解脲支原体感染与早产及胎膜早破的关系

Ureaplasma Urealyticum Infection and Premature Delivery or Premature Rupture of the Membrane

目的探讨解脲支原体（ＵＵ）感染与早产及胎膜早破的相关性。方法采用分离培养法，分别对４６例胎膜早破和７例早产患者（试验组）以及３２例正常妊娠（对照组）妇女的宫颈分泌物、胎膜和脐带进行ＵＵ检测；对部分试验组和对照组的胎盘组织进行电镜观察，并与阳性培养物负染电镜观察结果相比较。结果试验组宫颈分泌物、胎膜和脐带中ＵＵ检出率均为７３６％（３９／５３），对照组宫颈、胎膜和脐带中的ＵＵ检出率分别为４０６％（１３／３２）和１５６％（５／３２），两组比较，差异有极显著性（Ｐ＜０．０１，Ｐ＜０．００１）；ＵＵ阳性患者围产期死亡、死胎和低体重儿的发病率为３４１％（１５／４４），明显高于胎膜ＵＵ检出阴性的患者（７３％，３／４１，Ｐ＜０．０１）。电镜观察显示，从胎膜早破者胎盘组织的合体滋养层细胞的核膜周围及胶原纤维中见大量增殖的ＵＵ颗粒，并与负染电镜下所见的ＵＵ颗粒相一致。而在正常胎盘组织中未见到相同颗粒。结论ＵＵ感染是部分早产、低体重儿和胎膜早破的原因；滋养层细胞内ＵＵ的增殖，可诱发相应的细胞结构的改变，以致干扰胎儿的正常发育。

Objective To evaluate the relationships between ureaplasma urealyticum (UU) infection and premature delivery or premature rupture of the membrane (PROM). Methods The cervical swabs, fetal membrane and umbilical cord from 46 cases of PROM, 7 cases of premature delivery (study group), and 32 normal pregnancies (control group) were cultutred for UU. Some of these placenta tissues were examined under electron microscopy, and compared with the purified UU. Results The detective rates of UU were both 73.6%(39/53) in the cervix and fetal membrane of the study group, and to compare with the control group (40.6%, 13/32 and 15.6%, 5/32 respectivety), significant differences were shown (P<0.01, P<0.001). The prevalence rate of perinatal mortality, stillbirth and low birth weight in UUpositive cases (34.1%, 15/44) was significantly higher than that in UUnegative cases (7.3%, 3/41, P<0.01). Electron microscopy demonstrated that large amount of small multiplicated UU particles deposited around the nuclear membrane of the cytotrophoblasts and in the collagen fibers from the placenta of PROM, and its shape was in consistent with that of the purified UU. In contrast, no UU particles was seen in the normal control group. Conclusion the results show that UU is responsible for some cases of premature delivery, low birth weight and PROM. The multiplication of UU within the trophoblasts may disrupt cell structure which could interfere the normal fetal development.