细菌性阴道病的维生素D补充

T.F. Tatarchuk, L.V. Kalugina, T.I. Kvasha, R.O. Mnevets
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The study included 63 women of reproductive age with BV and with a level of 25-hydroxyvitamin D below 75 nmol/l, who were divided into groups: the main group included 32 women who were prescribed standard therapy (metronidazole 500 mg twice a day for 7 days) and cholecalciferol (Olidetrim) 4000 IU/day with subsequent continuation of its intake in a dose 2000 IU/day for up to 6 months; the comparison group included 31 women, who were not intake vitamin D preparation during the standard therapy and during the next 6 months of observation.After treatment, women provided completed questionnaires and self-collected vaginal swabs 1, 3, and 6 months after beginning of the study or before BV relapse. Evaluation of Gram-stained smears was carried out by microscopy according to Hay/Ison criteria, where BV corresponded to type III. The level of 25-hydroxyvitamin D in blood serum was determined by the chemiluminescent immunoassay method before the start of thestudy and at 3 and 6 months of follow-up.The primary endpoint was BV recurrence at any post-treatment interval; the patients were offered a second treatment in this case.Results. Vitamin D deficiency at the beginning of the study was detected in 12 (37.5%) patients of the main group and in 13 (41.94%) women of the comparison group, an insufficient level – in 20 (62.5%) patients of the main group and in 58.06% women of the comparison group.Patients complained of pathological vaginal discharge, itching, burning and dyspareunia lasting from 1 week to 2 months. At the seven-day course of basic BV therapy all participants noted the normalization of discharge and the absence of vaginal discomfort. Positive dynamics were also observed according to the gynecological examination.One month after the treatment, 4 (12.5%) participants of the main and 6 (19.36%) women of the comparison group noted the recovery of symptoms. Absence of BV recurrence after 3 months was noted by 25 (78.12%) women of the main group and 16 (51.61%) women of the comparison group (p = 0.054), that was confirmed by the laboratory tests. At the same time, the level of 25-hydroxyvitamin D in the main group increased by 43.37% (p = 0.05), and in the comparison group it did not differ from the initial level. There were no complaints in 24 (75.0%) patients after 6 months, however, a laboratory-confirmed normal state of the vaginal microbiome was observed in 22 (70.96%) participants of the main group and in 14 (45.16%, p = 0.07) women of the comparison group. 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引用次数: 0

