Unlü Cihat, Donders Gilbert
Department of Obstetrics and Gynaecology, Acıbadem University, Bakırköy Hospital, İstanbul, Turkey.
Department of Obstetrics and Gynaecology, Regional Hospital Heilig Hart Tienen, University Hospital Gasthuisberg Leuven, and University Hospital Citadelle Liège, Liège, Belgium.
J Turk Ger Gynecol Assoc. 2011 Dec 1;12(4):239-46. doi: 10.5152/jtgga.2011.57. eCollection 2011.
To maintain a healthy vaginal ecosystem or to restore any disturbance, sufficient estrogen levels, an intact mature vaginal epithelium, and physiological lactobacillary microflora are essential. Thus, a combination of beneficial lactobacilli and estrogen is an appealing treatment option. This article reviews the published data on the use of viable Lactobacillus acidophilus KS400 and a low dose of estriol (0.03 mg E3) in the form of vaginal tablets (Gynoflor®). In vitro studies demonstrated that L. acidophilus KS400 produces lactic acid and hydrogen peroxide (H2O2), inhibits the growth of relevant vaginal pathogens, and inhibits adherence of pathogens to epithelial cells. Topical administration of E3 for treatment of vaginal diseases is generally preferred, as this route of application of hormones produces a more significant local proliferative response and has no stimulating effect on the endometrium. Overall, 16 clinical studies have been published with the combination of L. acidophilus KS400 and 0.03 mg E3. The results of these trials have demonstrated that the combination improves the vaginal epithelium and the restoration of the lactobacillary microflora with an excellent safety profile, even during pregnancy. The combination can be used in pre- and postmenopausal women for the restoration of the vaginal flora after anti-infective therapy, for treatment of symptomatic vaginal atrophy, and for abnormal vaginal flora therapy. It can be also considered in repetitive therapy courses for the long-term prevention of recurrences of bacterial vaginosis, even though further clinical studies are needed to substantiate the benefit of this application.
为维持健康的阴道生态系统或恢复任何紊乱状态，足够的雌激素水平、完整的成熟阴道上皮和生理性乳酸杆菌微生态群至关重要。因此，有益乳酸杆菌与雌激素的联合是一种有吸引力的治疗选择。本文综述了关于使用活的嗜酸乳杆菌KS400和低剂量雌三醇（0.03 mg E3）制成的阴道片（Gynoflor®）的已发表数据。体外研究表明，嗜酸乳杆菌KS400产生乳酸和过氧化氢（H2O2），抑制相关阴道病原体的生长，并抑制病原体与上皮细胞的黏附。局部应用E3治疗阴道疾病通常更受青睐，因为这种激素给药途径会产生更显著的局部增殖反应，且对子宫内膜无刺激作用。总体而言，已发表了16项关于嗜酸乳杆菌KS400与0.03 mg E3联合应用的临床研究。这些试验结果表明，该联合用药可改善阴道上皮并恢复乳酸杆菌微生态群，安全性良好，甚至在孕期也是如此。该联合用药可用于绝经前后女性，用于抗感染治疗后恢复阴道菌群、治疗有症状的阴道萎缩以及治疗异常阴道菌群。对于细菌性阴道病复发的长期预防，在重复治疗疗程中也可考虑使用，尽管还需要进一步的临床研究来证实这种应用的益处。
