摘要
目的通过对延边地区孕妇支原体(UU)、衣原体(CT)、B族溶血性链球菌(GBS)感染与胎膜早破(PROM)的关系及其不良妊娠结局的研究,寻找临床上预防和治疗胎膜早破的途径,以便进一步做好围产期保健,促进母儿健康,提高妊娠质量。
方法选择2010年11月初至2011年4月末在延边大学附属医院妇产科住院患者190例,其中胎膜早破孕妇114例(观察组),未胎膜早破正常孕妇76例(对照组)。取宫颈管分泌物,进行解尿支原体、沙眼衣原体、B族溶血性链球菌培养、检测和胎膜病理检测,从而研究支原体、衣原体、B族溶血性链球菌感染与胎膜早破及其不良妊娠结局之间的关系。
结果1、胎膜早破与未胎膜早破病例,解尿支原体感染率之间有显著性差异。2、胎膜早破病例的解尿支原体感染率高达49.12%,其中足月前胎膜早破的解尿支原体感染率(57.58%)明显高于足月胎膜早破(37.50%),两者之间有显著性差异。3、胎膜早破与未胎膜早破病例,绒毛膜羊膜炎患病率之间有显著性差异。4、解尿支原体感染病例,早产、新生儿窒息发病率明显高于未感染病例。5、沙眼衣原体、B族溶血性链球菌感染病例,围产儿死亡率明显高于未感染病例。6、本地区朝汉孕妇解尿支原体感染率之间无显著性差异。
结论1、孕妇生殖道解尿支原体感染是导致胎膜早破的重要因素。而且是足月前胎膜早破的重要原因。孕前及孕期常规多次检测及治疗生殖道解尿支原体感染是预防早产的重要途径。2、解尿支原体感染导致胎膜早破的机制并不是通过绒毛膜羊膜炎,可能是其他途径。3、本地区孕妇沙眼衣原体、B族溶血性链球菌感染率极低,并不是导致胎膜早破的重要感染致病菌。4、孕妇沙眼衣原体、B族溶血性链球菌感染与绒毛膜羊膜炎有关。5、沙眼衣原体、B族溶血性链球菌感染率低,但一旦感染,围生儿预后差。
Objective:To study Correlation of Ureaplasma urealyticum (UU), Chlamydia(CT), Sroup B streptococcus(GBS) infection of gravida and premature rupture of membrane(PROM) in yanbian areas, Looking for clinical prophylaxis and treatment of premature rupture of membrane, further work perinatal care, to promote the health of the mother and the children, to increase pregnancy quality.
Method:Selection in November 2010-April 2011 at the obstetrics and gynecology in YanBian university hospital in-patient obstetric delivery in pregnant women 114 cases of premature rupture of membranes(observation group)and 76 cases of full—term pregnancy, premature rupture of membranes without labor(NPROM) hospitalized pregnant women (control group)of cervical secretions for Ureaplasma urealyticum (UU), Chlamydia(CT), Group B streptococcus (GBS) to cultivation and fetal membranes pathology detection, and analysis of the outcome of pregnancy.
Result:1、Ureaplasma urealyticum (UU) infection rates of premature rupture of membrane is higher than womb not tire premature rupture of membrane cases.2、Ureaplasma urealyticum (UU) infection rates of preterm PROM(57.58%) is higher than full—term pregnancy PROM(37.50%), that have significant differences.3、Premature rupture of membranes and womb not tire premature rupture of membrane cases, differentiate between amniotic membrane infection rates were significantly different.4、Ureaplasma urealyticum (UU) infection is related premature delivery and neonatal asphyxia, isn't related HCA, amniotic fluid pollution and postpartum hemorrhage.5、Chlamydia(CT) and Group B streptococcus (GBS) infection is related perinatal mortality rate.6、Ureaplasma urealyticum (UU) infection rates of chao and han gravidaum have not significant differences.
