Studies of Vaginal Flora and Bacterial Vaginosis

阴道菌群和细菌性阴道病的研究

• 批准号: 7334095
• 负责人: JIM ZHANG
• 金额: --
• 依托单位: EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH & HUMAN DEVELOPMENT
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/7334095
• 关键词: Studies; Vaginal; Flora; Bacterial; Vaginosis

Bacterial vaginosis is a syndrome in which the normal Lactobacillus-predominant vaginal flora is replaced with mixed anaerobic-predominant organisms. It is present in 10 to 25% of women in the general population, and is the most common vaginal infection. It has been associated with a number of adverse sequelae in reproductive health including acquisition of HIV, pelvic inflammatory disease, cervical dysplasia, and complications of gynecological procedures. During pregnancy it has been associated with an increased risk of preterm birth and postpartum maternal infection. However, the vaginal microbial flora remains poorly understood. Information on variation in microbial flora and its association with BV from a longitudinal study is unavailable. This prospective observational study aims to advance our knowledge of the natural history and abnormal alteration in vaginal microbial flora, and to identify risk factors that are associated with these changes. A total of 3600 healthy, non-pregnant women of reproductive age have been enrolled and were followed in Birmingham, Alabama for one year (baseline visit plus once every three months afterwards, totaling five visits). Detailed information on sociodemographic status, medical history, hygiene practice, sexual behavior and psychosocial stress was collected through in-person interviews. Routine gynecological and dental examinations were carried out during the study visits. Samples of vaginal secretion and blood were collected. Laboratory tests to quantify vaginal microbial flora and to identify infection of bacterial vaginosis as well as common sexually transmitted diseases were conducted. Sub-studies evaluate the day-to-day change in vaginal flora, and the effect of cessation of douching. The final study visits were completed in June 2003, and various analyses are underway. In results poublished during this reporting period, a pilot randomized trial of douching cessation and the incidence and persistence of bacterial vaginosis demonstrated the feasibility of such a large trial. Compliance with assigned treatment was very good, and no adverse effects of douching continuation versus cessation were found. Also, perceived psychological stress was demonstrated to increase a woman's risk of acquiring BV. This study used the novel "case-crossover" design, and is the first paper on this topic to utilize this approach. Abstracts describing the association between BV and periodontal disease, between BV and obesity, and on nutritional risk factors for BV were presented. In addition, the case-crossover design on factors that prompt a change in douching behavior resulted in an abstract at this year's Congress of epidemiology. Ongoing analysis are focusing on the effect of douching cessation and BV incidence. In addition, work continued with the NICHD MFMU Network Bacterial Vaginosis and Trichomonas vaginalis clinical trials, publishing several secondary papers from this effort.

细菌性阴道病是一种以乳杆菌为主的正常阴道菌群被以厌氧菌为主的混合微生物取代的综合征。在普通人群中，有10%到25%的女性患有此病，是最常见的阴道感染。它与生殖健康中的一些不良后遗症有关，包括感染艾滋病毒、盆腔炎、宫颈发育不良和妇科手术的并发症。在怀孕期间，它与早产和产后产妇感染的风险增加有关。然而，阴道微生物区系仍然知之甚少。关于微生物区系的变化及其与BV的关系的纵向研究的信息是不可用的。这项前瞻性的观察性研究旨在提高我们对阴道微生物区系的自然历史和异常变化的认识，并确定与这些变化相关的危险因素。共登记了3600名健康的非怀孕育龄妇女，并在阿拉巴马州伯明翰进行了为期一年的跟踪调查(基线访问加上之后每三个月一次，总共五次访问)。通过面对面访谈收集了有关社会人口状况、病史、卫生习惯、性行为和心理社会压力的详细信息。在研究访问期间进行了常规的妇科和牙科检查。采集阴道分泌物和血样。进行了实验室测试，以量化阴道微生物菌群，并确定细菌性阴道病和常见性传播疾病的感染情况。子研究评估每天阴道菌群的变化，以及停止冲洗的效果。 最后的考察访问已于2003年6月完成，目前正在进行各种分析。在本报告期间公布的结果中，一项关于停止冲洗以及细菌性阴道病的发生率和持久性的试点随机试验证明了这样一项大型试验的可行性。对指定治疗的依从性非常好，没有发现继续冲洗与停止冲洗的不良反应。此外，感知到的心理压力也被证明会增加女性感染BV的风险。本研究采用了新颖的“案例-交叉”设计，是第一篇运用这一方法的研究论文。摘要描述了BV与牙周病、BV与肥胖之间的关系，以及BV的营养危险因素。此外，关于促使冲洗行为改变的因素的病例交叉设计在今年的流行病学大会上产生了一篇摘要。正在进行的分析集中在停止冲洗和BV发生率的影响上。 此外，NICHD MFMU网络细菌性阴道病和阴道毛滴虫临床试验的工作仍在继续，发表了这项工作的几篇二级论文。