B族链球菌感染及阴道微生态变化与不良妊娠结局的关系

doi:10.11958/20231696

摘要/Abstract

摘要：

目的分析B族链球菌（GBS）感染及阴道微生态变化与不良妊娠结局的关系。方法收集202例孕晚期检出GBS感染（阳性组）及202例未感染GBS孕妇（阴性组）资料，比较2组一般资料、阴道微生态及不良妊娠结局。根据阴道微生态检查结果，将2组细分为阳性正常组（76例）、阳性失衡组（126例）、阴性正常组（154例）及阴性失衡组（48例）。阳性组发生胎膜早破后立即给患者使用抗生素治疗，无胎膜早破的孕妇在临产后行抗生素治疗；滴虫性阴道炎、霉菌性阴道炎或细菌性阴道病，给予硝呋太尔制霉素阴道软胶囊治疗。比较4组不良妊娠结局。结果与阴性组比较，阳性组妊娠期糖尿病占比、pH值>4.5占比、霉菌性阴道炎、细菌性阴道病检出率、早产率、胎膜早破率、产后出血率、胎儿宫内窘迫率高（P<0.05）；与阴性正常组比较，阴性失衡组早产率、胎膜早破率、产褥感染率、胎儿宫内窘迫率高（P<0.05），阳性失衡组早产率、胎膜早破率、产后出血率、产褥感染率、胎儿宫内窘迫率、宫内感染率、新生儿感染率高（P<0.05）；与阴性失衡组比较，早产率、胎膜早破率、胎儿宫内窘迫率在阳性正常组中低，在阳性失衡组中高（P<0.05）；与阳性正常组比较，阳性失衡组早产率、胎膜早破率、胎儿宫内窘迫率高（P<0.05）。结论孕晚期GBS感染增加了不良妊娠结局发生率，阴道微生态失衡与其协同促进不良妊娠结局。

关键词: 无乳链球菌, 妊娠结局, 感染, 产前诊断, 阴道微生态

Abstract:

Objective To analyze the relationship between group B streptococcus (GBS) infection, vaginal microecological changes and adverse pregnancy outcomes of pregnant women. Methods The data of 202 pregnant women with GBS infection (the positive group) and 202 pregnant women without GBS infection (the negative group) in the third trimester of pregnancy were collected. The general data, vaginal microecology and adverse pregnancy outcomes were compared between the two groups. According to the results of vaginal microecological examination, patients in the two groups were divided into the positive normal group (76 cases), the positive imbalance group (126 cases), the negative normal group (154 cases) and the negative imbalance group (48 cases). Pregnant women in the positive group were treated with antibiotics immediately after premature rupture of membranes, and pregnant women without premature rupture of membranes were treated with antibiotics after labor. Pregnant women with trichomonas vaginitis or fungal vaginitis or bacterial vaginosis were given nifuratel nystatin vaginal soft capsules for treatment. The adverse pregnancy outcomes were compared between the four groups. Results Compared with the negative group, the proportion of gestational diabetes mellitus, proportion of pH value>4.5, detection rates of mycotic vaginitis and bacterial vaginosis, premature delivery rate, premature membrane rupture rate, postpartum hemorrhage rate and fetal intrauterine distress rate were higher in the positive group (P<0.05). The premature delivery rate, premature membrane rupture rate, puerperal infection rate and fetal intrauterine distress rate were higher in the negative imbalance group than those in the negative normal group (P<0.05), and the positive imbalance group had higher premature delivery rate, premature membrane rupture rate, postpartum hemorrhage rate, puerperal infection rate, fetal intrauterine distress rate, intrauterine infection rate and neonatal infection rate (P<0.05). Compared with the negative imbalance group, the premature delivery rate, premature membrane rupture rate and fetal intrauterine distress rate were lower in the positive normal group, and those were higher in the positive imbalance group (P<0.05). The positive imbalance group had higher rates of premature delivery, premature membrane rupture and fetal intrauterine distress compared to the positive normal group (P<0.05). Conclusion GBS infection in the third trimester of pregnancy increases the incidence of adverse pregnancy outcomes, and vaginal microecological imbalance its synergies promote of adverse pregnancy outcomes.

