阴道菌群微生态与早产的关系及影响因素
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摘要
目的：通过对乌市妇幼保健院2247例早产患者病历资料的回顾性分析,探讨早产的相关危险因素；再通过对268例妊娠期妇女进行细菌性阴道病(bacterial vaglnosls, BV)筛查并跟踪随访至分娩,探讨早产与BV的关系。方法：1、回顾性分析乌鲁木齐妇幼保健院2004年1月至2009年12月早产病例,与该院同期足月分娩病例进行对照,找出两组间差异有统计学意义的因素,把这些因素进行Logistic回归分析,筛选早产的相关危险因素。2、对2010年1月份以来的268例妊娠期妇女,采用细菌性阴道病快速试剂盒筛查妊娠中晚期孕妇,了解妊娠期的BV发病情况,并跟踪阳性者的妊娠结局。结果：1、2004年至2009年各年度早产构成比分别为6.6%、6.4%、5.4%、6．1%、7.6%、10.5%,早产构成比近年无明显降低,甚至呈现上升趋势。医源性早产中,子痫前期、胎盘因素所致产前出血及胎儿窘迫为其前三位原因；前次早产史、胎膜早破(Premature rupure of membrane, PROM)、产前出血、子痫前期、胎位异常、多双胎、妊娠期内外科合并症、羊水过多等为早产的相关危险因素。2、268例妊娠中晚期妇女中检出BV患者68例,妊娠合并BV的检出率为25.4%。妊娠期BV患者早产发病率明显高于正常妊娠妇女(p<0.01)。甲硝唑泡腾片治疗细菌性阴道病有效率为80.0%。结论：1、本院的早产构成比近年无明显降低,甚至呈现上升趋势。2、早产是多因素共同作用的结果。年龄、早产史、反复流产史、产检次数、多／双胎、胎膜早破、产前出血、子痫前期、胎位异常、妊娠期内外科合并症、羊水过多和子宫因素等为早产的相关危险因素。3、医源性早产中子痫前期,胎盘因素所致产前出血,胎儿窘迫,为其前三位主要原因。医源性早产与自发性早产的主要原因不同,但早产在病因学上存在同质性,从病因上不能将其截然分开。4、BV是在细菌学上表现为生殖道正常菌群(H202产乳杆菌)数量的减少,代之以一组厌氧菌群(类杆菌、和支原体等)数量增加的临床症侯群,BV表现出与早产的相关性。妊娠期BV阳性者早产的发生率明显升高。治疗妊娠合并BV对降低围产期母婴的不良结局具有积极意义。
Objective:To investigate the risk factors of premature delivery,in order to provide a screening basis of high-risk group of premature delivery pregnant women for clinical. Methods:retrospective study:Change tendency of preterm birth total and the rate of preterm birth from January of 2004 to December of 2009 in Urumqi Maternal and Child Health Hospital. To investigate main causaes of preterm birth and iatrogenic preterm birth.Take normal term labor cases as control group, To carry out regression analysis screening high-risk factors of preterm birth. Prospective Studie:Adopt bacterial vaginosis(BV) fast kit to screen pregnant women during the second and advanced stage trimester, to probe incidence rate in pregnant women and follow their Pregnancy Outcome. Results:Part 1:retrospective study:1. the rate of preterm birth from 2004 to 2009 each is 6.6%、6.4%、5.4%、6.1%、7.6%、10.5% the rate of preterm birth, doesn't decrease obviously recent years,even show tendency of upgrade. The main first three causes of iatrogenic preterm birth were preeclampsia,vaginal bleeding caused by placenta previa and placental abruption, fetal distress in uterus.2. Anterior preterm birth history, Premature rupture of fetal membranes (PROM), Pregnant-induced hypertension(PIH), Abnormal fetal position、Placenta factors、Multiple or double pregnancies、hydramnios、medical or surgical department complication were the major relevant risk factors of preterm delivery.Part 2:Prospective Study:68 cases with BV patient were checkd out during the 268 second and advanced stage trimester pregnant women. detection rate of Pregnancy combined BV is 25.4%. preterm delivery rate of patient with BV duringgestationalperiod issuper-to normal pregnant moman(p<0.01) effective power of metronidazole is 80.0%. Conclusions:1. the rate of preterm birth, doesn't decrease obviously recent years,even show tendency of upgrade.2. multiple factors all can cause preterm birth, age, anterior preterm birth history, Premature rupture of fetal membranes (PROM), Pregnant-induced hypertension(PIH), Abnormal fetal position, Placenta factors, Multiple or double pregnancies, hydramnios, medical or surgical department complication were the major relevant risk factors of preterm delivery.3. The main first three causes of iatrogenic preterm birth were preeclampsia,vaginal bleeding caused by placenta previa and placental abruption, fetal distress in uterus. The major cause of iatrogenic preterm iatrogenic preterm is different, but they ara homogeneity in preterm etiologically and can't be taken apart completely.4.BV shows correlation with preterm delivery. The incidence of premature delivery in patients with BV were significantly higher than that in normal pregnant women. Treatment to getational pregnant women with BV will have Positive significance for reducing maternal and infant's bad outcome during perinatal period.
