30 | 0 | 10 |
下载次数 | 被引频次 | 阅读次数 |
生殖道微生物对保持盆腔内外环境的菌群平衡状态、促进子宫内膜修复、预防宫腔粘连(IUA)复发起到关键作用。中西医结合治疗方案在平衡生殖道微生物菌群、调节阴道微生态环境、改善宫腔局部免疫功能等方面展现出巨大潜力,可能成为治疗IUA的新突破点。本文对中西医结合调控生殖道微生物治疗IUA的认识、相关作用机制、具体方法进行综述,旨在为IUA的临床治疗提供新的思路和方法。
Abstract:The reproductive tract microbiota plays a crucial role in maintaining the balance of microbial communities within and outside the pelvic environment, promoting endometrial repair, and preventing the recurrence of intrauterine adhesions(IUAs). Integrative treatments combining traditional Chinese and western medicine show great potential in balancing reproductive microbiota, regulating vaginal microecological environments, and improving local immune function within the uterine cavity, which could become a new breakthrough in the treatment of IUAs. This article reviews the understanding, mechanisms of action, and therapeutic approaches of integrative medicine in the treatment of IUAs through the modulation of reproductive microbiota, aiming to provide new insights and methods for clinical treatment.
[1] 中华医学会妇产科学分会.宫腔粘连临床诊疗中国专家共识[J].中华妇产科杂志,2015,50:881-887.
[2] 石薇,牛晓宇,陈悦悦,等.盆底神经肌肉电刺激治疗薄型子宫内膜患者的临床研究[J].中华妇幼临床医学杂志(电子版),2021,17:215-220.
[3] Salazar CA,Isaacson K,Morris S.A comprehensive review of Asherman’s syndrome:causes,symptoms and treatment options[J].Curr Opin Obstet Gynecol,2017,29:249-256.
[4] Chen X,Lu Y,Chen T,et al.The female vaginal microbiome in health and bacterial vaginosis[J].Front Cell Infect Microbiol,2021,11:2235-2988.
[5] 刘芬婷,杨硕,周平,等.女性生殖道菌群与细胞因子紊乱对反复着床失败的影响[J].中华生殖与避孕杂志,2024,44:8-15.
[6] 赵子童,毛雪涛,郑艺,等.生殖道微生物群与宫腔粘连的相关性研究进展[J].中南大学学报,2022,47:1495-1503.
[7] Al-Nasiry S,Ambrosino E,Schlaepfer M,et al.The interplay between reproductive tract microbiota and immunological system in human reproduction[J].Front Immunol,2020,11:378-397.
[8] Kovachev SM.Obstetric and gynecological diseases and complications resulting from vaginal dysbacteriosis[J].Microb Ecol,2014,68:173-184.
[9] 薛凤霞,王宝晨,王辰.下生殖道感染诊治中面临的问题与挑战[J].中国妇产科临床杂志,2016,17:481-482.
[10] 姜梦杰,唐浩能,唐玲丽.宏基因组学技术在女性生殖道疾病中应用的研究进展[J].中华预防医学杂志,2023,57:172-178.
[11] Al-Nasiry S,Ambrosino E,Schlaepfer M.Investigation of the microbiota of the reproductive tract in women undergoing a total hysterectomy and bilateral salpingo-oopherectomy[J].Fertil Steril,2017,107:813-820.
[12] Coudray MS,Madhivanan P.Bacterial vaginosis-A brief synopsis of the literature[J].Eur J Obstet Gynecol Reprod Biol,2020,245:143-148.
[13] 张慧珍,靳双玲,纪爱芳,等.HR-HPV感染宫颈鳞状上皮内病变与阴道菌群关系的研究[J].长治医学院学报,2020,34:351-354.
[14] 张碧云,钟兴明,王晓霞,等.子宫内膜乳酸杆菌主导的微生物群与生殖的关系[J].实用医学杂志,2024,40:898-903.
[15] 丘甜美,蔡慧华,何援利,等.基于Illumina测序分析宫腔粘连患者子宫内膜菌群多样性[J].现代妇产科进展,2020,8:588-592.
[16] Qiu T,Liu L,Zhou H,et al.Analysis of endometrial microbiota in intrauterine adhesion by high-throughput sequencing[J].Ann Transl Med,2021,9:195-195.
[17] Wang Y,Zhao Y,Ge Y,et al.Reproductive outcomes and reproductive tract microbiota shift in women with moderate-to-severe intrauterine adhesions following 30-day post-hysteroscopic placement of balloon stents or intrauterine contraceptive devices:A randomized controlled trial[J].E Clinical Medicine,2022,43:101200.
[18] Xiang R,Li M,Gu Z,et al.Chronic endometritis positively correlates with the aggravation of intrauterine adhesions but has limited effects on reproductive prognosis with antibiotic application[J].Int J Gynecol Obstet,2023,160:986-992.
