细菌性阴道病的治疗进展

Progress in Treatment of Bacterial Vaginosis

细菌性阴道病(bacterial vaginosis,BV)是育龄期妇女最常见的下生殖道感染性疾病,会导致盆腔炎、不良妊娠结局和多种性传播疾病感染风险增加。目前临床用于治疗BV的药物主要为甲硝唑、克林霉素等抗生素,但难以解决部分患者治疗失败以及复发率高等问题。其原因可能在于抗生素的抑菌机制较为单一,且作用强度不足,无法重建以乳杆菌为主的阴道微生态,也无法抑制阴道加德纳菌主导的致病性生物被膜产生。因此,亟需开发新的替代药物或采用联合疗法用于BV治疗。基于BV的微生物学基础,综述近期BV治疗方式的研究进展,包括乳杆菌制剂、生物被膜抑制剂等。这些疗法大多安全性好、有效性高,极具研究价值,部分已初步应用于临床。

Bacterial vaginosis(BV)is the most common lower reproductive tract infection among women of childbearing age,leading to an increasing risk of pelvic inflammatory disease,poor pregnancy outcomes,and multiple sexually transmitted infections.At present,the main clinical drugs used for BV treatment are antibiotics such as metronidazole and clindamycin,but it is difficult to solve the problems of treatment failure and high recurrence rate in some patients.The reason might be that the antibiotics have a single mechanism of bacterial inhibition,and the intensity is insufficient,which cannot rebuild the vaginal microbiota dominated by Lactobacillus,nor can they inhibit the production of pathogenic biofilms dominated by Gardnerella vaginalis.Therefore,there is an urgent need to develop new alternative drugs or combination therapies for BV treatment.This article reviews the recent research advances in new treatment for BV based on its microbiological foundation,especially lactobacillus preparations and biofilm inhibitors.Most of these therapies have good safety and high effectiveness,with great research value.Some of the applications have been available in clinic practice in these years.