Objective:To investigate the risk factors of premature delivery,in order to provide a screening basis of high-risk group of premature delivery pregnant women for clinical. Methods:retrospective study:Change tendency of preterm birth total and the rate of preterm birth from January of 2004 to December of 2009 in Urumqi Maternal and Child Health Hospital. To investigate main causaes of preterm birth and iatrogenic preterm birth.Take normal term labor cases as control group, To carry out regression analysis screening high-risk factors of preterm birth. Prospective Studie:Adopt bacterial vaginosis(BV) fast kit to screen pregnant women during the second and advanced stage trimester, to probe incidence rate in pregnant women and follow their Pregnancy Outcome. Results:Part 1:retrospective study:1. the rate of preterm birth from 2004 to 2009 each is 6.6%、6.4%、5.4%、6.1%、7.6%、10.5% the rate of preterm birth, doesn't decrease obviously recent years,even show tendency of upgrade. The main first three causes of iatrogenic preterm birth were preeclampsia,vaginal bleeding caused by placenta previa and placental abruption, fetal distress in uterus.2. Anterior preterm birth history, Premature rupture of fetal membranes (PROM), Pregnant-induced hypertension(PIH), Abnormal fetal position、Placenta factors、Multiple or double pregnancies、hydramnios、medical or surgical department complication were the major relevant risk factors of preterm delivery.Part 2:Prospective Study:68 cases with BV patient were checkd out during the 268 second and advanced stage trimester pregnant women. detection rate of Pregnancy combined BV is 25.4%. preterm delivery rate of patient with BV duringgestationalperiod issuper-to normal pregnant moman(p<0.01) effective power of metronidazole is 80.0%. Conclusions:1. the rate of preterm birth, doesn't decrease obviously recent years,even show tendency of upgrade.2. multiple factors all can cause preterm birth, age, anterior preterm birth history, Premature rupture of fetal membranes (PROM), Pregnant-induced hypertension(PIH), Abnormal fetal position, Placenta factors, Multiple or double pregnancies, hydramnios, medical or surgical department complication were the major relevant risk factors of preterm delivery.3. The main first three causes of iatrogenic preterm birth were preeclampsia,vaginal bleeding caused by placenta previa and placental abruption, fetal distress in uterus. The major cause of iatrogenic preterm iatrogenic preterm is different, but they ara homogeneity in preterm etiologically and can't be taken apart completely.4.BV shows correlation with preterm delivery. The incidence of premature delivery in patients with BV were significantly higher than that in normal pregnant women. Treatment to getational pregnant women with BV will have Positive significance for reducing maternal and infant's bad outcome during perinatal period.
引文
[1]朗景和主译,威廉姆斯产科学(F.Gary Cunning ham主编),早产(第34章)世界图书出版社公司,2001年4月,第20版836-865
[2]曾蔚越等。早产与早产儿[M].北京：人民军医出版社,2006.6-7
[3]曾蔚,越廖华.多胎妊娠与早产[J]实用妇产科杂志,2006,22(9)：521-523
[4]蔡坚,黄顺英,钟依平,等.体外受精一胚胎移植后妊娠早产的相关因素分析[J].中山大学学报(医学科学版).25(2)：150-152
[5]Howard DL,Marshall SS,Kaufman JS.Variations in low birth weight and preterm delivery among blacks in velation to ancestry and nativity:New York City,1998-2002[J].Pediatrics,2006,118(5):1399-1405.