[19] Zhang L,Wang M,Zhang Q,et al.Estrogen therapy before hysteroscopic adhesiolysis improves the fertility outcome in patients with intrauterine adhesions[J].Arch Gynecol Obstet,2019,300:933-939.
[20] 陈曦,段华,张颖.微生物群与子宫内膜异位症发病关系的研究进展[J].中国医刊,2020,55:1179-1181.
[21] Dreisler E,Kjer JJ.Asherman’s syndrome:current perspectives on diagnosis and management[J].Int J Womens Health,2019,11:191-198.
[22] Senok AC,Verstraelen H,Temmerman M,et al.Probiotics for the treatment of bacterial vaginosis[J].Cochrane Database Syst Rev,2009(4):CD006289.
[23] Lev-Sagie A,Goldman-Wohl D,Cohen Y,et al.Vaginal microbiome transplantation in women with intractable bacterial vaginosis[J].Nat Med,2019,25:1500-1504.
[24] 马宝璋,齐聪.中医妇科学[M].北京:中国中医药出版社,2015:126.
[25] Bu QR,Bao MY,Yang Y,et al.Targeting virulence factors of Candida albicans with natural products[J].Foods,2022,11:2951.
[26] Huang Z,Pan X,Zhou J,et al.Chinese herbal medicine for acute upper respiratory tract infections and reproductive safety:a systematic review[J].Biosci Trends,2019,13:117-129.
[27] Zhang L,Wang X,Wang R,et al.Baicalin potentiates TRAIL-induced apoptosis through p38 MAPK activation and intracellular reactive oxygen species production[J].Mol Med Rep,2017,16:8549-8555.
[28] Wang Y,Nie XB,Liu SJ,et al.Curcumol attenuates endometriosis by inhibiting the JAK2/STAT3 signaling pathway[J].Med Sci Monit,2022,28:e934914.
[29] 苏佳丽,魏绍斌.中医药从微生态角度防治盆腔炎性疾病反复发作的研究进展[J].湖南中医杂志,2024,40:228-232.
[30] Shi T,Hou C,Duan Y,et al.Mechanism of Smilax china L.in the treatment of intrauterine adhesions based on network pharmacology,molecular docking and experimental validation[J].BMC Complementary Med Ther,2024,24:1-16.
[31] 赵行平,何书涵,尤昭玲,等.中药养膜方改善宫腔镜下宫腔粘连分离术后宫腔粘连的预后[J].中南大学学报(医学版),2022,47:1540-1549.
[32] 张敏敏,刘淑华.补肾活血方调节TGF-β1/Smad信号通路治疗宫腔粘连临床研究[J].浙江中西医结合杂志,2024,34:233-236.
[33] 侯梦卉,李莹,张清钥,等.基于微生态失衡的子宫内膜异位症致病机制及中药干预治疗研究进展[J].天津中医药,2024,41:537-544.
[34] Wang XR,Hao HG,Chu L.Glycyrrhizin inhibits LPS-induced inflammatory mediator production in endometrial epithelial cells[J].Microb Pathog,2017,109:110-113.
[35] 何月萍,黄健妹,陈敏,等.六味地黄汤治疗细菌性阴道病的疗效及对阴道菌群和免疫功能的影响[J].临床合理用药,2024,17:3634-3640.
[36] Li L,Deng J,Lin LM,et al.Metabolomics and pharmacodynamic analysis reveal the therapeutic role of Prunella vulgaris oil on intrauterine adhesion rats[J].J Pharm Biomed Anal,2022,209:114532.
[37] 陶丽丹,贾旺.加味生化汤联合透明质酸钠宫腔注入治疗稽留流产临床研究[J].陕西中医,2021,42:857-859.
[38] 王英,潘丽贞,吴聚文.益肾养膜汤联合丹参宫腔灌注治疗中重度宫腔粘连术后临床研究[J].现代中医药,2022,42:135-138.
[39] 卓缘圆,宁艳,林彦廷,等.针刺对卵巢早衰患者血清激素及生殖道菌群的影响[J].针灸临床杂志,2023,12:1-6.
[40] Liu J,Zhu Q,Pan Y,et al.Electroacupuncture alleviates intrauterine adhesion through regulating autophagy in rats[J].Mol Hum Reprod,2023,29:gaad037.
[41] 王果连,田丽颖.针灸调理冲任对输卵管炎性阻塞性不孕症微生物感染情况的临床观察[J].中医药临床杂志,2017,29:1282-1284.
基本信息:
DOI:
中图分类号:R711.74
引用信息:
[1]潘慧,张琼,郭晓雅等.中西医结合调控生殖道微生物治疗宫腔粘连的研究进展[J].生殖医学杂志,2025,34(05):706-711.
基金信息:
国家自然科学基金项目(82305283)