Characteristics of the vaginal microbiome in women with and without clinically confirmed vulvodynia.
Characteristics of the vaginal microbiome in women with and without clinically confirmed vulvodynia.
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DOI：
10.1016/j.ajog.2020.02.039
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发表时间：
2020-09
影响因子：
9.8
通讯作者：
中科院分区：
文献类型：
--
作者：
外阴疼痛（特发性外阴疼痛）影响高达8%的40岁女性，病因不明，治疗效果各异。有几个危险因素与外阴痛有关，从酵母菌感染史到抑郁症和过敏症。最近的研究表明，改变的免疫炎症机制在外阴痛病理生理学中发挥着作用。由于阴道微生物组在局部免疫炎症反应中起着重要作用，我们评估了外阴痛女性的阴道微生物组，并与对照组进行了比较，作为免疫系统的一个组成部分。描述临床确诊的外阴痛女性和年龄匹配的对照组的阴道微生物组，并评估其与外阴痛的总体相关性，以及它如何改变与外阴痛相关的其他因素。我们对234名明尼阿波利斯/圣保罗地区临床确诊外阴痛的妇女和234名年龄匹配的临床确诊无外阴痛史的对照进行了病例对照研究。所有参与者均提供外阴阴道拭子样本，用于基于培养和基于非培养（测序）的微生物评估;关于人口统计学特征、性和生殖史以及心理社会因素史的背景和病史问卷。使用Shannon Alpha多样性指数评估阴道微生物组多样性。使用逻辑回归分析数据。阴道微生物组的培养和分子分析显示，病例和对照组之间几乎没有差异。然而，在α多样性低于中位数（低）的女性中，相对于对照组的可比时间段，酵母菌感染数量增加与外阴疼痛发作之间存在强相关性（年龄调整的比值比[OR] 8.1，95%CI：5个或更多酵母菌感染者为2.9-22.7）。此外，在微生物组多样性低的女性中，我们观察到中度至重度儿童虐待，先前的焦虑，抑郁，高水平的反刍和外阴痛之间存在强烈的相关性，OR从1.83到2.81。在具有高度多样性微生物组的女性中没有观察到这些关联。虽然病例和对照组之间的微生物组特征没有总体差异，但阴道微生物组多样性影响了环境和心理社会风险因素与外阴痛之间的关联。然而，目前尚不清楚阴道的多样性是否改变了危险因素和外阴痛之间的关联，或者作为关联的结果而改变。酵母菌感染史、焦虑和儿童期虐待与外阴痛之间的关联可能会因阴道微生物组的特征而改变。
Vulvodynia (idiopathic vulvar pain) affects up to 8% of women by age 40, has a poorly understood etiology, and variable treatment efficacy. Several risk factors are associated with vulvodynia from history of yeast infections to depression and allergies. Recent work suggests an altered immune inflammatory mechanism plays a role in vulvodynia pathophysiology. As the vaginal microbiome plays an important role in local immune-inflammatory responses, we evaluated the vaginal microbiome among women with vulvodynia compared to controls as one component of the immune system. Characterize the vaginal microbiome in women with clinically-confirmed vulvodynia and age-matched controls and assess its overall association with vulvodynia, and how it may serve to modify other factors that are associated with vulvodynia as well. We conducted a case-control study of 234 Minneapolis/Saint Paul area women with clinically-confirmed vulvodynia and 234 age-matched controls clinically confirmed with no history of vulvar pain. All participants provided vulvovaginal swab samples for culture-based and non-culture (sequencing) based microbiological assessments; background and medical history questionnaires on demographic characteristics, sexual and reproductive history, and history of psychosocial factors. Vaginal microbiome diversity was assessed using the Shannon Alpha Diversity Index. Data were analyzed using logistic regression. Culture and molecular-based analyses of the vaginal microbiome showed few differences between cases and controls. However, among women with alpha diversity below the median (low), there was a strong association between increasing numbers of yeast infections and vulvodynia onset, relative to comparable time periods among controls (age-adjusted odds ratio [OR] 8.1, 95% CI: 2.9–22.7 in those with 5 or more yeast infections). Also among women with low diversity microbiomes, we observed a strong association between moderate-to-severe childhood abuse, antecedent anxiety, depression, and high levels of rumination and vulvodynia with ORs from 1.83 to 2.81. These associations were not observed in women with high diversity microbiomes. Although there were no overall differences in microbiome profiles between cases and controls, vaginal microbiome diversity influenced associations between environmental and psychosocial risk factors and vulvodynia. However, it is unclear whether vaginal diversity modifies the association between the risk factors and vulvodynia or is altered as a consequence of the associations. The associations between history of yeast infections, anxiety, and childhood abuse and vulvodynia may be modified by characteristics of the vaginal microbiome.
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影响因子：
48
作者：
Callahan BJ;McMurdie PJ;Rosen MJ;Han AW;Johnson AJ;Holmes SP
通讯作者：
Holmes SP
影响因子：
3.3
作者：
Jayaram, Aswathi;Witkin, Steven S.;Forney, Larry J.
通讯作者：
Forney, Larry J.
DOI：
10.1136/bmj.i969
发表时间：
2016-02-25
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Pearce N
通讯作者：
Pearce N
影响因子：
3.5
作者：
Pukall, Caroline F.;Goldstein, Andrew T.;Bachmann, Gloria
通讯作者：
Bachmann, Gloria
影响因子：
4.4
作者：
Kozich, James J.;Westcott, Sarah L.;Schloss, Patrick D.
通讯作者：
Schloss, Patrick D.