302例胎膜早破孕妇阴道微环境菌群分析
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摘要
目的:本文通过回顾性分析胎膜早破孕妇阴道微环境菌群的分布及改变,以期为感染引起的胎膜早破预防和治疗提供参考。方法:选取2016年1月至2017年10月我院收治的胎膜早破孕妇,排除其他相关并发症,对其破膜时阴道微环境菌群及妊娠结局进行分析。结果:入选302例胎膜早破孕妇,其中PPROM167例,PROM135例;胎膜早破孕妇阴道菌群以G+大杆菌为主,同时合并解脲支原体(ureaplasma urealyticum,UU)感染和其他细菌感染较多。PPROM组阴道分泌物优势菌为非G+大杆菌,UU阳性率及其他菌阳性率均明显高于PROM组(P<0.05)。阴道优势菌变化对菌群改变无明显影响(P>0.05),阴道菌群变化对新生儿出生时脐动脉血气pH无明显影响(P>0.05)。阴道优势菌为非G+大杆菌组及菌群抑制时,新生儿出生后24 h经皮胆红素测定值升高;阴道优势菌为非G+大杆菌同时伴有UU及其他病原菌阳性,可引起新生儿出生后24 h经皮胆红素测定值升高;阴道微生态菌群抑制伴有UU阳性,可引起新生儿出生后24 h经皮胆红素测定值升高(P<0.05)。结论:阴道菌群为非G+大杆菌同时合并UU及其他菌感染是PPROM的高危因素。阴道优势菌改变对其他菌群变化无明显影响,但阴道微生态优势菌改变、支原体及其他病原菌感染可引起新生儿黄疸。
Objective:To investigate the distribution and variation of bacterial flora in the vaginal microenvironment of pregnant women with premature rupture of membranes(PROM)through a retrospective analysis,and to provide a reference for the prevention and treatment of PROM caused by infection. Methods:The pregnant women with PROM who were admitted to our hospital from January2016 to October 2017 were enrolled,with other related complications excluded. The bacterial flora in vaginal microenvironment during rupture of membranes and pregnancy outcome were analyzed. Results:A total of 302 patients were enrolled and divided into PROM group(n =135) and preterm premature rupture of membranes(PPROM) group(n =167). The vaginal flora of pregnant women with PROM was dominated by G+bacillus,usually with ureaplasma urealyticum(UU)infection and other bacterial infection. The dominant bacteria in the vaginal discharge of PPROM group were non-G+bacillus,and showed significantly higher positive rates of UU and other bacteria than the PROM group(P<0.05). The change in dominant vaginal bacteria had no significant effect on vaginal flora(P >0.05),and the change in vaginal flora had no significant effect on umbilical artery blood pH of neonates at birth(P >0.05). When the dominant vaginal bacteria were non-G+bacillus and the flora was inhabited,the transcutaneous bilirubin measurement of neonates aged 24 h was increased. When the dominant vaginal bacteria were non-G+bacillus with positive UU and other pathogenic bacteria,the transcutaneous bilirubin measurement of neonates aged 24 h could be increased. When the bacterial flora in vaginal microecology was inhibited with positive UU,the transcutaneous bilirubin measurement of neonates aged 24 h could be increased(P <0.05). Conclusion:Vaginal flora composed of non-G+bacillus and infection with UU and other bacteria is the high-risk factor for PPROM. The change in dominant vaginal bacteria cannot cause imbalance of other flora. However,the change in dominant bacteria of vaginal microecology and infection with mycoplasma and other pathogenic bacteria can lead to neonatal jaundice.
Objective:To investigate the distribution and variation of bacterial flora in the vaginal microenvironment of pregnant women with premature rupture of membranes(PROM)through a retrospective analysis,and to provide a reference for the prevention and treatment of PROM caused by infection. Methods:The pregnant women with PROM who were admitted to our hospital from January2016 to October 2017 were enrolled,with other related complications excluded. The bacterial flora in vaginal microenvironment during rupture of membranes and pregnancy outcome were analyzed. Results:A total of 302 patients were enrolled and divided into PROM group(n =135) and preterm premature rupture of membranes(PPROM) group(n =167). The vaginal flora of pregnant women with PROM was dominated by G+bacillus,usually with ureaplasma urealyticum(UU)infection and other bacterial infection. The dominant bacteria in the vaginal discharge of PPROM group were non-G+bacillus,and showed significantly higher positive rates of UU and other bacteria than the PROM group(P<0.05). The change in dominant vaginal bacteria had no significant effect on vaginal flora(P >0.05),and the change in vaginal flora had no significant effect on umbilical artery blood pH of neonates at birth(P >0.05). When the dominant vaginal bacteria were non-G+bacillus and the flora was inhabited,the transcutaneous bilirubin measurement of neonates aged 24 h was increased. When the dominant vaginal bacteria were non-G+bacillus with positive UU and other pathogenic bacteria,the transcutaneous bilirubin measurement of neonates aged 24 h could be increased. When the bacterial flora in vaginal microecology was inhibited with positive UU,the transcutaneous bilirubin measurement of neonates aged 24 h could be increased(P <0.05). Conclusion:Vaginal flora composed of non-G+bacillus and infection with UU and other bacteria is the high-risk factor for PPROM. The change in dominant vaginal bacteria cannot cause imbalance of other flora. However,the change in dominant bacteria of vaginal microecology and infection with mycoplasma and other pathogenic bacteria can lead to neonatal jaundice.
