乳酸桿菌活菌制劑與甲硝唑類制劑治療妊娠合并細菌性陰道病的系統評價_《中國循證醫學雜志》

作者：

趙騰飛 ,  鐘玲 , 羅丹

重慶醫科大學附屬第二醫院婦產科（重慶 400010）;

關鍵詞：

乳酸桿菌活菌制劑甲硝唑制劑妊娠細菌性陰道病系統評價

DOI：

10.7507/1672-2531.20100592

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目的　比較乳酸桿菌活菌制劑與甲硝唑類制劑治療妊娠合并細菌性陰道病的療效及對妊娠結局的影響。
方法　計算機檢索PubMed、Cochrane圖書館、VIP、CNKI、萬方數據庫、中國生物醫學文獻數據庫、西文生物醫學期刊文獻數據庫、康健臨床決策循證數據庫等，納入乳酸桿菌活菌制劑與甲硝唑類制劑比較治療妊娠合并細菌性陰道病（BV）的療效及對妊娠結局影響的隨機對照試驗（RCT）。對納入RCT進行質量評價，采用RevMan 5.0.24軟件進行Meta分析。
結果　最終納入8篇文獻，共計1 687例受試者。Meta分析結果顯示：兩組療效差異無統計學意義［RR=1.04，95%CI（1.00，1.08），P=0.08］；乳酸桿菌活菌制劑治療后復發率低，差異具有統計學意義［RR=0.16，95%CI（0.06，0.43），P=0.000 4］；乳酸桿菌活菌制劑治療的早產發生率低于對照組［RR=0.56，95%CI（0.33，0.94），P=0.03］，差異具有統計學意義；而胎膜早破、產褥感染、低體重兒、新生兒感染、新生兒黃疸等妊娠結局發生率方面，兩組差異無統計學意義。
結論　① 乳酸桿菌制劑與甲硝唑類制劑治療妊娠合并BV的療效相似。② 乳酸桿菌制劑治療妊娠合并BV的復發率低于甲硝唑類制劑。③ 乳酸桿菌制劑治療妊娠合并BV后早產的發生率低于甲硝唑類制劑，但對于治療后胎膜早破、產褥感染、低體重兒、新生兒感染、新生兒黃疸等妊娠結局發生率兩者無明顯差異。

引用本文： 趙騰飛,鐘玲,羅丹. 乳酸桿菌活菌制劑與甲硝唑類制劑治療妊娠合并細菌性陰道病的系統評價. 中國循證醫學雜志, 2010, 10(11): 1338-1344. doi: 10.7507/1672-2531.20100592 復制