[6]Li mlomwongse n,Liab suetrakul T.Cohort study of depressive moods in Thai women during late pregnancy and 6-8weeks of postpartumus-ing the Edinburgh Postnatal Depression Scale (EPDS) [J]-Arch Won-ens Ment Health,2006,9,(3):131
[7]Steerp.ThE epidemiology of proterm labor. BJOG,2005,112(1):1-3
[8]Martin JA,Hamilton BE, Sutton PD,etal.Births:final data for 2004[J].National Vital Statistics Reports.2006,55:1-101
[9]Shennam AH,Bewley S.Why Should preterm births be rising[J].British Medical Journal.2006,332:924-925.
[10]Langhoff-Roos J,Kesmodel U,Jacobsso B,et al,Spontaneous preterm delivery in primiparous women at low risk in Denmark:population based study[J].British Medical Journal.2006,332:937-939
[11]Fronterhouse W,Christensen FC,Rayburn LA,et al.Mandated preterm delivery:Its prevalence and impact at a tertiary care center[J].J Mater Fet Med.2001,10(3):62-165.
[12]樊尚荣,刘小平早产的感染病因[J].中国全科医学.2007,10(4)：263-265
[13]Steer P.The epidemiology of preterm labour[J].British Journal of Obstetrics and Gynaecology,2005,112:1-3.
[14]Goldenberg RL,Andrews WW,Hauth JC.Choriodecidual infetion and preterm birth[J].Nutrition reviews,2002,60:19-25.
[15]KaratC,MadhivananP,KruppK,et al.The clinical and microbi-logical correlates of premature rupture of membranes [J].Indian J MedMicrobiol,2006,24(4):283-285.
[16]Ananth CV,VintjileosAM.Epidemiology of preterm birth and its clinical subtypes [J].Maternal-Fetal Keonatal Med,2006,19(12):773-782
[17]Bin W.The prospect and current situation of prenatal diagnosis inmainlan China [J].Peking University(Health Sci),2006,381,38(1):15-16
[18]徐爱群,曾蔚越医源性早产[J].国外医学妇产科学分册,2006,33(1)：26-30
[19]Gffinet F. Primary predictors of preterm labour. BJOG,2005,112(Suppl.1):38-47
[20]Haram K, Morttensen JH, Wollen AL. Vreterm delivery:An overview Acta Obstet Gyneeol Scand,2003,82:687-704
[21]Dole N, Savitz DA, Hertz Picciotto I, et al. Maternal stress and preterm birth.Am J Epidemiol,2003.1 57.14-24
[22]Conde_Agudelo A, Rosas-Bermudez A, Kafury-Goeta AC, Birth spacing and risk of adverse perinatal Outcomes. JAMA,2006,296:1809-1823
[23]Spong Yc. Prediction and prevention of recurrent spontaneous preterm birth.Obstet Gynecol,2007,110:405-415
[24]NoIIIn JF. Preterm labour. Cervical function and prematurity Best Prac Res Clin Obstet Gynecol,2007,21:791-805
[25]Sadler L, Saftlas A, Wang W, et al. Treatment for cervical intraepithelial neoplasia and risk of preterm delivery. JAMA,2004,.291:2100-2106
[26]苏应宽.实用产科学.济南：山东科学技术出版社,2004：478 483
[27]曾蔚越.早产与早产儿.北京：人民卫生出版社,2006；58-75
[28]段涛,等.高危妊娠.北京：人民军医出版社·2006：525-528
[29]Fahey JO. Clinical management of intra-amniotie infection and chorioamnionitis:a reviewb of the literature. J Midwifery Womens Health,2008, May--Jun,53(3): 227-350
[30]Rouse D, Landon M, I, eveno K, et al. The maternal-fetal medicine units cesarean registry:chorioamnionitis at term and its duration_relatlonshlp to outcomes. Am J Obstet Gynecol,2004,191:211-216
[31]Lau J, Fergall M, Zhenguo Q, et al. Chorioamnionitis with a fetal inflammatory response is associated wIth higher neonatal mortalky, morbidity, and resource use than ehorioamnionitis displaying maternal inflammatory response only. Am J Obstet Gynecol,2004,193:708-713
[32]Sarno JL, Schatz F, Lockwood CJ, et al. Thrombin and interleukin-1 beta regulate HOXA10 expression in human term decidual cells:implications for preterm labor. J Clin Endocrinol Metab,2006,91(5):2366-2372
[33]Goldenberg R L, Culhane J F. Infection as a cause of preterm birth Clin Perinatol, 2004,30(4):677-700
[34]Dorbudak O, Eberhardt R, Vim 1, et al. Perlodontitis, a marker of risk in pregnancy for preterm birth J Clin Periodontol,2005,32(1):45-52
[35]Berghella V, Owen J, MacPherson C, et al. Natural historY of cerrical funneling in wonen at highrisk for spontⅢous preterm birth. National Institute of Child Health and Human Development (NICHD)Materml Fetal Medicine Units Network (MFM-U). Obstet Gynecol,2007,109(4):863-869
[36]赵文,应群华妊娠合并细菌性阴道病检测结果分析[J].中华妇幼保健,2008,23：1896.