Conclusion:1、Ureaplasma urealyticum (UU) of gravida infection is premature rupture of membranes (PROM) important factor, furthermore that is preterm delivery PROM important reason.2、mechanism of Ureaplasma urealyticum (UU) infection causes PROM isn't related to chorioamnionitis.3、Chlamydia(CT) and Group B streptococcus (GBS) of YanBian gravida infection rates is lower, that isn't important infection pathogenic bacteria of PROM.4、Chlamydia(CT) and Group B streptococcus (GBS) infection of gravida is related chorioamnitis.5、Chlamydia(CT) and Group B streptococcus(GBS) infection rates is low, but it infect, that perinatal mortality prognosis is poor.
引文
1. Gire C, Nicaise C, Shojai & et al. Preterm Premature Rupture of Membrane and Twin-to-Twin Transfusion Syndrome before 20 weeks:A Favour able Outcome. Fetal Diagn Ther 2002; Jul-Asg; 17(4):252-254
2. Gomez B. Romero R. Edwin SS Pathogenesis of preterm labor and preterm premature rupture of membranes associated with intraamniotic infection 1997(1)
3.喻玲.丁依玲.胡艳胎膜早破425例临床分析[期刊论文]-中国综合临床2004(01)
4.郝艳华.邓志敏.程明刚解脲支原体感染对妊娠结局的影响[期刊论文]-广东医学2005(02)
5.李冬梅衣原体、支原体感染研究进展[期刊论文]-国外医学(妇幼保健分册)2002(01)
6.邢成英.周应芳沙眼衣原体解脲支原体与女性生殖器官感染[期刊论文]-中国妇幼保健2004
7. Sweet BL. Gibbs RS Infectious diseases of the female genital tract 2009
8. Centers for Disease Control and Prevention Prevention of perinatal group B streptococcal disease. Revised guidelines from CDC 2002
9. Van Dyke MK. Phares CR. Lynfield R Evaluation f universal antenatal screening for group B streptococcus 2009
10. Barcaite E. Bartusevicius A. Tameliene R Prevalence of maternal group B streptococcal colonization in European countries 2008
11.张景林.袁林.杨永弘600名妊娠妇女及新生儿GBS带菌情况的研究1995
12.马延敏.吴连方.黄醒华孕妇B族溶血性链球菌带菌与母婴预后的关系[期刊论文]-中华妇产科杂志2000(1)
13.赵莲产前阴道内B族链球菌携带对母儿的影响[期刊论文]-首都医科大学学报1999(4)
14.梁梅英.王山米产前B族链球菌感染对母儿的影响[期刊论文]-中华围产医学杂志1999(1)
15.李铁耕.秦雨春新生儿B族链球菌败血症合并化脓性脑膜炎二例[期刊论文]-中国新生儿科杂志2006(5)
16.孙芾.林宏.于俊峰.王厚芳.方辉孕妇B型链球菌感染率及药物敏感性分析[期刊论文]-江西医学检验2005(3)
17.邓江红.姚开虎.胡惠丽.俞桑洁.高薇.伏利兵.何乐健.Alexander Dmitriev.杨永弘新生儿肺炎死亡病例中B族链球菌的检测[期刊论文]-中华儿科杂志2006(11)
18.叶蓉华.赵扬玉严重宫内感染导致多脏器功能障碍1例[期刊论文]-中国妇产科临床杂志2008(1)
19. Grable IA. Garcia PM. Perry D Group B streptococcus and preterm premature rupture of membranes:Arandomized, double-blind clinical trial of antepartum ampicillin 1996
20. NelosonHD, Helfand M. Screening for chlamydial infection. Am J Prey Med, 2001,20(supple3),95
21. Smith JM. Rexroth JA.Chaffin DG Serotyping group B streptococci in a small community hospital:an analysis of distribution and site of isolation 2002
22.张景林.袁林.杨永弘.600名妊娠妇女及新生儿GBS带菌情况的研究1995
23.马延敏.吴连方.黄醒华.孕妇B族溶血性链球菌带菌与母婴预后的关系[期刊论文]-中华妇产科杂志2000(1)
24.赵莲.产前阴道内B族链球菌携带对母儿的影响[期刊论文]-首都医科大学学报1999(4)
25.梁梅英.王山米产前B族链球菌感染对母儿的影响[期刊论文]-中华围产医学杂志1999(1)
26.刘运德.微生物学检验[M].2版.北京：人民卫生出版社,2005：334
27. Alice Rhoton—Vlaska, MD. Inefections and infertility [J]. Science 1nc, 2000,7(5):200-206.
28. Bachmaier K, Neu N, Maza Lm, et al. Chlamydin infections and heart disease Linked through antigenic mimicry [J]. Science,1999,283(5406):1335-1336.