1.	Guise JM, Mahon SM, Aickin M, et al. Screening for bacterial vaginosis in pregnancy. American Journal of Preventive Medicine, 2001, 20(3 Suppl): 62-72.
2.	McDonald HM, Brocklehurst P, Gordon A. Antibiotics for treating bacterial vaginosis in pregnancy. The Cochrane Library, 2007, 24(1): CD000262.
3.	Darwish A, Elnshar EM, Hamadeh SM, et al. Treatment options for bacterial vaginosis in patients at high risk of preterm labor and premature rupture of membranes. The Journal of Obstetrics and Gynaecology Research, 2007, 33(6): 781.
4.	Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2002, MMWR Recomm Rep, 51(RR-6): 1-78.
5.	Mitchell C, Balkus J, Agnew K, et al. Changes in the vaginal microenvironment with metronidazole treatment for bacterial vaginosis in early pregnancy. BJOG, 2009, 116(10): 1315-1324.
6.	Marcone V, Calzolari E, Bertini M, et al. Effectiveness of vaginal administration of Lactobacillus rhamnosus following conventional metronidazole therapy: how to lower the rate of bacterial vaginosis recurrences. New Microbiological, 31(3): 429-433.
7.	馬延琴, 康雪萍. 乳酸菌膠囊在治療妊娠合并細菌性陰道病中的應用. 陜西醫學雜志, 2008, 37(2): 253-254.
8.	劉冬梅, 孟瑞雪, 高淑麗, 等. 活性乳酸桿菌制劑治療妊娠期細菌性陰道病療效觀察及其對妊娠結局的影響. 華中科技大學學報（醫學版）, 2006, 35(4): 555-558.
9.	田志紅, 黃醒華. 妊娠期細菌性陰道病的研究. 中國婦幼保健, 2007, 22(4): 437-440.
10.	李煜, 馮建文, 劉玲, 等. 乳酸桿菌治療妊娠合并細菌性陰道病臨床觀察. 海南醫學, 2006, 17(2): 18, 49.
11.	喬麗雅, 田可歌, 宋平, 等. 乳桿菌活菌膠囊治療妊娠期細菌性陰道病的臨床觀察. 中國優生與遺傳雜志, 2006, 14(9): 27-28.
12.	衛愛民, 葉春萍, 哈寶書, 等. 3種方法治療妊娠期細菌性陰道病及預防不良妊娠結局的效果比較. 中國婦幼保健, 2008, 23(31): 4445-4446.
13.	張力, 喬麗雅. 定君生膠囊用于妊娠期細菌性陰道病的臨床觀察. 中國優生與遺傳雜志, 2007, 15(9): 77-78.
14.	陳萍英, 劉淮, 陳寧寧, 等. 臨床干預對妊娠晚期細菌性陰道病不良妊娠結局的預防效果研究. 中國婦幼保健, 2008, 23(29): 4117-4118.
15.	McGregor JA, French JI. French, CNM, MS. Bacterial vaginosis in pregnancy. Obstetrical and Gynecological Survey, 2000, 55(50) (supplement 1).
16.	曹澤毅, 等. 中華婦產科學臨床版. 第1版. 北京: 人民衛生出版社, 2010, 21: 232-233.
17.	Thorsen P, Vogel I, Molsted K, et al. Risk factors for bacterial vaginosis in pregnancy: a population-based study on Danish women. Acta Obstetricia and Gynecologica Scandinavica, 2006, 8(85): 906-911.
18.	Caro-Patón T , Carvajal A, de Diego IM, et al. Is metronidazole teratogenic? A meta-analysis. British Journal of Clinical Pharmacology, 2003, 44(2): 179-182.
19.	Ugwumadu AH, Hay P, et al. Bacterial vaginosis: sequelae and management. Current Opinion in infectious Diseases, 1999, 12(1): 53-59.
20.	Hendler I, Andrews WW, et al. The relationship between resolution of asymptomatic bacterial vaginosis and spontaneous preterm birth in fetal fibronectin-positive women. American Journal of Obstetrics and Gynecology, 2007, 197(5): 488.e1-488.e5.
21.	Camargo RP, Simoes JA, et al. Impact of treatment for bacterial vaginosis on prematurity among Brazilian pregnant women: a retrospective cohort study. Sao Paulo Medical Journal, 2005, 123(3): 108-120.
22.	Shennan A, Crawshaw S, Briley A, et al. A randomized controlled trial of metronidazole for the prevention of preterm birth in women positive for cervicovaginal fetal fibronectin: the PREMET Study. BIOG: An International Journal of Obstetrics and Gynaecology, 2005, 113(1): 65-74.
23.	Carey JC, Klebanoff MA, et al. Is a change in the vaginal flora associated with an increased risk of preterm birth? American Journal of Obstetrics and Gynecology, 2005, 192(4): 1341-1346.
24.	Varma R, Gupta JK, et al. Antibiotic treatment of bacterial vaginosis in pregnancy: multiple meta-analyses and dilemmas in interpretation. Eur J Obstet Gynecol Reprod Biol, 2006, 124(1): 10-14.
25.	Marcone V, Calzolari E, et al. Effectiveness of vaginal administration of Lactobacillus rhamnosus following conventional metronidazole therapy: how to lower the rate of bacterial vaginosis recurrences. New Microbiol, 2008, 31(3): 429-433.
26.	Mastromarino P, Macchia S, et al. Effectiveness of Lactobacillus-containing vaginal tablets in the treatment of symptomatic bacterial vaginosis. Clinical Microbiology and Infection, 2008, 15(1): 67-74.
27.	Tsvetkov K, Vasileva P, et al. Probiotics in the treatment and prevention of bacterial vaginosis relapses. Akush Ginekol(Sofiia), 2007, 46(2): 41.