[37]KekkiM,K-arkiT,KotomakiTetal,Cost-effectivenesso fscreening and treatment for bacterial vagmosis in early pregnancy among women at low risk for preterm birth [J].Acta Obstet Gynecol Scand,2004,83(1):27-36.
[38]O'Brien RF.Bacterial Vaginosis:many questions-any answers [J].CurvOpin Pediatr, 2005,17:473
[39]Holst UF,Lasson PG,VasqunezA,et al.Bacterial vaginosis-a micro-biological and immunological enigma[J].APMIS,2005,113:81
[40]李连青,朱庆义,刘俊芬,等阴道加德纳菌对细菌性阴道病的病原学诊断评价[J].中华医院感染学杂志,2005,15(2)：226
[41]吴晓宁,黄燕细菌性阴道病交叉感染的调查[J].广西医学,2008,30(1)；50.
[42]Chaim W. The relationship between bacterial vaginosis and preterm birth [J].Arch Gynecel obstect,1997,259(2);51
[43]Kebanoff MA,Hillier SL,NugentRP,et al.Is bacterial Vaginosis a stronger risk factor forpreterm birthwhen it is diagnosis earlier in gestation[J].Am jobstet Gynecol,2005, 192:470-477.
[44]BoskyER,Atherly-Trim SA,O'CampoPJ,et al.Acceptability OFA Self-Sampling Technique To Collect Vaginal Smears For Gram Stain Diagnosis of Bacterial Vaginoss [J].Women's Health Issues,2004,15:14-18.
[45]Jacobsson B,pemevip,Chidekel,etal.Bacterial Vaginosis in early pregnancy may predisposefor preterm birth and postpartum endometriyis[J].Actaobstericiaet Gyneco-logica Scan,2002,81(11):1006.
[46]GillesR.Gmoni f.M.D.DavidA.Baker,M.D.Infectious Diseases in Obste trics and Gynecology,ISBN,It-88096-57.
[47]CDC.Sexually transmitted diseases treatment guideline 2006.MMWR,2006,55 (RR-11):1-94.
[48]魏玉梅,杨慧霞.细菌性阴道病与早产的关系[J].中国医刊200641(9)：520-522.
[49]Nicoll A, Simmsl, Wilson J, et al Bacterial vaginosis:a public health review. BJOG, 2001, May.108(5):439-450
[50]Nugent RP,Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by astandardized method of gram stain interpretation.J Clin Microbiol, 1991,Feb,29(2):297-301
[51]Guise JM, Mahon SM,Aickin M, et al. Screening for bacterial vaginosis in pregnancy. Am J Prev Med,2001, Apr,20(3 Suppl):62-72
[52]Ugwumadu A,Manyonda I,Reid F, et al. Effect of early oral cllndamycin on late miscarriage and preterm delivery in asymptomatic women with abnormal vaginal flora and bacteri81 vaginosis:A randomised controlled trial. Lancet,2003,361:983-988
[53]Leitich H, Bodner-Adler B, Brunhauer M, et al.Bacterial vaginosis as a risk factor for pretermde livery; a meta-analysis. Am J Obstet Gynecol,2003, Jul,189(1):139-147
[54]U.S.Preventive Services Task Force. Screening for bacterial vaginosis in pregnancy to prevent preterm delivery:U.S.Preventive Services Task Force recommendation statement. Ann Intern Med,2008, Feb 5,148(3):214-219
[55]McDonatd H, Brocklehurst P, Parsons J,et al. Antibiotics for terating bacterial vaginosis in pregnancy Cochrane Database Syst Rev,2003, (2):CD000262
[56]McDonald HM.Brocklehurst P, Gordon A. Antibiofics for treating bacterial vaginosis in pregnancy Cochrane Database Syst Rev.2007, Jan 24(1):CD000262
[57]岛野敏司.细菌性膣症忙土为治瘵早虚予防对策.廑婿寞噤.2006，55：95-102
[1]乐杰主编.妇产科学[M].第6版.北京：人民卫生出版社,2006：92-93.
