细菌性阴道病的菌群亚型与治疗结局的相关性研究

Correlation between the types of bacterial composition and treatment outcomes of bacterial vaginosis

目的探讨细菌性阴道病的菌群亚型与不同治疗结局的相关性,为细菌性阴道病分型诊断及个体化治疗提供理论依据。方法选取2012年9月至2013年7月在北京大学第一医院妇产科门诊诊断为细菌性阴道病的育龄期女性为研究对象,规范使用甲硝唑凝胶治疗,分别采集患者用药前、用药后6-8d、用药后1个月的阴道分泌物,提取细菌组DNA,进行454焦磷酸测序,分析阴道微生物菌群的多样性和丰度差异,探讨细菌性阴道病患者阴道菌群的构成差异与预后之间的相关性。结果共有109例细菌性阴道病患者,其中61名患者完成了2次随访,共计183份阴道分泌物样品。对所有采集的标本进行454焦磷酸测序分析,共发现192种细菌。根据高通量测序结果分析,可将细菌性阴道病的菌群结构分为3种亚型：普雷沃菌型（Prevotella,I型）、阿托波菌型（Atopobium,II型）和乳杆菌型（Lactobacillus,III型）。细菌性阴道病不同的菌群亚型,其治愈率是不同的。乳杆菌型的治愈率最高,约为76.5%,阿托波菌型的治愈率最低,约为42.8%。结论细菌性阴道病的菌群存在不同亚型,且与治疗结局存在相关性,乳杆菌型菌群结构的患者对甲硝唑的治愈率最高。

Objective To explore thecorrelation between the types of bacterial composition and treatment outcomes of bacterial vaginosis（BV）,and provide evidence for itstypical diagnosis and individualized treatment.Methods Womenof reproductive age diagnosed as BV at the Department of Obstetrics and Gynecology,Peking University First Hospital between September 2012 and July 2013 were included and treated with metronidazole gel intravaginally.The vaginal secretions were collected before treatment,6to 8days after and1 month after the medication respectively.Bacterial DNA genomes were extracted and analyzed with the 454pyrosequencing;the diversity and abundance of the vaginal microbiomewere analyzed to explore the correlation between bacterial composition and the prognosis of bacterial vaginosis.Results 109 women with BV were enrolled,of whom 61 completed both two follow ups.A total of 183 samples of vaginal secretions were sequenced and 192 bacteria were found.High throughput sequencing results revealed that the bacterial composition could be divided into 3types,including Prevotellagroup（type I）,Atopobium group（type II）and Lactobacillus group（type III）.The cure rates of different types varied,with that of Lactobacillus group being the highest（76.5%）while that of Atopobiumgroup being the lowest（42.8%）.Conclusion The bacterial compositions in bacterial vaginosis have different types,and are associated with different treatment outcomes.Lactobacillus group has highest cure rate to metronidazole.