乳杆菌在阴道-子宫内膜菌群稳态及生殖健康中的作用

doi:10.12280/gjfckx.20250721

摘要/Abstract

摘要：

女性生殖道微生态平衡是维系生殖健康的核心，乳杆菌属作为优势菌群发挥关键作用。阴道内，卷曲乳杆菌、詹氏乳杆菌等菌种占主导，可通过产酸、分泌抗菌物质及免疫调节维持环境稳定，是健康微生态的标志；而惰性乳杆菌占主导或高多样性状态则增加细菌性阴道病、人乳头瘤病毒（human papilloma virus，HPV）持续感染及早产风险，但惰性乳杆菌的功能受菌株来源和宿主状态影响。多项16S rRNA测序研究显示，子宫内膜可检出低生物量的微生物群落，其群落组成是否以乳杆菌占主导仍存争议。宫腔微生态失调（乳杆菌减少、致病菌增多或特定菌富集）与慢性子宫内膜炎、宫腔粘连及子宫内膜异位症等密切相关。目前在干预策略方面，应用特定益生菌株或靶向工程菌在辅助治疗细菌性阴道病或HPV感染、预防宫腔粘连术后复发及促进内膜修复方面具有潜力。然而，现有证据级别、菌株选择精准性及工程菌转化应用仍存在挑战。未来需深入菌株与功能基因水平研究，结合多组学与严格方法学，推动女性生殖道微生态精准诊疗。

关键词: 乳杆菌属, 子宫内膜菌群, RNA，核糖体，16S, 生态失调, 生殖器疾病，女（雌）性

Abstract:

The microecological balance of the female reproductive tract is the core of maintaining reproductive health, and the genus Lactobacillus, as the dominant flora, plays a crucial role. In the vagina, the dominant species such as Lactobacillus crispatus and Lactobacillus jensenii can maintain environmental stability through acid production, secretion of antibacterial substances, and immune regulation, which is a sign of a healthy microecology. In contrast, the dominance of Lactobacillus iners or a state of high diversity increases the risks of bacterial vaginosis, persistent human papilloma virus (HPV) infection, and preterm birth. However, the function of Lactobacillus iners is affected by the strain source and host status. Multiple 16S rRNA sequencing studies have shown that a low-biomass microbiota community can be detected in the endometrium, and there is still controversy over whether Lactobacillus is the dominant genus in its community composition. Uterine cavity microecological dysbiosis (decrease in Lactobacillus, increase in pathogenic bacteria, or enrichment of specific bacteria) is closely related to chronic endometritis, intrauterine adhesions, and endometriosis. Currently, in terms of intervention strategies, the application of specific probiotic strains or targeted engineered bacteria has potential in the adjuvant treatment of bacterial vaginosis or HPV infection, prevention of recurrence after intrauterine adhesion surgery, and promotion of endometrial repair. However, there are still challenges in the level of existing evidence, the precision of strain selection, and the translational application of engineered bacteria. In the future, in-depth research at the strain and functional gene levels, combined with multi-omics and strict methodologies, is needed to promote the precise diagnosis and treatment of the female reproductive tract microecology.

Key words: Lactobacillus, Gastrointestinal microbiome, RNA, ribosomal, 16S, Dysbiosis, Genital diseases, female

蒋杰, 陶增, 罗伊洋. 乳杆菌在阴道-子宫内膜菌群稳态及生殖健康中的作用[J]. 国际妇产科学杂志, 2025, 52(6): 629-633.

JIANG Jie, TAO Zeng, LUO Yi-yang. Role of Lactobacillus in the Vaginal-Endometrial Microbiota Homeostasis and Reproductive Health[J]. Journal of International Obstetrics and Gynecology, 2025, 52(6): 629-633.

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