摘要

研究目的:评价维生素D补充剂(Olidetrim)在育龄妇女细菌性阴道病(BV)复合抗复发治疗中的作用。材料和方法。该研究纳入了63名患有BV且25-羟基维生素D水平低于75 nmol/l的育龄妇女,她们被分为两组:主要组包括32名妇女,她们接受标准治疗(甲硝唑500毫克,每天两次,持续7天)和胆钙化醇(Olidetrim) 4000 IU/天,随后继续以2000 IU/天的剂量摄入,持续6个月;对照组包括31名妇女,她们在标准治疗期间和接下来的6个月观察期间没有摄入维生素D制剂。治疗后,女性在研究开始后1、3和6个月或BV复发前提供完整的调查问卷和自行收集的阴道拭子。显微镜下根据Hay/Ison标准对革兰氏染色涂片进行评估,其中BV对应于III型。在研究开始前和随访3个月和6个月时,采用化学发光免疫分析法测定血清中25-羟基维生素D的水平。主要终点是BV在任何治疗间隔内的复发;在这种情况下,患者接受了第二次治疗。在研究开始时,在主要组的12名(37.5%)患者和对照组的13名(41.94%)女性中检测到维生素D缺乏症,主要组的20名(62.5%)患者和对照组的58.06%女性中检测到维生素D缺乏症。患者主诉病理性阴道分泌物、瘙痒、灼烧和性交困难,持续1周至2个月。在为期7天的BV基础治疗过程中,所有参与者都注意到分泌物正常化和阴道不适的消失。根据妇科检查也观察到积极的动态。治疗1个月后,主组4人(12.5%)、对照组6人(19.36%)症状恢复。3个月后,主组25例(78.12%)无BV复发,对照组16例(51.61%)无BV复发(p = 0.054)。同时,主组25-羟基维生素D水平提高43.37% (p = 0.05),对照组与初始水平无差异。6个月后24例(75.0%)患者无主诉,但试验组22例(70.96%)患者阴道菌群检测正常,对照组14例(45.16%,p = 0.07)患者阴道菌群检测正常。在接下来的3个月里,继续以2000 IU/天的剂量摄入维生素D, 25-羟基维生素D水平维持在正常值范围内(主组为81.7±6.23 nmol/l,对照组为38.51±5.43 nmol/l, p = 0.05)。在维持正常维生素D水平期间,发现女性BV复发频率降低,因此建议在标准治疗中加入胆钙化醇补充剂(Olidetrim)。对于复发性BV患者,建议长期监测血清维生素D水平,以便及时处方补充。
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Vitamin D supplementation in bacterial vaginosis
Research objectives: to evaluate the effect of vitamin D supplementation (Olidetrim) in the complex anti-relapse therapy of bacterial vaginosis (BV) in women of reproductive age.Materials and methods. The study included 63 women of reproductive age with BV and with a level of 25-hydroxyvitamin D below 75 nmol/l, who were divided into groups: the main group included 32 women who were prescribed standard therapy (metronidazole 500 mg twice a day for 7 days) and cholecalciferol (Olidetrim) 4000 IU/day with subsequent continuation of its intake in a dose 2000 IU/day for up to 6 months; the comparison group included 31 women, who were not intake vitamin D preparation during the standard therapy and during the next 6 months of observation.After treatment, women provided completed questionnaires and self-collected vaginal swabs 1, 3, and 6 months after beginning of the study or before BV relapse. Evaluation of Gram-stained smears was carried out by microscopy according to Hay/Ison criteria, where BV corresponded to type III. The level of 25-hydroxyvitamin D in blood serum was determined by the chemiluminescent immunoassay method before the start of thestudy and at 3 and 6 months of follow-up.The primary endpoint was BV recurrence at any post-treatment interval; the patients were offered a second treatment in this case.Results. Vitamin D deficiency at the beginning of the study was detected in 12 (37.5%) patients of the main group and in 13 (41.94%) women of the comparison group, an insufficient level – in 20 (62.5%) patients of the main group and in 58.06% women of the comparison group.Patients complained of pathological vaginal discharge, itching, burning and dyspareunia lasting from 1 week to 2 months. At the seven-day course of basic BV therapy all participants noted the normalization of discharge and the absence of vaginal discomfort. Positive dynamics were also observed according to the gynecological examination.One month after the treatment, 4 (12.5%) participants of the main and 6 (19.36%) women of the comparison group noted the recovery of symptoms. Absence of BV recurrence after 3 months was noted by 25 (78.12%) women of the main group and 16 (51.61%) women of the comparison group (p = 0.054), that was confirmed by the laboratory tests. At the same time, the level of 25-hydroxyvitamin D in the main group increased by 43.37% (p = 0.05), and in the comparison group it did not differ from the initial level. There were no complaints in 24 (75.0%) patients after 6 months, however, a laboratory-confirmed normal state of the vaginal microbiome was observed in 22 (70.96%) participants of the main group and in 14 (45.16%, p = 0.07) women of the comparison group. Continuation of vitamin D intake at a dose of 2000 IU/day for the next 3 months demonstrated maintenance of the 25-hydroxyvitamin D level within normal values (81.7 ± 6.23 nmol/l in the main group vs. 38.51 ± 5.43 nmol/l in comparison group, p = 0.05).Conclusions. A decrease in the frequency of BV recurrences in women during support a normal level of vitamin D was found, which allows recommending the inclusion of cholecalciferol supplementation (Olidetrim) in the standard treatment. In patients with recurrent BV a long-term monitoring of the serum level of vitamin D is advisable in order to timely prescribe supplementation.
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来源期刊
Reproductive Endocrinology
Reproductive Endocrinology Medicine-Obstetrics and Gynecology
CiteScore
0.50
自引率
0.00%
发文量
13
审稿时长
8 weeks
期刊最新文献
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