[2]Behrman RE, Butler AS. Preterm Birth:Causes, Consequences, and Preven-tion. Washington,.D.C:The National Academies Press,2007:311-345,604-643
[3]曾蔚越.早产与早产儿.北京：人民军医出版社,2008：3—14
[4]Di Redo GC, Roura LC. European Association of Perinatal Medicine_Study Group on Preterm Birth.Guidelines for the management of spontaneous preterm labor. J Perinat Med,2006.34(5)359-366
[5]Cunningham FG, Hauth JC, Leveno Kj, et al. Williams Obstetfics.22nd ed. New York:The McGraw-Hill Companies Inc,2005:855-880
[6]王文珊,傅冷西,叶君健.TNF-a信号传导通路的研究进展.[J]福建医科大学学报,2005,39(suppl):27-31.
[7]马薇,周昌菊．胎膜早破与早产.实用妇产科杂志,2005,21(11)：646.
[8]Romero R, Chalworpaongsa T, Kuivnaiemi H, etal.Bacterial Vaginosis, The inflammatory response and the risk of Preterm birth:A role for Genetic epidemiology in the prevention of preterm birih[J].Am J Obstet Gnyeocl,2004,190:1509-1519.
[9]Macones QParry S,Elkousy M,et al.A Polymoprhism in the Promote re- gion of TNF and baeterial vaginosis:Perlimniary evidence of gene-enviromnnet interaction in the etiology of spnotnaenos preterm birth[J].Am J Obstet Gyneeol,2004,190:1504-1508.
[10]Nien J K, Yoon B H, Espinoza J,et al. A rapid MMP-8 bedside test for the detection of intra-amniotic inflammation identifies patients at risk for imminent preterm delivery[J]. AmJ Obstet Gynecol,2006,195(4):1025-1030.
[11]Gravett MG,Hummel D,Eschenhach DA,et al.Preterm labor associated with subclinical amnilotic fluid infection and wlth bacterlaI vaginosls. obstet Gynecol, 1986,67:229-237
[12]Minkoff H, Grunebaum AN, schwarz RH, et al. Rlsk factors for prematurity and premature Rupture of membranes A propective study of the vaginal flora in pregnancy. Am J Obstet Gynecol,1984,150:965-972
[13]中华妇产科学分会感染性疾病协作组.外阴阴道念珠菌病诊治规范(草案).中华妇产科杂志,2004,39(6)：430449
[14]刘志杰,刘淑芸.核因子NF-KB在早产及分娩发动中的研究[J].国外医学妇幼保健分册,2005,16(6)：358-360.
[15]Buchmayer S. M. Previous pregnancy loss:risk related to severity of preterm delivery[J]. Am J Obstet Gynecol,2004,191 (4):1 225-1 231.
[16]孙念素,杨晓梅,郁翔,等.唾液E3值联合B超检测宫颈长度在预测早产中价值的临床研究.河北医学,2009,15(2)：228-229.
[17]时春艳,张云燕,金燕志,等.阴道超声检测宫颈长度预测早产.中华妇产科杂志,2003,38(1)：264-266.
[18]Spong CR. Prediction and prevention of recurrent spontaneous preterm birth[j].Obstet Gynecol,2007,110(2):405-415.
[19]谢爱兰,陈小知,林莲莲,等.经阴道B超测量宫颈长度与内口宽度预测早产的价值[J].实用妇产科杂志,2004,20(1)：37-38.
[20]时春艳,杨慧霞,金燕志,等.胎儿纤维连接蛋白对先兆早产孕妇发生早产的预测价值.中华围产医学杂志,2006,9：1-4.
[21]Eroglu D, Yanik F,Oktem M,et al. Prediction of Preterm Delivery among Women with Threatened Preterm Labor[J]. Gynecol Obstet Invest,2007,64 (2):109-116
[2]曾蔚越等。早产与早产儿[M].北京：人民军医出版社,2006.6-7
[3]曾蔚,越廖华.多胎妊娠与早产[J]实用妇产科杂志,2006,22(9)：521-523
[4]蔡坚,黄顺英,钟依平,等.体外受精一胚胎移植后妊娠早产的相关因素分析[J].中山大学学报(医学科学版).25(2)：150-152
[5]Howard DL,Marshall SS,Kaufman JS.Variations in low birth weight and preterm delivery among blacks in velation to ancestry and nativity:New York City,1998-2002[J].Pediatrics,2006,118(5):1399-1405.