29.张波,蒋天伦,郑世菊等.孕妇宫颈分泌物解脉支原体和沙眼衣原体的检测及其临床意义[J].中华医学荟萃杂志,2002,2(1)：4—6.
30.周丽萍,方周溪,周洁等.解脲支原体宫内感染与胎盘绒毛膜超微结构改变的相关性研究.疾病监测,2001：859
31.郭英花,刘颖.沙眼衣原体及解脲支原体与胎膜早破、早产的关系.中日友好医院学报,2002,16(1)：11.13.
32.叶玲玲,张碧云,曹文丽.子宫颈支原体感染与胚胎停止发育的关系.中华妇产科杂志,2004,39(2)：83·85.
33. Yang X. Role of cytokines in Chlmaydia trachomatis porteetive immunity and immunopathology. Curr pharm Des,2003,9(1):67-73
34. WilsonDP, Timms P, MeElwainDL. Amathematical model for the investigation of The Thl immune response to Chlamydia trachomatis. Math Biosci,2003,182(1): 27-44.
35. King. Uterine leukoeyte and decidualization. Hum ReProd Update,2000,6(1): 28-36
36. Andrie R, Braun, P, WelschU, et al. Chlmaydial and human heat shock portein60 Homologues in acute coronary syndromes. (Auto-) immune reactions as a link between Inefction and atheorsclerosis. ZKardiol,2003,92(6):455-65
37. Dbeattista J, Timms P, Allna J. immunoPathogenesis of Chlmaydia trachomatis Infctions in women. Fertil steril,2003,79(6):1273-1287
38. Grable IA. Garcia PM. Perry D Group B streptococcus and preterm premature rupture of membranes:A randomized, double-blind clinical trial of antepartum ampicillin 1996
[1]乐杰妇产科学2004
[2]Kanayama N Collagen types in normal and prematurely rutured amniotic memdrane 1985
[3]单连峰,黄德生,张惠单.胎膜早破母体微量元素及羊膜Ⅲ型胶原含量变化.数理医药学杂志,2005,(1)
[4]Pressman EK.Cavanaugh JK. Woods JR. Physical properties of chorioamnion throughout gestation 2002(05)
[5]Gomez B. Romero R. Edwin SS Pathogenesis of preterm labor and preterm premature rupture of membranes associated with intraamniotic infection 1997(1)
[6]喻玲.丁依玲.胡艳胎膜早破425例临床分析[期刊论文]-中国综合临床2004(01)
[7]Steel J H. Malatos S. Kennea N Bacteria and inflammatory cells in fetal membranes do not alwayscause preterm labor 2005 (03)
[8]Park K H. Chaiworapongsa T.Kim Y M atrixmetalloproteinase 3 in parturition, premature rupture of he membranes, and microbial invasion of the amniotic cavity 2003(01)
[9]任雁林.马秀菊.赵屹细胞凋亡与胎膜早破的相关性研究[期刊论文]-生殖与避孕2005(07)
[10]Matthew J M. Eva K P. James R W Prevention of pPROM:Current and future strategies 2006(12)
[11]Devlieger R.Millar L K.Bryant G Fetal membrane healing after spontaneous and iatrogenic membranerupture:Areview of current evidence 2006
[12]Vishal P.Kellie J.Robert M The force required to rupture fetal membranes paradoxically increaseswith acute in vitro repteated stretching 2007
[13]Sunny.Novinse. Mercer Separation of amniofromchoriodecidua is an integral event to the ruptureof normal term fetal membranes and constitutes asignificant component of the work required 2006