产后妇女阴道菌群状况及其影响因素分析

Vaginal microflora and relevant factors in puerperium

目的探讨产后6-8周妇女的阴道菌群状况及其相关的影响因素。方法选取2007年6-10月7家医院产后6-8周来院复查的560例产后妇女作为研究对象，对其进行相关因素的问卷调查，并行阴道分泌物涂片的Nugent评分及阴道菌群检查。结果（1）阴道分泌物涂片Nugent评分结果及菌群比率：Nugent评分结果为菌群正常的产后妇女有48例（8．6％，48／560），评分结果为菌群临界的产后妇女有337例（60．2％，337／560），评分结果为细菌性阴道病（BV）的产后妇女有175例（31．2％，175／560）。560例产后妇女中有74例阴道内检出乳杆菌（13．2％，74／560）；560例产后妇女中有322例检出加德纳菌和类杆菌（57．5％，322／560），有214例检出染色不定弯曲小杆菌（38．2％，214／560）。（2）分娩方式及会阴侧切对产后妇女阴道菌群状况的影响：①阴道分娩266例，其中Nugent评分结果为阴道菌群正常25例（9．4％，25／266），菌群临界为148例（55．6％，148／266），诊断BV93例（35。O％，93／266）。②剖宫产分娩294例，其中Nugent评分结果阴道菌群正常23例（7．8％，23／294），菌群临界189例（64．3％，189／294），诊断BV82例（27．9％，82／294）。阴道分娩与剖宫产分娩者的BV发牛率比较，差异无统计学意义（P=0．204）。③会阴侧切233例，其中阴道菌群正常22例（9．4％，22／233），菌群临界状态135例（57．9％，135／233），诊断BV76例（32．6％，76／233）。④无会阴侧切327例，其中Nugent评分结果阴道菌群正常26例（8．0％，26／327），菌群临界202例（61．8％，202／327），诊断BV99例（30．3％，99／327）。有会阴侧切与无会阴侧切者的BV发生率比较，差异无统计学意义（P=0．790）。（3）孕期阴道炎症及孕期性生活对阴道菌群状况的影响：①孕期有阴道炎症46例，其中Nugent评分结果阴道菌群正常5例（10．9％，5／46），菌群临界26例（56．5％，26／46），诊断BV15例（32．6％，15／46）。②无阴道炎症514例，其中Nugent评分结果阴道菌群正常43例（8．4％，43／514），菌群临界311例（60．5％，311／514），诊断BV160例（31．1％，160／514）。有阴道炎症与无阴道炎症者的BV发生率比较，差异无统计学意义（P=0．962）。③孕期无性生活的284例中诊断BV78例（27．5％，78／284）；偶尔有性生活的270例中诊断BV96例（35．6％，96／270）；经常有性生活的6例巾诊断BV1例（1／6）。3者分别比较，差异均无统计学意义（P=0．185）。（4）喂养方式对阴道菌群状况的影响：母乳喂养的216例中诊断BV67例（31．0％，67／216）；人工喂养的89例中诊断BV35例（39．3％，35／89）；混合喂养的255例中诊断BV73例（28．6％，73／255），3者分别比较，差异无统计学意义（P=0．573）。结论产后妇女阴道乳杆菌明显减少，菌群比率明显失调。阴道分娩、会阴侧切、阴道炎症、孕期性生活及喂养方式对产后妇女的BV发病无显著影响。产后妇女的BV发生率较高。

Objective To find out the bacterial species in the vagina of postpartum women and the possible influencing factors on colonization. Methods From Jun. 2007 to Oct. 2007, 560 postpartum women from 7 hospitals in China were enrolled. Questionnaire survey, gynecological examination and Nugent score of vaginal smear and microbial spectrum study of the vaginal flora were completed. Results （1） According to the Nugent score, 48 out of the 560 women were normal （8.6%）, 337 at the borderline （60. 2% ） and 175 （31.2%） were complicated with bacterial vaginosis （BV）. Among the 560 women, Bacterium lacticum were identified in 74 cases （13.2%）, but not in the rest 486 cases （86. 8% ）. Gardnerella and bacteroids were detected in 322 women （ 57.5% ） and small flectobacillus in 214 women （38.2%） out of the 560 subjects. （2） Influencing factors on vaginal microflora： among the 266 women who had normal vaginal delivery, 25 （ 9. 4% ） showed normal vaginal microflora, 148 （ 55.6% ） at borderline and BV was diagnosed in 93 women （35.0%）. The corresponding figures among the 294 women who underwent cesarean section were 23 （7.8%）, 189 （64.3%） and 82（27.9%）, respectively. However,the incidence of BV had no statistical difference between these two groups （ P = 0. 204）. In the 233 women who received episiotomy, 22 （9.4%） showed normal vaginal microflora, 135 （57.9%） at borderline and 76 presented with BV （32. 6% ） , the corresponding figures among the 327 women without episiotomy were 26 （8.0%）, 202 （61.8%） and 99 （30. 2% ）, respectively. The incidence of BV did not show any statistical difference between the above two groups （ P = 0. 790 ）. （ 3 ） Prenatal vaginitis were reported in 46 women, among which 5 （10.9%） with normal vaginal flora, 26 （56.5%） at borderline and 15 （32. 6% ） with BV, and again in the 514 women without prenatal vaginits, the above figures changed to 43 （8.4%） , 311 （60. 5% ） and 160 （31.1%）. No significant difference was found in the incidence of BV between the two groups （ P = 0. 962）. The rate of BV in women without sex, with sex occasionally and with sex frequently during pregnancy was 27. 5% （78/284）, 35.6% （96/270） and 1/6, respectively （P = O. 185 ） , and the numbers in women who had breast-feeding, bottle feeding and mixed feeding were 31.0% （67/216）, 39.3% （35/89） and 28.6% （73/255）, respectively （P =0.573）. Conclusions The amount of Lactobacillus in vagina of postpartum women is greatly reduced leading to dysbaeteria. The incidence of BV is not affected by vaginal delivery, episiotomy, vaginitis, prenatal intercourse and the way of feeding, but is higher in postpartum women.