[6]Li mlomwongse n,Liab suetrakul T.Cohort study of depressive moods in Thai women during late pregnancy and 6-8weeks of postpartumus-ing the Edinburgh Postnatal Depression Scale (EPDS) [J]-Arch Won-ens Ment Health,2006,9,(3):131
[7]Steerp.ThE epidemiology of proterm labor. BJOG,2005,112(1):1-3
[8]Martin JA,Hamilton BE, Sutton PD,etal.Births:final data for 2004[J].National Vital Statistics Reports.2006,55:1-101
[9]Shennam AH,Bewley S.Why Should preterm births be rising[J].British Medical Journal.2006,332:924-925.
[10]Langhoff-Roos J,Kesmodel U,Jacobsso B,et al,Spontaneous preterm delivery in primiparous women at low risk in Denmark:population based study[J].British Medical Journal.2006,332:937-939
[11]Fronterhouse W,Christensen FC,Rayburn LA,et al.Mandated preterm delivery:Its prevalence and impact at a tertiary care center[J].J Mater Fet Med.2001,10(3):62-165.
[12]樊尚荣,刘小平早产的感染病因[J].中国全科医学.2007,10(4)：263-265
[13]Steer P.The epidemiology of preterm labour[J].British Journal of Obstetrics and Gynaecology,2005,112:1-3.
[14]Goldenberg RL,Andrews WW,Hauth JC.Choriodecidual infetion and preterm birth[J].Nutrition reviews,2002,60:19-25.
[15]KaratC,MadhivananP,KruppK,et al.The clinical and microbi-logical correlates of premature rupture of membranes [J].Indian J MedMicrobiol,2006,24(4):283-285.
[16]Ananth CV,VintjileosAM.Epidemiology of preterm birth and its clinical subtypes [J].Maternal-Fetal Keonatal Med,2006,19(12):773-782
[17]Bin W.The prospect and current situation of prenatal diagnosis inmainlan China [J].Peking University(Health Sci),2006,381,38(1):15-16
[18]徐爱群,曾蔚越医源性早产[J].国外医学妇产科学分册,2006,33(1)：26-30
[19]Gffinet F. Primary predictors of preterm labour. BJOG,2005,112(Suppl.1):38-47
[20]Haram K, Morttensen JH, Wollen AL. Vreterm delivery:An overview Acta Obstet Gyneeol Scand,2003,82:687-704
[21]Dole N, Savitz DA, Hertz Picciotto I, et al. Maternal stress and preterm birth.Am J Epidemiol,2003.1 57.14-24
[22]Conde_Agudelo A, Rosas-Bermudez A, Kafury-Goeta AC, Birth spacing and risk of adverse perinatal Outcomes. JAMA,2006,296:1809-1823
[23]Spong Yc. Prediction and prevention of recurrent spontaneous preterm birth.Obstet Gynecol,2007,110:405-415
[24]NoIIIn JF. Preterm labour. Cervical function and prematurity Best Prac Res Clin Obstet Gynecol,2007,21:791-805
[25]Sadler L, Saftlas A, Wang W, et al. Treatment for cervical intraepithelial neoplasia and risk of preterm delivery. JAMA,2004,.291:2100-2106
[26]苏应宽.实用产科学.济南：山东科学技术出版社,2004：478 483
[27]曾蔚越.早产与早产儿.北京：人民卫生出版社,2006；58-75
[28]段涛,等.高危妊娠.北京：人民军医出版社·2006：525-528
[29]Fahey JO. Clinical management of intra-amniotie infection and chorioamnionitis:a reviewb of the literature. J Midwifery Womens Health,2008, May--Jun,53(3): 227-350
[30]Rouse D, Landon M, I, eveno K, et al. The maternal-fetal medicine units cesarean registry:chorioamnionitis at term and its duration_relatlonshlp to outcomes. Am J Obstet Gynecol,2004,191:211-216
[31]Lau J, Fergall M, Zhenguo Q, et al. Chorioamnionitis with a fetal inflammatory response is associated wIth higher neonatal mortalky, morbidity, and resource use than ehorioamnionitis displaying maternal inflammatory response only. Am J Obstet Gynecol,2004,193:708-713
[32]Sarno JL, Schatz F, Lockwood CJ, et al. Thrombin and interleukin-1 beta regulate HOXA10 expression in human term decidual cells:implications for preterm labor. J Clin Endocrinol Metab,2006,91(5):2366-2372
[33]Goldenberg R L, Culhane J F. Infection as a cause of preterm birth Clin Perinatol, 2004,30(4):677-700
[34]Dorbudak O, Eberhardt R, Vim 1, et al. Perlodontitis, a marker of risk in pregnancy for preterm birth J Clin Periodontol,2005,32(1):45-52
[35]Berghella V, Owen J, MacPherson C, et al. Natural historY of cerrical funneling in wonen at highrisk for spontⅢous preterm birth. National Institute of Child Health and Human Development (NICHD)Materml Fetal Medicine Units Network (MFM-U). Obstet Gynecol,2007,109(4):863-869
[36]赵文,应群华妊娠合并细菌性阴道病检测结果分析[J].中华妇幼保健,2008,23：1896.
