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Lancet Oncol：阴道微生物群影响卵巢癌风险？

2019-07-26 Vina MedSci原创

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与健康对照和非突变携带者相比，50岁以下被诊断患有卵巢癌或携带增加卵巢癌风险的BRCA1突变的女性在其子宫颈阴道微生物群中的保护性细菌水平较低。该发现来自于7月9日在线发表在《柳叶刀肿瘤学》上的病例对照研究。研究人员推测，在患有卵巢癌或有患卵巢癌风险的女性中，微生物群缺乏保护性乳酸杆菌的事实表明，阴道微生物群与患病率增加之间可能具有因果关系。然而，他们补充道，现在还不能说用益生菌栓剂恢复宫

与健康对照和非突变携带者相比，50岁以下被诊断患有卵巢癌或携带增加卵巢癌风险的BRCA1突变的女性在其子宫颈阴道微生物群中的保护性细菌水平较低。

该发现来自于7月9日在线发表在《柳叶刀肿瘤学》上的病例对照研究。

研究人员推测，在患有卵巢癌或有患卵巢癌风险的女性中，微生物群缺乏保护性乳酸杆菌的事实表明，阴道微生物群与患病率增加之间可能具有因果关系。

然而，他们补充道，现在还不能说用益生菌栓剂恢复宫颈阴道微生物群可降低卵巢癌风险。

社论作家、比利时根特大学的Hans Verstraelen博士提出对此持怀疑态度。

他解释说，在大多数人群中，年轻女性的阴道微生物群主要由乳酸杆菌控制，并且在偏离正常阴道微生物状态的女性中能观察到不良的生殖健康结果。

“然而，阴道也是一个高度动态的生态系统，”Verstraelen指出，“仅通过一次微生物群评估，作者的发现可能存在错误分类偏差的风险，”他指出。

Verstraelen建议，更重要的问题是探明阴道微生物群如何促进卵巢癌。

可能阴道微生物群仅仅反映了一些可能与卵巢癌发生有关的外在因素的共同影响。例如，吸烟被认为会对乳酸杆菌的优势产生负面影响，而口服避孕药和激素替代疗法被认为会促进乳酸杆菌的增殖，他指出。

“一些研究人员认为，阴道微生物群可以作为上生殖道的所谓微生物种子库，”Verstraelen补充道，这表明卵巢癌中卵巢外来源的作用。

“总的来说，没有直接的证据证明人类微生物群在癌症因果关系中具有关键作用，”Verstraelen强调说。

“但在未来的研究中需要考虑微生物群，”他在这点上同研究作者一致。

开创性的研究
“据我们所知，这项研究是卵巢癌女性和卵巢癌高风险女性宫颈阴道微生物组的首例病例对照分析，”英国伦敦大学学院的首席研究员Nuno Nene博士及其同事评论道。  

“一旦确定卵巢癌发展的社区O型宫颈阴道微生物群（即乳酸杆菌<50％的物种）的功能相关性，在BRCA1突变的年轻携带者中进行阴道乳酸杆菌移植可以作为降低风险的措施，”他们建议。

在健康女性中，宫颈阴道微生物群主要由四种不同种类的乳杆菌组成。作者解释说，乳酸杆菌通过产生乳酸降低阴道pH值以及其他机制来预防泌尿生殖系统疾病。

他们还表示，较低的阴道pH可能会降低上行性感染的风险。

FORECEE计划
阴道微生物群研究是欧洲进行的多中心FORECEE（4C）计划的一部分，该计划涉及18-87岁的女性。

一个队列由360个人组成，其中176人患有上皮性卵巢癌（主要是浆液性，高级别疾病），115人是健康对照，69人是良性妇科疾病的对照组。

该BRCA组由220名妇女，109人有高达BRCA1基因突变，97人健康对照组，14例良性妇科疾病的控制。

使用ThinPrep系统（Hologic，Marlborough，Massachusetts）从所有参与者收集宫颈阴道涂片样品并进行基因测序。

“对于每个样本，我们计算了乳酸杆菌种类（即Lactobacillus crispatus，Lactobacillus iners，Lactobacillus gasseri和Lactobacillus jensenii）的比例，这些对于在子宫颈阴道微生物群中产生保护性低阴道pH值至关重要，”作者指出。

然后将样品分组成乳酸杆菌占存在物种的至少50％（群落类型I）和乳酸杆菌占存在物种的少于50％（群落类型O）的样品。

年轻 vs 老年患者
结果显示，与没有卵巢癌病史者相比，50岁以下的卵巢癌患者在宫颈阴道样本中携带低于50％的乳酸杆菌的可能性几乎是其三倍（比值比[OR]， 2.8; P = .20）。

