。
作者简介
Alena D. Minakova
I.M. Sechenov First Moscow State Medical University
编辑信件的主要联系方式.
Email: alenami1205@yandex.ru
ORCID iD: 0000-0002-5157-1888
SPIN 代码: 6649-7776
Postgraduate Student
俄罗斯联邦, 8 Trubetskaya st, bldg 2, Moscow, 119048Tea A. Dzhibladze
I.M. Sechenov First Moscow State Medical University
Email: djiba@bk.ru
ORCID iD: 0000-0003-1540-5628
SPIN 代码: 5688-1084
MD, Dr. Sci. (Medicine), Professor
俄罗斯联邦, 8 Trubetskaya st, bldg 2, Moscow, 119048Vladimir M. Zuev
I.M. Sechenov First Moscow State Medical University
Email: vlzuev@bk.ru
ORCID iD: 0000-0001-8715-2020
SPIN 代码: 2857-0309
MD, Dr. Sci. (Medicine), Professor
俄罗斯联邦, 8 Trubetskaya st, bldg 2, Moscow, 119048Irina D. Khokhlova
I.M. Sechenov First Moscow State Medical University
Email: irhohlova5@gmail.com
ORCID iD: 0000-0001-8547-6750
SPIN 代码: 6858-5235
MD, Cand. Sci. (Medicine), Assistant Professor
俄罗斯联邦, 8 Trubetskaya st, bldg 2, Moscow, 119048参考
- Peebles K, Velloza J, Balkus JE, et al. High global burden and costs of bacterial vaginosis: a systematic review and meta-analysis. Sex Transm Dis. 2019;46(5):304–311. doi: 10.1097/OLQ.0000000000000972
- Abou Chacra L, Ly C, Hammoud A, et al. Relationship between bacterial vaginosis and sexually transmitted infections: coincidence, consequence or co-transmission? Microorganisms. 2023;11(10):2470. doi: 10.3390/microorganisms11102470
- Mohanty T, Doke PP, Khuroo SR. Effect of bacterial vaginosis on preterm birth: a meta-analysis. Arch Gynecol Obstet. 2023;308(4):1247–1255. doi: 10.1007/s00404-022-06817-5
- Kenfack-Zanguim J, Kenmoe S, Bowo-Ngandji A, et al. Systematic review and meta-analysis of maternal and fetal outcomes among pregnant women with bacterial vaginosis. Eur J Obstet Gynecol Reprod Biol. 2023; 289:9–18. doi: 10.1016/j.ejogrb.2023.08.013
- Vieira-Baptista P, Stockdale CK, Sobel J. International society for the study of vulvovaginal disease recommendations for the diagnosis and treatment of vaginitis. Lisbon: Admedic; 2023. Р. 73–75. doi: 10.59153/adm.rdtv.001
- Bradshaw CS, Morton AN, Hocking J, et al. 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(11):1478–1486. doi: 10.1086/503780
- O’Hanlon DE, Moench TR, Cone RA. Vaginal pH and microbicidal lactic acid when lactobacilli dominate the microbiota. PLoS One. 2013;8(11):e80074. doi: 10.1371/journal.pone.0080074
- O’Hanlon DE, Moench TR, Cone RA. In vaginal fluid, bacteria associated with bacterial vaginosis can be suppressed with lactic acid but not hydrogen peroxide. BMC Infect Dis. 2011; 11:200. doi: 10.1186/1471-2334-11-200
- Kira EF, Korshakova NYu. Open randomized placebo-controlled study of the effectiveness and safety of monotherapy of bacterial vaginosis by vaginal application of lactic acid. Obstetrics and Gynecology. 2018;(5):96–100. doi: 10.18565/aig.2018.5.96-101 EDN: XOSMXZ
- Ross JDC, Brittain C, Anstey Watkins J, et al. Intravaginal lactic acid gel versus oral metronidazole for treating women with recurrent bacterial vaginosis: the VITA randomised controlled trial. BMC Womens Health. 2023;23(1):241. doi: 10.1186/s12905-023-02303-5
- Paavonen J, Mangioni C, Martin MA, Wajszczuk CP. Vaginal clindamycin and oral metronidazole for bacterial vaginosis: a randomized trial. Obstet Gynecol. 2000;96(2):256–260. doi: 10.1016/s0029-7844(00)00902-9
- Mendling W, Weissenbacher ER, Gerber S, et al. Use of locally delivered dequalinium chloride in the treatment of vaginal infections: a review. Arch Gynecol Obstet. 2016;293(3):469–484. doi: 10.1007/s00404-015-3914-8
- Gaspar C, Rolo J, Cerca N, et al. Dequalinium chloride effectively disrupts bacterial vaginosis (BV) Gardnerella spp. biofilms. Pathogens. 2021;10(3):261. doi: 10.3390/pathogens10030261
- Antoni Vives J, Cancelo MJ, Losada MA, Domenech A. Dequalinium chloride use in adult Spanish women with bacterial vaginosis: an observational study. J Obstet Gynaecol. 2022;42(1):103–109. doi: 10.1080/01443615.2020.1867966
- Weissenbacher ER, Donders G, Unzeitig V, et al. A comparison of dequalinium chloride vaginal tablets (Fluomizin®) and clindamycin vaginal cream in the treatment of bacterial vaginosis: a single-blind, randomized clinical trial of efficacy and safety. Gynecol Obstet Invest. 2012;73(1):8–15. doi: 10.1159/000332398
- Raba G, Durkech A, Malík T, et al. Efficacy of dequalinium chloride vs metronidazole for the treatment of bacterial vaginosis: a randomized clinical trial. JAMA Netw Open. 2024;7(5):e248661. doi: 10.1001/jamanetworkopen.2024.8661
- Bhujel R, Mishra SK, Yadav SK, et al. Comparative study of Amsel’s criteria and Nugent scoring for diagnosis of bacterial vaginosis in a tertiary care hospital, Nepal. BMC Infect Dis. 2021;21(1):825. doi: 10.1186/s12879-021-06562-1
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