引文
[1]沈铿,马丁.妇产科学[M].3版.北京:人民卫生出版社,2015:163-166.
[2]何丽,黄琳娟,徐冬梅.妊娠期阴道微生态与阴道感染性疾病相关性的研究进展[J].中华医院感染学杂志,2015,25(16):3838-3840.
[3]马蔡昀,童明庆,王美莲,等.女性阴道微生态变化与年龄、妊娠及4种阴道疾病关系的探讨[J].南京医科大学学报(自然科学版),2005,25(10):722-724.
[4]陈婉珍,闫颖,吴林玲.妊娠期妇女阴道微生态研究进展[J].中国微生态学杂志,2016,28(4):489-492,497.
[5]Stricker T,Navratil F,Sennhauser FH.Vulvovaginitis in prepubertal girls[J].Arch Dis Child,2003,88:324-326.
[6]肖冰冰,张岱,廖秦平,等.妊娠期阴道菌群的微生态评价[J].中国妇产科临床杂志,2007,8(6):412-414,449.
[7]Freitas AC,Chaban B,Bocking A,et al.The vaginal microbiome of pregnant women is less rich and diverse,with lower prevalence of Mollicutes,compared to non-pregnant women[J].Sci Rep,2017,7:9212.
[8]佟玉,邵小光.妊娠晚期阴道微生态环境对不良妊娠结局的影响[J].中国当代医药,2017,24(8):93-95.
[9]耿炫,高玉民.胎膜早破与正常妊娠结局妊娠晚期阴道微环境对比观察[J].人民军医,2013,56(2):194-196.
[10]Honda H,Yokoyama T,Akimoto Y,et al.The frequent shift to intermediate flora in preterm delivery cases after abnormal vaginal flora screening[J].Sci Rep,2014,4:4799.
[11]Brown RG,Marchesi JR,Lee YS,et al.Vaginal dysbiosis increases risk of preterm fetal membrane rupture,neonatal sepsis and is exacerbated by erythromycin[J].BMC Med,2018,16:9.
[12]Stafford GP,Parker JL,Amabebe E,et al.Spontaneous preterm birth is associated with differential expression of vaginal metabolites by lactobacilli-dominated microflora[J].Front Physiol,2017,8:615.
[13]刘睿,王俊侠,李晓文,等.不同类型胎膜早破孕妇阴道微生态的对比研究[J].中国妇幼健康研究,2017,28(5):538-540.
[14]Jayaprakash TP,Wagner EC,van Schalkwyk J,et al.High diversity and variability in the vaginal microbiome in women following preterm premature rupture of membranes(PPROM):a prospective cohort study[J].PLoS One,2016,11(11):e0166794.
[15]仇娥,甄莉霞,金素娟,等.孕期B族链球菌与支原体和衣原体感染对胎膜早破和妊娠结局的影响[J].中华医院感染学杂志,2017,27(24):5665-5668.
[16]Kwak DW,Hwang HS,Kwon JY,et al.Co-infection with vaginal Ureaplasma urealyticum and Mycoplasma hominis increases adverse pregnancy outcomes in patients with preterm labor or preterm premature rupture of membranes[J].J Matern Fetal Neonatal Med,2014,27(4):333-337.
[17]吴娥玲,张玲玲,巨青晖,等.脐动脉血血气pH值与Apgar评分在新生儿窒息诊断中的比较研究[J].中国优生与遗传杂志,2017,25(9):82-84.
[18]赵蔓.胎儿窘迫及新生儿窒息的围产期高危因素调查研究[J].中国妇幼保健,2016,31(16):3375-3377.