同样，50岁以下携带BRCA1突变的女性阴道微生物群中乳酸杆菌水平的可能性几乎是未携带突变的女性的三倍（OR，2.79; P = .012）。     

“如果不止一个直系家庭成员受到任何癌症的影响，这种风险会进一步增加，”研究作者指出。该亚组患者的风险增加了五倍以上（OR，5.26; P = .0022）。

在卵巢癌和BRCA1队列中，研究人员观察到女性越年轻，乳酸杆菌水平低与卵巢癌风险之间的联系越强。

例如，与乳酸杆菌水平较高的女性相比，40岁以下女性阴道微生物群中乳酸杆菌水平较低的女性患卵巢癌的可能性要高7倍（OR，7.00; P = .025）。

BRCA组35岁以下女性发生卵巢癌的可能性是乳酸杆菌水平低的4倍，与乳酸杆菌水平较高的女性相比，OR值为4.40（P = .031） 。

相比之下，“卵巢癌队列中50岁及以上女性的宫颈阴道样本中，O型社区的患病率高于1型社区，”Nene及其同事指出。但是，两组之间的差异并不显著。

他们补充说，阴道微生物组中乳酸杆菌含量超过50％的老年女性与乳酸杆菌含量低于50％的女性之间的差异也不显著。

“在这项研究中，我们发现，与年龄相匹配的健康女性和没有BRCA1的女性相比，卵巢癌患者和尚未患癌症的BRCA1突变女性患有非乳酸杆菌为主的宫颈阴道微生物组的女性患病率更高。或分别为BRCA2突变，“Nene指出。

他们推测，“无论疾病阶段如何，卵巢癌患者社区I型微生物群的值低于健康对照的发现表明，这种I型微生物群的流行率降低可能是因果关系而非间接关系。”

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    2020-04-12 minlingfeng

    #Oncol#

    0

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    2019-11-24 howi

    #Lancet#

    0

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    2019-07-30 wjcjjian

    #微生物#

    0

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    2020-05-15 sjq027

    #癌风险#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1865683, encodeId=71471865683ee, content=<a href='/topic/show?id=16ce133504e' target=_blank style='color:#2F92EE;'>#Oncol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=17, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13350, encryptionId=16ce133504e, topicName=Oncol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Sun Apr 12 10:25:00 CST 2020, time=2020-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1830171, encodeId=692e18301e153, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Sun Nov 24 17:25:00 CST 2019, time=2019-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1825068, encodeId=83fb1825068d7, content=<a href='/topic/show?id=702a5065860' target=_blank style='color:#2F92EE;'>#微生物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50658, encryptionId=702a5065860, topicName=微生物)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0b7c20, createdName=wjcjjian, createdTime=Tue Jul 30 01:25:00 CST 2019, time=2019-07-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2061867, encodeId=0839206186e7f, content=<a href='/topic/show?id=e6e1e15509f' target=_blank style='color:#2F92EE;'>#癌风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71550, encryptionId=e6e1e15509f, topicName=癌风险)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d58a435, createdName=sjq027, createdTime=Fri May 15 05:25:00 CST 2020, time=2020-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1367787, encodeId=5782136e787c7, content=<a href='/topic/show?id=2cee50e22c6' target=_blank style='color:#2F92EE;'>#微生物群#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50722, encryptionId=2cee50e22c6, topicName=微生物群)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3609256, createdName=zhu_jun9837, createdTime=Sun Jul 28 00:25:00 CST 2019, time=2019-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1037883, encodeId=8a3d103e88364, content=谢谢梅斯分享这么多精彩信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=anti-cancer, createdTime=Fri Jul 26 12:25:00 CST 2019, time=2019-07-26, status=1, ipAttribution=)]
    2019-07-28 zhu_jun9837

    #微生物群#

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1865683, encodeId=71471865683ee, content=<a href='/topic/show?id=16ce133504e' target=_blank style='color:#2F92EE;'>#Oncol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=17, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13350, encryptionId=16ce133504e, topicName=Oncol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Sun Apr 12 10:25:00 CST 2020, time=2020-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1830171, encodeId=692e18301e153, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Sun Nov 24 17:25:00 CST 2019, time=2019-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1825068, encodeId=83fb1825068d7, content=<a href='/topic/show?id=702a5065860' target=_blank style='color:#2F92EE;'>#微生物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50658, encryptionId=702a5065860, topicName=微生物)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0b7c20, createdName=wjcjjian, createdTime=Tue Jul 30 01:25:00 CST 2019, time=2019-07-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2061867, encodeId=0839206186e7f, content=<a href='/topic/show?id=e6e1e15509f' target=_blank style='color:#2F92EE;'>#癌风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71550, encryptionId=e6e1e15509f, topicName=癌风险)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d58a435, createdName=sjq027, createdTime=Fri May 15 05:25:00 CST 2020, time=2020-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1367787, encodeId=5782136e787c7, content=<a href='/topic/show?id=2cee50e22c6' target=_blank style='color:#2F92EE;'>#微生物群#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50722, encryptionId=2cee50e22c6, topicName=微生物群)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3609256, createdName=zhu_jun9837, createdTime=Sun Jul 28 00:25:00 CST 2019, time=2019-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1037883, encodeId=8a3d103e88364, content=谢谢梅斯分享这么多精彩信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=anti-cancer, createdTime=Fri Jul 26 12:25:00 CST 2019, time=2019-07-26, status=1, ipAttribution=)]
    2019-07-26 anti-cancer

    谢谢梅斯分享这么多精彩信息

    0