1. Guise JM, Mahon SM, Aickin M, et al. Screening for bacterial vaginosis in pregnancy. American Journal of Preventive Medicine, 2001, 20(3 Suppl): 62-72.
2. McDonald HM, Brocklehurst P, Gordon A. Antibiotics for treating bacterial vaginosis in pregnancy. The Cochrane Library, 2007, 24(1): CD000262.
3. Darwish A, Elnshar EM, Hamadeh SM, et al. Treatment options for bacterial vaginosis in patients at high risk of preterm labor and premature rupture of membranes. The Journal of Obstetrics and Gynaecology Research, 2007, 33(6): 781.
4. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2002, MMWR Recomm Rep, 51(RR-6): 1-78.
5. Mitchell C, Balkus J, Agnew K, et al. Changes in the vaginal microenvironment with metronidazole treatment for bacterial vaginosis in early pregnancy. BJOG, 2009, 116(10): 1315-1324.
6. Marcone V, Calzolari E, Bertini M, et al. Effectiveness of vaginal administration of Lactobacillus rhamnosus following conventional metronidazole therapy: how to lower the rate of bacterial vaginosis recurrences. New Microbiological, 31(3): 429-433.
7. 馬延琴, 康雪萍. 乳酸菌膠囊在治療妊娠合并細菌性陰道病中的應用. 陜西醫學雜志, 2008, 37(2): 253-254.
8. 劉冬梅, 孟瑞雪, 高淑麗, 等. 活性乳酸桿菌制劑治療妊娠期細菌性陰道病療效觀察及其對妊娠結局的影響. 華中科技大學學報（醫學版）, 2006, 35(4): 555-558.
9. 田志紅, 黃醒華. 妊娠期細菌性陰道病的研究. 中國婦幼保健, 2007, 22(4): 437-440.
10. 李煜, 馮建文, 劉玲, 等. 乳酸桿菌治療妊娠合并細菌性陰道病臨床觀察. 海南醫學, 2006, 17(2): 18, 49.
11. 喬麗雅, 田可歌, 宋平, 等. 乳桿菌活菌膠囊治療妊娠期細菌性陰道病的臨床觀察. 中國優生與遺傳雜志, 2006, 14(9): 27-28.
12. 衛愛民, 葉春萍, 哈寶書, 等. 3種方法治療妊娠期細菌性陰道病及預防不良妊娠結局的效果比較. 中國婦幼保健, 2008, 23(31): 4445-4446.
13. 張力, 喬麗雅. 定君生膠囊用于妊娠期細菌性陰道病的臨床觀察. 中國優生與遺傳雜志, 2007, 15(9): 77-78.
14. 陳萍英, 劉淮, 陳寧寧, 等. 臨床干預對妊娠晚期細菌性陰道病不良妊娠結局的預防效果研究. 中國婦幼保健, 2008, 23(29): 4117-4118.
15. McGregor JA, French JI. French, CNM, MS. Bacterial vaginosis in pregnancy. Obstetrical and Gynecological Survey, 2000, 55(50) (supplement 1).
16. 曹澤毅, 等. 中華婦產科學臨床版. 第1版. 北京: 人民衛生出版社, 2010, 21: 232-233.
17. Thorsen P, Vogel I, Molsted K, et al. Risk factors for bacterial vaginosis in pregnancy: a population-based study on Danish women. Acta Obstetricia and Gynecologica Scandinavica, 2006, 8(85): 906-911.
18. Caro-Patón T , Carvajal A, de Diego IM, et al. Is metronidazole teratogenic? A meta-analysis. British Journal of Clinical Pharmacology, 2003, 44(2): 179-182.
19. Ugwumadu AH, Hay P, et al. Bacterial vaginosis: sequelae and management. Current Opinion in infectious Diseases, 1999, 12(1): 53-59.
20. Hendler I, Andrews WW, et al. The relationship between resolution of asymptomatic bacterial vaginosis and spontaneous preterm birth in fetal fibronectin-positive women. American Journal of Obstetrics and Gynecology, 2007, 197(5): 488.e1-488.e5.
21. Camargo RP, Simoes JA, et al. Impact of treatment for bacterial vaginosis on prematurity among Brazilian pregnant women: a retrospective cohort study. Sao Paulo Medical Journal, 2005, 123(3): 108-120.
22. Shennan A, Crawshaw S, Briley A, et al. A randomized controlled trial of metronidazole for the prevention of preterm birth in women positive for cervicovaginal fetal fibronectin: the PREMET Study. BIOG: An International Journal of Obstetrics and Gynaecology, 2005, 113(1): 65-74.
23. Carey JC, Klebanoff MA, et al. Is a change in the vaginal flora associated with an increased risk of preterm birth? American Journal of Obstetrics and Gynecology, 2005, 192(4): 1341-1346.
24. Varma R, Gupta JK, et al. Antibiotic treatment of bacterial vaginosis in pregnancy: multiple meta-analyses and dilemmas in interpretation. Eur J Obstet Gynecol Reprod Biol, 2006, 124(1): 10-14.
25. Marcone V, Calzolari E, et al. Effectiveness of vaginal administration of Lactobacillus rhamnosus following conventional metronidazole therapy: how to lower the rate of bacterial vaginosis recurrences. New Microbiol, 2008, 31(3): 429-433.
26. Mastromarino P, Macchia S, et al. Effectiveness of Lactobacillus-containing vaginal tablets in the treatment of symptomatic bacterial vaginosis. Clinical Microbiology and Infection, 2008, 15(1): 67-74.
27. Tsvetkov K, Vasileva P, et al. Probiotics in the treatment and prevention of bacterial vaginosis relapses. Akush Ginekol(Sofiia), 2007, 46(2): 41.

《中國循證醫學雜志》

乳酸桿菌活菌制劑與甲硝唑類制劑治療妊娠合并細菌性陰道病的系統評價

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《中國循證醫學雜志》

乳酸桿菌活菌制劑與甲硝唑類制劑治療妊娠合并細菌性陰道病的系統評價

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