不孕症患者术前阴道微生态状况及相关因素分析

Analysis of the Preoperation Vaginal Ecology and Correlative Factors in Infertile Patients

目的:研究和分析不孕症患者阴道分泌物病原体、阴道微生态状况及其相关因素。方法:选择2008年1月—2009年12月因不孕症接受宫腹腔镜检查和治疗的患者850例,术前常规进行病史采集并取阴道分泌物,利用Nugent评分评价阴道菌群后,分为菌群正常组(307例,占36.12%)和菌群异常组(543例,占63.88%)。根据菌群异常情况,又将菌群异常组分为5组,分别为乳酸杆菌减少组(325例)、革兰阳性小杆菌为优势菌组(173例)、细菌性阴道病(BV)组(26例)、菌群抑制组(11例)和外阴阴道假丝酵母菌病(VVC)组(8例),并进行回顾性分析。结果:阴道菌群异常组患者的5年以上不孕症病史、流产后并发症及药物流产史的发生率高于菌群正常组(P<0.05),OR值及95%CI分别为1.42(1.07～1.89)、1.97(1.28～3.05)、1.51(1.03～2.22)。其中乳酸杆菌减少患者药物流产史的发生率最高(OR=1.66,95%CI:1.09～2.51)。阴道革兰阳性小杆菌患者流产后并发症的发生率最高(OR=1.86,95%CI:1.13～3.07)。校正年龄、学历及家庭年收入后发现,流产后并发症是阴道菌群异常的危险因素(OR=2.653,95%CI:1.16～6.07)。结论:流产后阴道出血时间较长、下腹痛、发热等并发症会增加阴道菌群失调的危险性,流产后积极抗炎等预防性治疗对于保护阴道正常微环境有重要的临床意义。

Objective：To investigate and analyze the vaginal secretion pathogen and ecology correlative factors in infertile patients.Methods：A retrospective survey included 850 infertile women who accepted the hysteroscopy and laparoscopy examination and be treated from Jan 2008 to Dec 2009.Collected history and vaginal secretion before operation.The Nugent grade was used to evaluate the vaginal bacteria.The patients were chosen to two groups,normal bacteria group（307 cases） and abnormal group（543 cases） .The abnormal group was divided into five subgoups that were lactobacillus decreased group（325 cases） ,Gram positive bacillus small group（173 cases） ,bacterial vaginal disease group（26 cases） ,flora inhibit group（11 cases） and vulvovaginal candidiasis group（8 cases） .Results：Patients had more than 5 years infertility history,postabortion complication and drug abortion history would get more chance to had abnormal vaginal ecology（P〈0.05） ,OR and 95% CI was 1.42（1.07～1.89） ,1.97（1.28～3.05） and 1.51（1.0～2.22） respectively.Patients that vaginal lactobacillus decreased had the highest incidence of drug abortion history（OR=1.66,95%CI：1.09～2.51） ,while the vaginal Gram positive bacillus small group had the highest incidence of postabortion complication（OR=1.86,95%CI：1.13～3.07） .After adjusting age,education and family income,we found that postabortion complication was a risk factor for abnormal vaginal bacteria（OR=2.653,95%CI：1.16～6.07） .Conclusions：Vaginal bleeding for a longer time,hypogastralgia and fever after abortion would increase the risk of abnormal vaginal bacteria.Taking precautions against the postabortion complication would have important clinical meaning for normal vaginal microenvironment protection.