DataSheet_2_Correlation Analysis of Vaginal Microbiome Changes and Bacterial Vaginosis Plus Vulvovaginal Candidiasis Mixed Vaginitis Prognosis.pdf

Mixed vaginitis is the result of the simultaneous presence of different pathogenic processes mediated by at least two types of vaginal pathogens. Among the various types of mixed vaginitis presentations, bacterial vaginosis (BV) plus vulvovaginal candidiasis (VVC) presents to be the most prevalent form. Mixed vaginitis affects the health of women of all ages worldwide. However, few studies have focused on clinical manifestations, pathogenesis, diagnostic criteria, or therapy of mixed vaginitis. We recruited 48 symptomatic patients with clinical diagnoses of VVC complicated with BV, they were treated with oral metronidazole combined with local clotrimazole and followed to assess the drug efficacy and vaginal microbiome alterations before and after treatment. The vaginal microbiome in BV+VVC mixed vaginitis patients was altered significantly after the combined drug treatment within a unique form different from a simple overlay mode of BV and VVC, the key bacteria including Gardnerella and Atopobium, Lactobacillus. The combined drug therapy for the mixed vaginitis in this study was effective and enhanced treatment for BV may be more favorable because of more difficulty in dealing with BV according to the treatment outcome. The abundance of Lactobacillus in patients with mixed vaginitis affects the recovery of the vaginal microbiome as well as the prognosis, and the abundance should be actively restored. This is the first study to investigate the composition, diversity, and other characteristics of the vaginal microbiome in patients with BV+VVC mixed vaginitis before and after drug treatment, our results provide clues to improving the cure rate and reducing recurrences.

混合性阴道炎是指至少两类阴道病原体介导的不同致病过程同时存在所引发的疾病。在各类混合性阴道炎的表现亚型中，细菌性阴道病（bacterial vaginosis, BV）合并外阴阴道假丝酵母菌病（vulvovaginal candidiasis, VVC）是最为普遍的类型。混合性阴道炎会对全球各年龄段女性的健康造成损害。然而目前针对混合性阴道炎的临床表现、发病机制、诊断标准及治疗方案的相关研究仍较为稀缺。本研究纳入了48例经临床诊断为VVC合并BV的有症状患者，给予口服甲硝唑联合局部克霉唑治疗，并对患者进行随访以评估治疗前后的药物疗效与阴道微生物组变化。BV+VVC型混合性阴道炎患者在接受联合药物治疗后，其阴道微生物组发生了显著改变，且这种改变并非BV与VVC病理状态的简单叠加，而是呈现出独特的模式，核心菌群包括加德纳菌属（Gardnerella）、阿托波菌属（Atopobium）以及乳杆菌属（Lactobacillus）。本研究采用的联合药物治疗对混合性阴道炎具有确切疗效；结合治疗结局来看，由于BV的清除难度更高，强化针对BV的治疗或许更有利于患者康复。混合性阴道炎患者体内乳杆菌属的丰度会影响阴道微生物组的恢复与疾病预后，因此需积极采取措施恢复其丰度。本研究是首个针对BV+VVC型混合性阴道炎患者药物治疗前后阴道微生物组的组成、多样性及其他特征展开的系统研究，研究结果为提升该病的治愈率、降低复发率提供了重要线索。