【摘要】 目的:探讨基于阴道用乳酸杆菌的联合治疗是否能有效降低绝经期泌尿生殖综合征(GSM)治疗中局部雌激素用量并评估其有效性及安全性。方法:选择2023年1月至2023年12月就诊于安徽医科大学附属滁州第一人民医院的GSM患者128例作为研究对象，采用随机数字表法分为观察组(64例)和对照组(64例),观察组使用乳酸杆菌阴道胶囊联合0.03 g/次的超低剂量雌三醇乳膏，对照组使用0.5 g/次的标准剂量雌三醇乳膏。统计分析两组治疗前后临床疗效、阴道微生态指标(包括阴道pH值、菌群密集度以及优势乳酸杆菌占比)、阴道健康评分(VHIS)、临床症状改善时间、不良反应发生率及短期复发率。结果:观察组与对照组治疗总有效率分别为89.1%和92.2%(P>0.05),但两组患者治疗后阴道微生态指标比较，差异均有统计学意义(P<0.05)。治疗后两组患者的外阴或阴道瘙痒、灼热、阴道干涩等外阴阴道症状以及尿频、尿急、尿痛等泌尿道症状的改善时间比较差异均有统计学意义(P<0.05),但在性生活疼痛、干涩、性交困难等两组患者的症状缓解时间差异无统计学意义(P>0.05)。治疗后，两组患者的VHIS均明显提升，且观察组评分高于对照组，差异有统计学意义(P<0.05)。不良反应发生率方面，观察组为15.6%,对照组为17.2%,两组差异无统计学意义(P>0.05)。随访3个月，失访率为7.81%。短期复发率方面，观察组为13.79%(8/58),对照组为20.00%(12/60),两组差异无统计学意义(P>0.05)。结论:基于阴道用乳酸杆菌的联合治疗方案虽然在提高临床总有效率、改善性生活相关症状以及降低短期复发率方面与标准剂量雌三醇乳膏相比无显著优势，但能更显著地改善阴道微生态指标和VHIS,因此可以作为降低局部雌激素用量的潜在替代方案，尤其在乳腺癌以及子宫内膜增生的患者长期使用阴道内激素替代治疗风险未知的情况下，可能显示出一定的优势，且安全性良好。更多还原

【Abstract】 Objective:This study aims to evaluate whether combination therapy with vaginal Lactobacillus can effectively reduce the required dosage of local estrogen in the treatment of genitourinary syndrome of menopause(GSM) while assessing its efficacy and safety.Methods:A total of 128 patients diagnosed with GSM at the First Affiliated Chuzhou Hospital of Anhui Medical University between January and December 2023 were enrolled.Using a random numerical table method, they were assigned into two groups:64 in the observation group and 64 in the control group.The observation group received Lactobacillus vaginal capsules combined with ultra-low-dose estriol cream(0.03g/application),while the control group was treated with standard-dose estriol cream(0.5g/application).The clinical efficacy, vaginal microecological parameters(vaginal pH value, bacterial density, and dominant lactobacilli percentage),Vaginal Health Index Score(VHIS),symptom improvement time, incidence of adverse reactions, and short-term recurrence rates werestatistically analyzed for both groups before and after treatment.Results:The total clinical efficacy rates were 89.1% in the observation group and 92.2% in the control group, with no statistically significant difference(P>0.05).However, post-treatment vaginal microecological parameters showed significant differences between the two groups(P<0.05).The improvement time of vulvovaginal symptoms(pruritus, burning, vaginal dryness) and urinary tract symptoms(frequent micturition, urgent micturition, dysuria) of the two groups after treatment were significantly different(P<0.05).However, no significant difference was observed in relief time of symptoms such as sexual pain, dryness and dyspareunia between the two groups(P>0.05).Both groups showed a significant increase in VHIS after treatment, with the observation group scoring higher(P<0.05).The incidence of adverse reactions was 15.6% in the observation group and 17.2% in the control group, with no significant difference(P>0.05).At the three-month follow-up, the lost-to-follow-up rate was 7.81%,and the short-term recurrence rates were 13.79%(8/58) in the observation group and 20%(12/60) in the control group, with no statistically significant difference(P>0.05).Conclusions: While combination therapy with vaginal Lactobacillus does not significantly surpass standard-dose estriol cream in improving the overall clinical efficacy, relieving sexual symptoms, or reducing short-term recurrence rates, it demonstrates a superior effect in improving vaginal microecological parameters and VHIS;thus, it may serve as apotential alternative for reducing local estrogen use.Particularly in patients with breast cancer or endometrial hyperplasia, where the long-term risks of vaginal hormone replacement therapy remain unknown, this approach may offer certain advantages while exhibiting favourable safety profiles.更多还原