Vaginal Estrogen Therapy Is Associated With Decreased Inflammatory Response in Postmenopausal Women With Recurrent Urinary Tract Infections.
Vaginal Estrogen Therapy Is Associated With Decreased Inflammatory Response in Postmenopausal Women With Recurrent Urinary Tract Infections.
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DOI：
10.1097/spv.0000000000000790
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发表时间：
2021-01-01
影响因子：
1.6
通讯作者：
Mysorekar IU
中科院分区：
文献类型：
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作者：
Meister MR;Wang C;Lowder JL;Mysorekar IU
Vaginal estrogen therapy has been shown to decrease the risk of recurrent urinary tract infections in postmenopausal women, but the mechanism of action has not been fully described.我们的目的是评估绝经后尿液炎症特征是否因阴道雌激素治疗而发生变化。我们前瞻性地将绝经后患者分为三组：1）目前正在使用阴道雌激素治疗，无复发性尿路感染史； 2）有尿路感染史，目前采用阴道雌激素治疗； 3）有反复尿路感染史，未使用阴道雌激素治疗但愿意开始。我们对患者进行了 6-19 个月的随访，并在三个时间点收集了尿液样本。我们对 IL-6 进行了全面的细胞病理学分析、定量尿液炎症评分和酶联免疫吸附测定。招募了 70 名患者（第 1 组，n=30；第 2 组，n=20；第 3 组，n=20）。第 2 组和第 3 组患者的尿液显示炎症细胞、碎片和脱落的尿路上皮细胞增加。未接受阴道雌激素治疗的复发性尿路感染绝经后患者的定量尿液炎症评分和 IL-6 显着较高（0.12 vs 0.93，p<0.05），并且在开始阴道雌激素治疗后显着下降（0.93 vs 0.38，p<0.05）。患有复发性尿路感染的绝经后女性接受阴道雌激素治疗后，细胞脱落减少，尿液炎症评分降低，尿液 IL-6 降低。泌尿生殖炎症的调节可能代表了阴道雌激素治疗有助于预防绝经后妇女复发性尿路感染的一种机制。
Vaginal estrogen therapy has been shown to decrease the risk of recurrent urinary tract infections in postmenopausal women, but the mechanism of action has not been fully described. Our objectives were to assess whether the postmenopausal urine inflammatory profile changes in response to vaginal estrogen therapy. We prospectively enrolled postmenopausal patients into three groups: 1) currently using vaginal estrogen therapy without a history of recurrent urinary tract infections; 2) history of urinary tract infections, currently using vaginal estrogen therapy; and 3) history of recurrent urinary tract infections, not using vaginal estrogen therapy but willing to start. We followed patients over 6–19 months and collected urine samples at three time points. We performed comprehensive cytopathologic analysis, quantitative urine inflammatory scoring, and enzyme-linked immunosorbent assay for IL-6. Seventy patients were recruited (Group 1, n=30; Group 2, n=20; Group 3, n=20). Urine from patients in Groups 2 and 3 demonstrated increased inflammatory cells, debris, and exfoliated urothelial cells. Quantitative urine inflammatory scores and IL-6 were significantly higher in postmenopausal patients with recurrent urinary tract infections not on vaginal estrogen therapy (0.12 vs 0.93, p<0.05) and decreased significantly after initiating vaginal estrogen therapy (0.93 vs 0.38, p<0.05). Postmenopausal women with recurrent urinary tract infections on vaginal estrogen therapy demonstrate decreased cell shedding, reduced urine inflammatory scores, and decreased urine IL-6. Modulation of the genitourinary inflammatory profile may represent one mechanism through which vaginal estrogen therapy helps prevent recurrent urinary tract infections in postmenopausal women.