medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2022-16-5-25-30medsovet-6787Research ArticleРепродуктивное здоровье и ВРТReproductive health and ARTВосстановление микробиоты влагалища у пациенток с бактериальным вагинозомEvaluation of biomarkers in the studies of keloid tissue after laser therapyhttps://orcid.org/0000-0002-1462-4987ТихомировА. Л.TikhomirovA. L.

Тихомиров Александр Леонидович, д.м.н., Заслуженный врач РФ, профессор, профессор кафедры акушерства и гинекологии лечебного факультета

127473, Москва, ул. Делегатская, д. 20, стр. 1

Aleksander L. Tikhomirov, Dr. Sci. (Med.), Honored Doctor of the Russian Federation, Professor, Professor of the Department of Obstetrics and Gynecology of the Medical Faculty

20, Bldg. 1, Delegatskaya St., Moscow, 127473

pacificoff@mail.ruhttps://orcid.org/0000-0002-1599-0399КазенашевВ. В.KazenashevV. V.

Казенашев Виктор Викторович, к.м.н., ассистент кафедры акушерства и  гинекологии лечебного факультета

127473, Москва, ул. Делегатская, д. 20, стр. 1

Victor V. Kazenashev, Cand. Sci. (Med.), Assistant of the Department of Obstetrics and Gynecology of the Medical Faculty

20, Bldg. 1, Delegatskaya St., Moscow, 127473

vvkazenashev@gmail.comМосковский государственный медико-стоматологический университет имени А.И. ЕвдокимоваРоссияYevdokimov Moscow State University of Medicine and DentistryRussian Federation202219042022052530Copyright © Тихомиров А.Л., Казенашев В.В., 20222022Тихомиров А.Л., Казенашев В.В.Tikhomirov A.L., Kazenashev V.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6787

Основным метаболитом лактобактерий, регулирующим их противовоспалительные функции, является молочная кислота (МК), поддерживающая физиологическое состояние микробиоценоза влагалища женщин репродуктивного возраста. Нормоценоз влагалища базируется на сочетании кислой среды и колонизационной резистентности. Патогенные и условно-патогенные возбудители колонизируются преимущественно в  щелочной среде. МК является важным биологическим субстратом, поддерживающим микробиоту влагалища. В норме реакция влагалищного содержимого – pH от 3,8 до 4,5, и только в этом случае в биотопе преобладают лактобактерии, которые способны объединяться в особые сообщества – биопленки, формируя наиболее мощный фактор защиты влагалища от адгезии и инвазии патогенов: полноценная лактобациллярная биопленка нередко способна предотвращать адгезию даже возбудителей ИППП. Нарушение функционирования каждого из звеньев защиты вагинального микробиома приводит к  изменению рН среды обитания и  чрезмерному размножению условнопатогенных микроорганизмов. Частым инфекционным синдромом, сопровождающимся дисбалансом вагинальной микробиоты и  замещением лактофлоры на  различные виды анаэробных микроорганизмов (Gardnerella vaginalis, Ureaplasma urealyticum, Mycoplasma hominis, Mobiluncus, Prevotella), является бактериальный вагиноз. При назначении антибактериального лечения возможны побочные эффекты: аллергические реакции, гепатотоксичный, нефротоксичный эффекты, кандидоз. В обзоре представлена возможность применения МК, входящей в качестве основы в состав препарата Лактодепантол, – вагинальных суппозиториев, содержащих 100 мг МК в качестве основного фактора, регулирующего естественный состав микробиоты влагалища, и возможность использования вагинальных суппозиториев на основе МК (лактодепантол) для профилактики и лечения бактериального вагиноза в виде монотерапии и в комбинации с противомикробными препаратами.

The main metabolite of lactobacilli, regulating their anti-inflammatory functions, is lactic acid (LA), which maintains the physiological state of the microbiocenosis of the vagina of women of reproductive age. Normocenosis of the vagina is based on a combination of acidic environment and colonization resistance. Pathogenic and conditionally pathogenic pathogens are colonized mainly in  an alkaline environment. LA is an important biological substrate that supports the  vaginal microbiota. Normally, the reaction of the vaginal contents is a pH of 3.8 to 4.5, and only in this case lactobacilli predominate in the biotope, which are able to unite into special communities – biofilms, forming the most powerful factor in protecting the vagina from adhesion and invasion of pathogens: a full-fledged lactobacillary biofilm is often able to prevent adhesion of even STI pathogens. Disruption of the functioning of each of the links of protection of the vaginal microbiome leads to a change in the pH of the habitat and excessive reproduction of conditionally pathogenic microorganisms. A frequent infectious syndrome, accompanied by an imbalance of the vaginal microbiota and the replacement of lactoflora with various types of anaerobic microorganisms (Gardnerella vaginalis, Ureaplasma urealyticum, Mycoplasma hominis, Mobiluncus, Prevotella), is bacterial vaginosis. When prescribing antibacterial treatment, side effects are possible: allergic reactions, hepatotoxic, nephrotoxic, candidiasis. The review presents the possibility of using LA, which is a basis in the composition of the drug Lactodepantol (Femilex®) – vaginal suppositories containing 100 mg of LA, as the main factor regulating the natural composition of the vaginal microbiota and the possibility of using vaginal suppositories based on LA (lactodepantol) for the prevention and treatment of bacterial vaginosis in the form of monotherapy and in combination with antimicrobials.

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The authors declare that there are no conflicts of interest present.