Vaginal estrogen therapy is associated with increased Lactobacillus in the urine of postmenopausal women with overactive bladder symptoms.
Vaginal estrogen therapy is associated with increased Lactobacillus in the urine of postmenopausal women with overactive bladder symptoms.
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阴道雌激素疗法与绝经后妇女的尿液中乳酸杆菌升高有关，患有过度活跃的膀胱症状。
DOI：
10.1016/j.ajog.2020.08.006
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发表时间：
2020-11
影响因子：
9.8
通讯作者：
Wolfe AJ
中科院分区：
文献类型：
--
作者：
Thomas-White K;Taege S;Limeira R;Brincat C;Joyce C;Hilt EE;Mac-Daniel L;Radek KA;Brubaker L;Mueller ER;Wolfe AJ
先前的研究表明，阴道微生物群减少乳酸杆菌的优势，并在绝经后变得更加多样化。也有研究表明，雌激素治疗可以恢复阴道内乳酸杆菌的优势，并且局部雌激素与OAB症状改善有关。我们现在知道膀胱含有独特的微生物组，膀胱微生物组多样性的增加与OAB有关。然而，目前尚不清楚每种盆底微生物组对雌激素的反应速度有多快，也不清楚这些变化是否与症状改善有关。两项试验（NCT02524769和NCT02835846）的绝经后参与者的数据分析，他们选择阴道雌激素作为主要的OAB治疗方法，并每周两次使用0.5克结合雌激素（Premarin Cream, (Pfizer, New York City， NY)），持续12周。基线和12周随访数据包括OAB-q问卷，参与者提供导尿、阴道拭子、会阴拭子和排尿。通过强化培养方案检测微生物。使用线性混合模型来估计微生物组随时间的变化。通过细菌生长抑制试验评估尿AMP活性，并与尿组成员的相对丰度相关。12周雌激素治疗导致阴道内微生物多样性下降（Shannon, p=0.047; abundance, p=0.043），但其他生态位没有。膀胱（p=0.037）、阴道（p=0.33）、会阴（p=0.56）和排尿（p=0.28）中乳酸菌含量均显著增加。膀胱内乳酸杆菌水平的变化与急迫性尿失禁症状的轻微变化相关（p=0.02）。杆状杆菌属的相对丰度与雌激素治疗后尿液AMP活性呈正相关。雌激素治疗可能改变盆底不同生态位的微生物群。阴道的多样性开始减少，膀胱的乳酸杆菌水平显著增加；后者与OAB-q症状严重程度子量表的适度改善相关。雌激素治疗膀胱过度活动导致膀胱细菌多样性减少和膀胱乳酸杆菌增加，这与急迫性尿失禁症状的适度变化有关。
Previous work has shown that the vaginal microbiome decreases in Lactobacillus predominance and becomes more diverse following menopause. It has also been shown that estrogen therapy restores Lactobacillus-dominance in the vagina, and that topical estrogen is associated with OAB symptom improvement. We now know that the bladder contains a unique microbiome, and increased bladder microbiome diversity is associated with OAB. However, there is no understanding of how quickly each pelvic floor microbiome responds to estrogen or if those changes are associated with symptom improvement. Analysis of data from post-menopausal participants in two trials (NCT02524769 and NCT02835846) who chose vaginal estrogen as their primary OAB treatment and used 0.5 grams of conjugated estrogen (Premarin Cream, (Pfizer, New York City, NY)) twice weekly for 12 weeks. Baseline and 12-week follow-up data included the OAB-q questionnaire and participants provided catheterized urine, vaginal swabs, perineal swabs, and voided urine. Microbes were detected by an enhanced culture protocol. Linear mixed models were used to estimate microbiome changes over time. Urinary AMP activity was assessed by a bacterial growth inhibition assay and correlated with relative abundance of members of the urobiome. Twelve weeks of estrogen treatment resulted in decreased microbial diversity within the vagina (Shannon, p=0.047; Richness, p=0.043), but not in the other niches. A significant increase in Lactobacillus was detected in the bladder (p=0.037), but not the vagina (p=0.33), perineum (p=0.56), or voided urine (p=0.28). The change in Lactobacillus levels in the bladder was associated with modest changes in urgency incontinence symptoms (p=0.02). The relative abundance of the genus Corynebacterium correlated positively with urinary AMP activity after estrogen treatment. Estrogen therapy may change the microbiome of different pelvic floor niches. The vagina begins to decrease in diversity and the bladder experiences a significant increase in Lactobacillus levels; the latter is correlated with a modest improvement in the symptom severity sub-scale of the OAB-q. Estrogen therapy for overactive bladder resulted in decreased bladder bacterial diversity and increased bladder Lactobacillus, which were associated with modest changes in urgency incontinence symptoms.
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DOI：
10.1097/gme.0b013e3182104977
发表时间：
2011-09-01
影响因子：
2.7
作者：
Nelken, Rebecca S.;Oezel, Beguem Z.;Mishell, Daniel R., Jr.
通讯作者：
Mishell, Daniel R., Jr.
DOI：
10.1111/j.1532-5415.1990.tb03504.x
发表时间：
1990-03-01
影响因子：
6.3
作者：
HERZOG, AR;FULTZ, NH
通讯作者：
FULTZ, NH
影响因子：
3.7
作者：
Nienhouse V;Gao X;Dong Q;Nelson DE;Toh E;McKinley K;Schreckenberger P;Shibata N;Fok CS;Mueller ER;Brubaker L;Wolfe AJ;Radek KA
通讯作者：
Radek KA
影响因子：
3.5
作者：
Coyne, K;Revicki, D;Abrams, P
通讯作者：
Abrams, P
影响因子：
6.4
作者：
Pearce MM;Hilt EE;Rosenfeld AB;Zilliox MJ;Thomas-White K;Fok C;Kliethermes S;Schreckenberger PC;Brubaker L;Gai X;Wolfe AJ
通讯作者：
Wolfe AJ