Longitudinal analysis of the vaginal microflora in pregnancy suggests that L. crispatus promotes the stability of the normal vaginal microflora and that L. gasseri and/or L. iners are more conducive to the occurrence of abnormal vaginal microflora
Longitudinal analysis of the vaginal microflora in pregnancy suggests that L. crispatus promotes the stability of the normal vaginal microflora and that L. gasseri and/or L. iners are more conducive to the occurrence of abnormal vaginal microflora
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DOI：
10.1186/1471-2180-9-116
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发表时间：
2009-06-02
期刊：
影响因子：
4.2
通讯作者：
Vaneechoutte, Mario
中科院分区：
文献类型：
--
作者：
Verstraelen, Hans;Verhelst, Rita;Vaneechoutte, Mario
背景：尽管阴道乳酸杆菌具有抗菌潜力，但它们通常无法保持优势，导致其他细菌在阴道过度生长，如细菌性阴道病所观察到的那样。然而，阴道乳酸菌群落组成的个体间差异在多大程度上决定了该微生物区系的稳定性仍然难以捉摸。在前瞻性孕妇队列中，我们研究了正常阴道菌群的稳定性（通过革兰氏染色评估）与阴道乳酸菌指数物种（通过培养和 tRFLP 分子分析确定）的关系。结果：从 100 名连续白人女性中获得平均孕龄为 8.6（SD 1.4）、21.2（SD）的阴道拭子。分别为 1.3) 和 32.4 (SD 1.7) 周。根据革兰氏染色结果，77 名女性在妊娠前三个月的阴道微生物群 (VMF) 正常或以乳杆菌为主，其中 18 名女性为 Ia 级（卷曲乳杆菌细胞形态型）VMF（23.4%），16 名女性为 Iab 级（卷曲乳杆菌和其他乳杆菌细胞形态型）VMF（20.8%），43 名女性为 Ib 级（非卷曲乳杆菌细胞形态型）VMF（20.8%）。卷曲细胞形态型）VMF（55.8%）。 13 名基线时 VMF 正常的女性，在妊娠中期或晚期 (16.9%) 转变为异常 VMF，定义为以非乳杆菌为主的 VMF。与 Ia 级和 Iab 级 VMF 相比，Ib 级 VMF 从正常 VMF 转变为异常 VMF 的可能性高 10 倍（RR = 9.49，95% CI 1.30 - 69.40）（p = 0.009）。这是通过观察到包含 L.gasseri/iners 的正常 VMF 相对于非 L.gasseri/iners 转化为异常 VMF 的风险增加十倍来解释的。 Gasseri/iners VMF（RR 10.41，95% CI 1.39-78.12，p = 0.008），而包含卷曲乳杆菌的正常 VMF 相对于非乳杆菌，转化为异常 VMF 的风险降低五倍。卷曲乳杆菌 VMF（RR 0.20，95% CI 0.05-0.89，p = 0.04）。结论：正常阴道菌群中不同种类乳杆菌的存在是妊娠期该菌群稳定性的主要决定因素：卷曲乳杆菌可促进正常阴道菌群的稳定性，而 L.gasseri 和/或 L.iners 在一定程度上易导致该菌群的发生。阴道微生物群异常。
Background: Despite their antimicrobial potential, vaginal lactobacilli often fail to retain dominance, resulting in overgrowth of the vagina by other bacteria, as observed with bacterial vaginosis. It remains elusive however to what extent interindividual differences in vaginal Lactobacillus community composition determine the stability of this microflora. In a prospective cohort of pregnant women we studied the stability of the normal vaginal microflora (assessed on Gram stain) as a function of the presence of the vaginal Lactobacillus index species (determined through culture and molecular analysis with tRFLP).Results: From 100 consecutive Caucasian women vaginal swabs were obtained at mean gestational ages of 8.6 (SD 1.4), 21.2 (SD 1.3), and 32.4 (SD 1.7) weeks, respectively. Based on Gram stain, 77 women had normal or Lactobacillus-dominated vaginal microflora (VMF) during the first trimester, of which 18 had grade Ia (L. crispatus cell morphotypes) VMF (23.4%), 16 grade Iab (L. crispatus and other Lactobacillus cell morphotypes) VMF (20.8%), and 43 grade Ib (non-L. crispatus cell morphotypes) VMF (55.8%). Thirteen women with normal VMF at baseline, converted in the second or third trimester (16.9%) to abnormal VMF defined as VMF dominated by non-Lactobacillus bacteria. Compared to grade Ia and grade Iab VMF, grade Ib VMF were 10 times (RR = 9.49, 95% CI 1.30 - 69.40) more likely to convert from normal to abnormal VMF (p = 0.009). This was explained by the observation that normal VMF comprising L. gasseri/iners incurred a ten-fold increased risk of conversion to abnormal VMF relative to non-L. gasseri/iners VMF (RR 10.41, 95% CI 1.39-78.12, p = 0.008), whereas normal VMF comprising L. crispatus had a five-fold decreased risk of conversion to abnormal VMF relative to non-L. crispatus VMF (RR 0.20, 95% CI 0.05-0.89, p = 0.04).Conclusion: The presence of different Lactobacillus species with the normal vaginal microflora is a major determinant to the stability of this microflora in pregnancy: L. crispatus promotes the stability of the normal vaginal microflora while L. gasseri and/or L. iners predispose to some extent to the occurrence of abnormal vaginal microflora.