Key words: streptococcus agalactiae, pregnancy outcome, infections, prenatal diagnosis, vaginal microecology

中图分类号:

R714.7

图/表 4

参考文献 20

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组别		n	年龄/岁		BMI/（kg/m²）		受教育程度
组别		n	年龄/岁		BMI/（kg/m²）		初中及以下			中专及高中		大专及以上
阴性组		202	29.03±3.90		26.14±2.08		42（20.79）			102（50.50）		58（28.71）
阳性组		202	28.89±3.70		25.91±2.00		45（22.28）			98（48.51）		59（29.21）
t或χ²			0.380		1.123		0.192
组别	产次					流产史		妊娠期糖尿病	妊娠期高血压		妊娠合并甲状腺功能减退
组别	初产妇			经产妇		流产史		妊娠期糖尿病	妊娠期高血压		妊娠合并甲状腺功能减退
阴性组	118（58.42）			84（41.58）		59（29.21）		9（4.46）	8（3.96）		7（3.47）
阳性组	112（55.45）			90（44.55）		66（32.67）		24（11.88）	16（7.92）		12（5.94）
χ²	0.363					0.568		7.425^＊	2.835		1.381

组别		n	年龄/岁		BMI/（kg/m²）		受教育程度
组别		n	年龄/岁		BMI/（kg/m²）		初中及以下			中专及高中		大专及以上
阴性组		202	29.03±3.90		26.14±2.08		42（20.79）			102（50.50）		58（28.71）
阳性组		202	28.89±3.70		25.91±2.00		45（22.28）			98（48.51）		59（29.21）
t或χ²			0.380		1.123		0.192
组别	产次					流产史		妊娠期糖尿病	妊娠期高血压		妊娠合并甲状腺功能减退
组别	初产妇			经产妇		流产史		妊娠期糖尿病	妊娠期高血压		妊娠合并甲状腺功能减退
阴性组	118（58.42）			84（41.58）		59（29.21）		9（4.46）	8（3.96）		7（3.47）
阳性组	112（55.45）			90（44.55）		66（32.67）		24（11.88）	16（7.92）		12（5.94）
χ²	0.363					0.568		7.425^＊	2.835		1.381

组别	n	阴道pH值		滴虫性阴道炎	霉菌性阴道炎	细菌性阴道病
组别	n	4.0~4.5	>4.5	滴虫性阴道炎	霉菌性阴道炎	细菌性阴道病
阴性组	202	158（78.22）	44（21.78）	0	9（4.46）	18（8.91）
阳性组	202	78（38.61）	124（61.39）	1（0.50）	26（12.87）	39（19.31）
χ²或P		65.214^＊＊		1.000^▲	9.040^＊＊	9.008^＊＊

组别	n	阴道pH值		滴虫性阴道炎	霉菌性阴道炎	细菌性阴道病
组别	n	4.0~4.5	>4.5	滴虫性阴道炎	霉菌性阴道炎	细菌性阴道病
阴性组	202	158（78.22）	44（21.78）	0	9（4.46）	18（8.91）
阳性组	202	78（38.61）	124（61.39）	1（0.50）	26（12.87）	39（19.31）
χ²或P		65.214^＊＊		1.000^▲	9.040^＊＊	9.008^＊＊

组别	n		剖宫产		早产		胎膜早破		羊水污染		产后出血
阴性组	202		94（46.53）		10（4.95）		15（7.43）		12（5.94）		1（0.50）
阳性组	202		104（51.49）		44（21.78）		62（30.69）		21（10.40）		11（5.45）
χ²			0.990		24.710^＊＊		35.444^＊＊		2.673		8.588^＊＊
组别		产褥感染		胎儿宫内窘迫		宫内感染		新生儿感染		新生儿病理性黄疸
阴性组		4（1.98）		11（5.45）		1（0.50）		1（0.50）		17（8.42）
阳性组		10（4.95）		54（26.73）		5（2.48）		4（1.98）		29（14.36）
χ²		2.664		33.900^＊＊		1.523		0.810		3.533