乳酸杆菌活菌制剂与甲硝唑类制剂治疗妊娠合并细菌性阴道病的系统评价_《中国循证医学杂志》

作者：

赵腾飞 ,  钟玲 , 罗丹

重庆医科大学附属第二医院妇产科（重庆 400010）;

关键词：

乳酸杆菌活菌制剂甲硝唑制剂妊娠细菌性阴道病系统评价

DOI：

10.7507/1672-2531.20100592

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　比较乳酸杆菌活菌制剂与甲硝唑类制剂治疗妊娠合并细菌性阴道病的疗效及对妊娠结局的影响。
方法　计算机检索PubMed、Cochrane图书馆、VIP、CNKI、万方数据库、中国生物医学文献数据库、西文生物医学期刊文献数据库、康健临床决策循证数据库等，纳入乳酸杆菌活菌制剂与甲硝唑类制剂比较治疗妊娠合并细菌性阴道病（BV）的疗效及对妊娠结局影响的随机对照试验（RCT）。对纳入RCT进行质量评价，采用RevMan 5.0.24软件进行Meta分析。
结果　最终纳入8篇文献，共计1 687例受试者。Meta分析结果显示：两组疗效差异无统计学意义［RR=1.04，95%CI（1.00，1.08），P=0.08］；乳酸杆菌活菌制剂治疗后复发率低，差异具有统计学意义［RR=0.16，95%CI（0.06，0.43），P=0.000 4］；乳酸杆菌活菌制剂治疗的早产发生率低于对照组［RR=0.56，95%CI（0.33，0.94），P=0.03］，差异具有统计学意义；而胎膜早破、产褥感染、低体重儿、新生儿感染、新生儿黄疸等妊娠结局发生率方面，两组差异无统计学意义。
结论　① 乳酸杆菌制剂与甲硝唑类制剂治疗妊娠合并BV的疗效相似。② 乳酸杆菌制剂治疗妊娠合并BV的复发率低于甲硝唑类制剂。③ 乳酸杆菌制剂治疗妊娠合并BV后早产的发生率低于甲硝唑类制剂，但对于治疗后胎膜早破、产褥感染、低体重儿、新生儿感染、新生儿黄疸等妊娠结局发生率两者无明显差异。

引用本文： 赵腾飞,钟玲,罗丹. 乳酸杆菌活菌制剂与甲硝唑类制剂治疗妊娠合并细菌性阴道病的系统评价. 中国循证医学杂志, 2010, 10(11): 1338-1344. doi: 10.7507/1672-2531.20100592 复制

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.	马延琴, 康雪萍. 乳酸菌胶囊在治疗妊娠合并细菌性阴道病中的应用. 陕西医学杂志, 2008, 37(2): 253-254.
8.	刘冬梅, 孟瑞雪, 高淑丽, 等. 活性乳酸杆菌制剂治疗妊娠期细菌性阴道病疗效观察及其对妊娠结局的影响. 华中科技大学学报（医学版）, 2006, 35(4): 555-558.
9.	田志红, 黄醒华. 妊娠期细菌性阴道病的研究. 中国妇幼保健, 2007, 22(4): 437-440.
10.	李煜, 冯建文, 刘玲, 等. 乳酸杆菌治疗妊娠合并细菌性阴道病临床观察. 海南医学, 2006, 17(2): 18, 49.
11.	乔丽雅, 田可歌, 宋平, 等. 乳杆菌活菌胶囊治疗妊娠期细菌性阴道病的临床观察. 中国优生与遗传杂志, 2006, 14(9): 27-28.
12.	卫爱民, 叶春萍, 哈宝书, 等. 3种方法治疗妊娠期细菌性阴道病及预防不良妊娠结局的效果比较. 中国妇幼保健, 2008, 23(31): 4445-4446.
13.	张力, 乔丽雅. 定君生胶囊用于妊娠期细菌性阴道病的临床观察. 中国优生与遗传杂志, 2007, 15(9): 77-78.
14.	陈萍英, 刘淮, 陈宁宁, 等. 临床干预对妊娠晚期细菌性阴道病不良妊娠结局的预防效果研究. 中国妇幼保健, 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.	曹泽毅, 等. 中华妇产科学临床版. 第1版. 北京: 人民卫生出版社, 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. 马延琴, 康雪萍. 乳酸菌胶囊在治疗妊娠合并细菌性阴道病中的应用. 陕西医学杂志, 2008, 37(2): 253-254.
8. 刘冬梅, 孟瑞雪, 高淑丽, 等. 活性乳酸杆菌制剂治疗妊娠期细菌性阴道病疗效观察及其对妊娠结局的影响. 华中科技大学学报（医学版）, 2006, 35(4): 555-558.
9. 田志红, 黄醒华. 妊娠期细菌性阴道病的研究. 中国妇幼保健, 2007, 22(4): 437-440.
10. 李煜, 冯建文, 刘玲, 等. 乳酸杆菌治疗妊娠合并细菌性阴道病临床观察. 海南医学, 2006, 17(2): 18, 49.
11. 乔丽雅, 田可歌, 宋平, 等. 乳杆菌活菌胶囊治疗妊娠期细菌性阴道病的临床观察. 中国优生与遗传杂志, 2006, 14(9): 27-28.
12. 卫爱民, 叶春萍, 哈宝书, 等. 3种方法治疗妊娠期细菌性阴道病及预防不良妊娠结局的效果比较. 中国妇幼保健, 2008, 23(31): 4445-4446.
13. 张力, 乔丽雅. 定君生胶囊用于妊娠期细菌性阴道病的临床观察. 中国优生与遗传杂志, 2007, 15(9): 77-78.
14. 陈萍英, 刘淮, 陈宁宁, 等. 临床干预对妊娠晚期细菌性阴道病不良妊娠结局的预防效果研究. 中国妇幼保健, 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. 曹泽毅, 等. 中华妇产科学临床版. 第1版. 北京: 人民卫生出版社, 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.

《中国循证医学杂志》

乳酸杆菌活菌制剂与甲硝唑类制剂治疗妊娠合并细菌性阴道病的系统评价

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《中国循证医学杂志》

乳酸杆菌活菌制剂与甲硝唑类制剂治疗妊娠合并细菌性阴道病的系统评价

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