[19]姚丽萍,田佳.新生儿高胆红素血症病因构成随时间变迁分析[J].中国妇幼保健,2016,31(21):4456-4459.
[20]吴秋珍,董志巧.正常新生儿经皮胆红素值的临床分析[J].医药论坛杂志,2016,37(4):86-87.
[21]Chimhini GLT,Chimhuya S,Chikwasha V.Evaluation of transcutaneous bilirubinometer(DRAEGER JM 103)use in Zimbabwean newborn babies[J].Matern Health Neonatol Perinatol,2018,4:1.
[2]何丽,黄琳娟,徐冬梅.妊娠期阴道微生态与阴道感染性疾病相关性的研究进展[J].中华医院感染学杂志,2015,25(16):3838-3840.
[3]马蔡昀,童明庆,王美莲,等.女性阴道微生态变化与年龄、妊娠及4种阴道疾病关系的探讨[J].南京医科大学学报(自然科学版),2005,25(10):722-724.
[4]陈婉珍,闫颖,吴林玲.妊娠期妇女阴道微生态研究进展[J].中国微生态学杂志,2016,28(4):489-492,497.
[5]Stricker T,Navratil F,Sennhauser FH.Vulvovaginitis in prepubertal girls[J].Arch Dis Child,2003,88:324-326.
[6]肖冰冰,张岱,廖秦平,等.妊娠期阴道菌群的微生态评价[J].中国妇产科临床杂志,2007,8(6):412-414,449.
[7]Freitas AC,Chaban B,Bocking A,et al.The vaginal microbiome of pregnant women is less rich and diverse,with lower prevalence of Mollicutes,compared to non-pregnant women[J].Sci Rep,2017,7:9212.
[8]佟玉,邵小光.妊娠晚期阴道微生态环境对不良妊娠结局的影响[J].中国当代医药,2017,24(8):93-95.
[9]耿炫,高玉民.胎膜早破与正常妊娠结局妊娠晚期阴道微环境对比观察[J].人民军医,2013,56(2):194-196.
[10]Honda H,Yokoyama T,Akimoto Y,et al.The frequent shift to intermediate flora in preterm delivery cases after abnormal vaginal flora screening[J].Sci Rep,2014,4:4799.
[11]Brown RG,Marchesi JR,Lee YS,et al.Vaginal dysbiosis increases risk of preterm fetal membrane rupture,neonatal sepsis and is exacerbated by erythromycin[J].BMC Med,2018,16:9.
[12]Stafford GP,Parker JL,Amabebe E,et al.Spontaneous preterm birth is associated with differential expression of vaginal metabolites by lactobacilli-dominated microflora[J].Front Physiol,2017,8:615.
[13]刘睿,王俊侠,李晓文,等.不同类型胎膜早破孕妇阴道微生态的对比研究[J].中国妇幼健康研究,2017,28(5):538-540.
[14]Jayaprakash TP,Wagner EC,van Schalkwyk J,et al.High diversity and variability in the vaginal microbiome in women following preterm premature rupture of membranes(PPROM):a prospective cohort study[J].PLoS One,2016,11(11):e0166794.
[15]仇娥,甄莉霞,金素娟,等.孕期B族链球菌与支原体和衣原体感染对胎膜早破和妊娠结局的影响[J].中华医院感染学杂志,2017,27(24):5665-5668.
[16]Kwak DW,Hwang HS,Kwon JY,et al.Co-infection with vaginal Ureaplasma urealyticum and Mycoplasma hominis increases adverse pregnancy outcomes in patients with preterm labor or preterm premature rupture of membranes[J].J Matern Fetal Neonatal Med,2014,27(4):333-337.
[17]吴娥玲,张玲玲,巨青晖,等.脐动脉血血气pH值与Apgar评分在新生儿窒息诊断中的比较研究[J].中国优生与遗传杂志,2017,25(9):82-84.
[18]赵蔓.胎儿窘迫及新生儿窒息的围产期高危因素调查研究[J].中国妇幼保健,2016,31(16):3375-3377.
[19]姚丽萍,田佳.新生儿高胆红素血症病因构成随时间变迁分析[J].中国妇幼保健,2016,31(21):4456-4459.
[20]吴秋珍,董志巧.正常新生儿经皮胆红素值的临床分析[J].医药论坛杂志,2016,37(4):86-87.
[21]Chimhini GLT,Chimhuya S,Chikwasha V.Evaluation of transcutaneous bilirubinometer(DRAEGER JM 103)use in Zimbabwean newborn babies[J].Matern Health Neonatol Perinatol,2018,4:1.