Associations between improvement in genitourinary symptoms of menopause and changes in the vaginal ecosystem.
Associations between improvement in genitourinary symptoms of menopause and changes in the vaginal ecosystem.
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DOI：
10.1097/gme.0000000000001037
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发表时间：
2018-05
期刊：
影响因子：
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通讯作者：
Fredricks DN
中科院分区：
文献类型：
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作者：
Mitchell CM;Srinivasan S;Plantinga A;Wu MC;Reed SD;Guthrie KA;LaCroix AZ;Fiedler T;Munch M;Liu C;Hoffman NG;Blair IA;Newton K;Freeman EW;Joffe H;Cohen L;Fredricks DN
确定绝经期泌尿生殖系统症状的改善与阴道微生物群、阴道糖原和血清雌激素之间的关系。30名绝经后妇女参加了一项热潮热治疗试验（口服雌二醇、文拉法辛和安慰剂），她们报告了GSM，并在0、4和8周时提供了阴道拭子。利用16S rRNA基因V3-V4区域的深度测序对细菌群落进行了表征。参与者选择了一种最令人烦恼的泌尿生殖系统症状（干燥、分泌物、疼痛、瘙痒/灼烧或无法发生性行为），并在基线和8周时以10分制对严重程度进行评分。在入组和8周时测定阴道糖原和血清雌二醇和雌二醇。根据最恼人症状（MBS）的改善情况进行比较，采用卡方检验、Wilcoxon符号秩检验或Hotelling t检验。在30名参与者中，21名（70%）在8周的研究中MBS得到改善，9名（30%）MBS没有改善或恶化。与安慰剂（54%,p = 0.28）相比，接受雌二醇或文拉法辛治疗的女性报告MBS改善的比例更高（88%,78%）。在入组时，MBS的改善与乳酸菌为主的阴道微生物群相关（57% vs 22%, p = 0.08）。阴道糖原、血清雌二醇和雌酮在MBS改善的妇女中显著升高。GSM改善在接受口服雌二醇或文拉法辛治疗的女性和阴道微生物群以乳酸杆菌为主的女性中更为常见，但差异无统计学意义。需要更大规模的试验来确定阴道微生物群是否改变或调节GSM妇女的治疗反应。
Identify associations between improvement in genitourinary symptoms of menopause (GSM) and vaginal microbiota, vaginal glycogen and serum estrogen. Thirty postmenopausal women enrolled in a hot flash treatment trial (oral estradiol vs. venlafaxine vs. placebo) who reported GSM and provided vaginal swabs at 0, 4 and 8 weeks were studied. Bacterial communities were characterized using deep sequencing targeting the 16S rRNA gene V3–V4 region. Participants selected a most bothersome genitourinary symptom (dryness, discharge, pain, itch/burn or inability to have sex) and rated severity on a 10-point scale at baseline and 8 weeks. Vaginal glycogen and serum estradiol and estrone were measured at enrollment and 8 weeks. Comparisons according to improvement in most bothersome symptom (MBS) were made using chi-square, Wilcoxon signed-rank test, or Hotelling’s t test. Of 30 participants, 21 (70%) had improvement in MBS over the 8-week study, and 9 (30%) had no improvement or worsening of MBS. A higher proportion of women receiving estradiol or venlafaxine reported improvement in MBS (88%, 78%) compared to placebo (54%; p = 0.28). MBS improvement was associated with Lactobacillus-dominant vaginal microbiota at enrollment (57% vs 22%, p = 0.08). Vaginal glycogen, serum estradiol and estrone increased significantly in women whose MBS improved. Improvement in GSM was more common in women receiving oral estradiol or venlafaxine and those with Lactobacillus-dominant vaginal microbiota at enrollment but differences were not statistically significant. Larger trials are need to determine whether vaginal microbiota modify or mediate treatment responses in women with GSM.