[37]KekkiM,K-arkiT,KotomakiTetal,Cost-effectivenesso fscreening and treatment for bacterial vagmosis in early pregnancy among women at low risk for preterm birth [J].Acta Obstet Gynecol Scand,2004,83(1):27-36.
[38]O'Brien RF.Bacterial Vaginosis:many questions-any answers [J].CurvOpin Pediatr, 2005,17:473
[39]Holst UF,Lasson PG,VasqunezA,et al.Bacterial vaginosis-a micro-biological and immunological enigma[J].APMIS,2005,113:81
[40]李连青,朱庆义,刘俊芬,等阴道加德纳菌对细菌性阴道病的病原学诊断评价[J].中华医院感染学杂志,2005,15(2)：226
[41]吴晓宁,黄燕细菌性阴道病交叉感染的调查[J].广西医学,2008,30(1)；50.
[42]Chaim W. The relationship between bacterial vaginosis and preterm birth [J].Arch Gynecel obstect,1997,259(2);51
[43]Kebanoff MA,Hillier SL,NugentRP,et al.Is bacterial Vaginosis a stronger risk factor forpreterm birthwhen it is diagnosis earlier in gestation[J].Am jobstet Gynecol,2005, 192:470-477.
[44]BoskyER,Atherly-Trim SA,O'CampoPJ,et al.Acceptability OFA Self-Sampling Technique To Collect Vaginal Smears For Gram Stain Diagnosis of Bacterial Vaginoss [J].Women's Health Issues,2004,15:14-18.
[45]Jacobsson B,pemevip,Chidekel,etal.Bacterial Vaginosis in early pregnancy may predisposefor preterm birth and postpartum endometriyis[J].Actaobstericiaet Gyneco-logica Scan,2002,81(11):1006.
[46]GillesR.Gmoni f.M.D.DavidA.Baker,M.D.Infectious Diseases in Obste trics and Gynecology,ISBN,It-88096-57.
[47]CDC.Sexually transmitted diseases treatment guideline 2006.MMWR,2006,55 (RR-11):1-94.
[48]魏玉梅,杨慧霞.细菌性阴道病与早产的关系[J].中国医刊200641(9)：520-522.
[49]Nicoll A, Simmsl, Wilson J, et al Bacterial vaginosis:a public health review. BJOG, 2001, May.108(5):439-450
[50]Nugent RP,Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by astandardized method of gram stain interpretation.J Clin Microbiol, 1991,Feb,29(2):297-301
[51]Guise JM, Mahon SM,Aickin M, et al. Screening for bacterial vaginosis in pregnancy. Am J Prev Med,2001, Apr,20(3 Suppl):62-72
[52]Ugwumadu A,Manyonda I,Reid F, et al. Effect of early oral cllndamycin on late miscarriage and preterm delivery in asymptomatic women with abnormal vaginal flora and bacteri81 vaginosis:A randomised controlled trial. Lancet,2003,361:983-988
[53]Leitich H, Bodner-Adler B, Brunhauer M, et al.Bacterial vaginosis as a risk factor for pretermde livery; a meta-analysis. Am J Obstet Gynecol,2003, Jul,189(1):139-147
[54]U.S.Preventive Services Task Force. Screening for bacterial vaginosis in pregnancy to prevent preterm delivery:U.S.Preventive Services Task Force recommendation statement. Ann Intern Med,2008, Feb 5,148(3):214-219
[55]McDonatd H, Brocklehurst P, Parsons J,et al. Antibiotics for terating bacterial vaginosis in pregnancy Cochrane Database Syst Rev,2003, (2):CD000262
[56]McDonald HM.Brocklehurst P, Gordon A. Antibiofics for treating bacterial vaginosis in pregnancy Cochrane Database Syst Rev.2007, Jan 24(1):CD000262
[57]岛野敏司.细菌性膣症忙土为治瘵早虚予防对策.廑婿寞噤.2006，55：95-102
[1]乐杰主编.妇产科学[M].第6版.北京：人民卫生出版社,2006：92-93.
