背景:先前的研究已经报道了与对照组相比,混合性尿失禁女性的特定分类群和社区差异。因此,研究人员提出了一个假设,即较高的泌尿和阴道微生物组多样性与尿失禁严重程度增加相关.
目的:本研究旨在测试特定的尿液或阴道微生物群落类型是否与女性混合性尿失禁的严重程度相关。
方法:这个计划的次要,横断面分析评估了泌尿和阴道微生物组与尿失禁严重程度之间的关联,包括对混合性尿失禁患者进行运动增强手术治疗效果的子部分。使用在基线时收集的膀胱日记和尿路不适问卷测量失禁严重程度。在基线治疗前同时收集导管化尿液样品和阴道拭子以评估泌尿和阴道微生物组。值得注意的是,对V4至V6可变区的16SrRNA进行测序,使用DADA2管道和SILVA数据库将细菌分类单元表征为属水平。使用Dirichlet多项混合方法,样本根据核心分类单元分为群落类型。社区类型与严重程度衡量标准之间的关联(尿路窘迫量表总分,尿路窘迫量表子量表得分,和尿失禁发作次数[总数,紧迫性,和压力]来自膀胱日记),使用线性回归模型对年龄和体重指数进行了调整。此外,分析了丰富度(分类群总数)和均匀度(分类群丰度的比例分布)的α多样性指标与尿失禁发作和社区类型的关联。
结果:总体而言,确定了6种尿液微生物群落类型,以不同水平的普通属(乳酸杆菌,加德纳菌,普雷沃氏菌,Tepidimonas,Acidovorax,埃希氏菌,和其他人)。对126名混合性尿失禁参与者的尿失禁严重程度的分析确定了乳杆菌为主的参考组,其中乳杆菌的丰度最高(平均相对丰度为76%)。以乳酸杆菌较少(平均相对丰度为19%)和较高的α多样性为特征的社区与较高的总尿失禁发作有关(2.67日泄漏;95%置信区间,0.76-4.59;P=.007)和急迫性尿失禁发作(1.75每日泄漏;95%置信区间,0.24-3.27;P=.02)比参考组。在社区类型和压力性尿失禁发作或泌尿生殖器不适量表总数或得分之间没有观察到显着关联。阴道群落类型和泌尿群落类型的组成相似,但由略有不同的细菌分类群组成。阴道社区类型与尿失禁严重程度无关,通过膀胱日记或泌尿生殖道窘迫量表总分和子量表得分来衡量。α多样性表明,更大的样本丰富度与尿液中更多的失禁发作有关(观察到的P=.01属)。均匀度(Shannon和Pielou)与尿失禁或阴道微生物组的严重程度无关。
结论:在患有混合性尿失禁的女性的泌尿系统中,与单个属占主导地位的社区类型相比,乳杆菌较少,细菌更多样化的社区类型与更严重的尿失禁发作(总体和紧迫性)有关。乳酸杆菌.混合性尿失禁的严重程度是否归因于乳酸菌的较少优势,其他非乳杆菌属的存在更多,或由泌尿生物群落类型组成的细菌的补体仍有待确定。
BACKGROUND: Urinary microbiome (urobiome) studies have previously reported on specific taxa and community differences in women with mixed urinary incontinence compared with controls. Therefore, a hypothesis was made that higher urinary and vaginal microbiome diversity would be associated with increased urinary incontinence severity.
OBJECTIVE: This study aimed to test whether specific urinary or vaginal microbiome community types are associated with urinary incontinence severity in a population of women with mixed urinary incontinence.
METHODS: This planned secondary, cross-sectional analysis evaluated associations between the urinary and vaginal microbiomes and urinary incontinence severity in a subset of Effects of Surgical Treatment Enhanced With Exercise for Mixed Urinary Incontinence trial participants with urinary incontinence. Incontinence severity was measured using bladder diaries and Urinary Distress Inventory questionnaires collected at baseline. Catheterized urine samples and vaginal swabs were concurrently collected before treatment at baseline to assess the urinary and vaginal microbiomes. Of note, 16S rRNA V4 to V6 variable regions were sequenced, characterizing bacterial taxa to the genus level using the DADA2 pipeline and SILVA database. Using Dirichlet multinomial mixtures methods, samples were clustered into community types based on core taxa. Associations between community types and severity measures (Urinary Distress Inventory total scores, Urinary Distress Inventory subscale scores, and the number of urinary incontinence episodes [total, urgency, and stress] from the bladder diary) were evaluated using linear regression models adjusted for age and body mass index. In addition, alpha diversity measures for richness (total taxa numbers) and evenness (proportional distribution of taxa abundance) were analyzed for associations with urinary incontinence episodes and community type.
RESULTS: Overall, 6 urinary microbiome community types were identified, characterized by varying levels of common genera (Lactobacillus, Gardnerella, Prevotella, Tepidimonas, Acidovorax, Escherichia, and others). The analysis of urinary incontinence severity in 126 participants with mixed urinary incontinence identified a Lactobacillus-dominated reference group with the highest abundance of Lactobacillus (mean relative abundance of 76%). A community characterized by fewer Lactobacilli (mean relative abundance of 19%) and greater alpha diversity was associated with higher total urinary incontinence episodes (2.67 daily leaks; 95% confidence interval, 0.76-4.59; P=.007) and urgency urinary incontinence episodes (1.75 daily leaks; 95% confidence interval, 0.24-3.27; P=.02) than the reference group. No significant association was observed between community type and stress urinary incontinence episodes or Urogenital Distress Inventory total or subscores. The composition of vaginal community types and urinary community types were similar but composed of slightly different bacterial taxa. Vaginal community types were not associated with urinary incontinence severity, as measured by bladder diary or Urogenital Distress Inventory total and subscale scores. Alpha diversity indicated that greater sample richness was associated with more incontinence episodes (observed genera P=.01) in urine. Measures of evenness (Shannon and Pielou) were not associated with incontinence severity in the urinary or vaginal microbiomes.
CONCLUSIONS: In the urobiome of women with mixed urinary incontinence, a community type with fewer Lactobacilli and more diverse bacteria was associated with more severe urinary incontinence episodes (total and urgency) compared with a community type with high predominance of a single genus, Lactobacillus. Whether mixed urinary incontinence severity is due to lesser predominance of Lactobacillus, greater presence of other non-Lactobacillus genera, or the complement of bacteria consisting of urobiome community types remains to be determined.