[2]Behrman RE, Butler AS. Preterm Birth:Causes, Consequences, and Preven-tion. Washington,.D.C:The National Academies Press,2007:311-345,604-643
[3]曾蔚越.早产与早产儿.北京：人民军医出版社,2008：3—14
[4]Di Redo GC, Roura LC. European Association of Perinatal Medicine_Study Group on Preterm Birth.Guidelines for the management of spontaneous preterm labor. J Perinat Med,2006.34(5)359-366
[5]Cunningham FG, Hauth JC, Leveno Kj, et al. Williams Obstetfics.22nd ed. New York:The McGraw-Hill Companies Inc,2005:855-880
[6]王文珊,傅冷西,叶君健.TNF-a信号传导通路的研究进展.[J]福建医科大学学报,2005,39(suppl):27-31.
[7]马薇,周昌菊．胎膜早破与早产.实用妇产科杂志,2005,21(11)：646.
[8]Romero R, Chalworpaongsa T, Kuivnaiemi H, etal.Bacterial Vaginosis, The inflammatory response and the risk of Preterm birth:A role for Genetic epidemiology in the prevention of preterm birih[J].Am J Obstet Gnyeocl,2004,190:1509-1519.
[9]Macones QParry S,Elkousy M,et al.A Polymoprhism in the Promote re- gion of TNF and baeterial vaginosis:Perlimniary evidence of gene-enviromnnet interaction in the etiology of spnotnaenos preterm birth[J].Am J Obstet Gyneeol,2004,190:1504-1508.
[10]Nien J K, Yoon B H, Espinoza J,et al. A rapid MMP-8 bedside test for the detection of intra-amniotic inflammation identifies patients at risk for imminent preterm delivery[J]. AmJ Obstet Gynecol,2006,195(4):1025-1030.
[11]Gravett MG,Hummel D,Eschenhach DA,et al.Preterm labor associated with subclinical amnilotic fluid infection and wlth bacterlaI vaginosls. obstet Gynecol, 1986,67:229-237
[12]Minkoff H, Grunebaum AN, schwarz RH, et al. Rlsk factors for prematurity and premature Rupture of membranes A propective study of the vaginal flora in pregnancy. Am J Obstet Gynecol,1984,150:965-972
[13]中华妇产科学分会感染性疾病协作组.外阴阴道念珠菌病诊治规范(草案).中华妇产科杂志,2004,39(6)：430449
[14]刘志杰,刘淑芸.核因子NF-KB在早产及分娩发动中的研究[J].国外医学妇幼保健分册,2005,16(6)：358-360.
[15]Buchmayer S. M. Previous pregnancy loss:risk related to severity of preterm delivery[J]. Am J Obstet Gynecol,2004,191 (4):1 225-1 231.
[16]孙念素,杨晓梅,郁翔,等.唾液E3值联合B超检测宫颈长度在预测早产中价值的临床研究.河北医学,2009,15(2)：228-229.
[17]时春艳,张云燕,金燕志,等.阴道超声检测宫颈长度预测早产.中华妇产科杂志,2003,38(1)：264-266.
[18]Spong CR. Prediction and prevention of recurrent spontaneous preterm birth[j].Obstet Gynecol,2007,110(2):405-415.
[19]谢爱兰,陈小知,林莲莲,等.经阴道B超测量宫颈长度与内口宽度预测早产的价值[J].实用妇产科杂志,2004,20(1)：37-38.
[20]时春艳,杨慧霞,金燕志,等.胎儿纤维连接蛋白对先兆早产孕妇发生早产的预测价值.中华围产医学杂志,2006,9：1-4.
[21]Eroglu D, Yanik F,Oktem M,et al. Prediction of Preterm Delivery among Women with Threatened Preterm Labor[J]. Gynecol Obstet Invest,2007,64 (2):109-116