302例胎膜早破孕妇阴道微环境菌群分析

An analysis of bacterial flora in the vaginal microenvironment of 302 pregnant women with premature rupture of membranes

目的:本文通过回顾性分析胎膜早破孕妇阴道微环境菌群的分布及改变,以期为感染引起的胎膜早破预防和治疗提供参考。方法:选取2016年1月至2017年10月我院收治的胎膜早破孕妇,排除其他相关并发症,对其破膜时阴道微环境菌群及妊娠结局进行分析。结果:入选302例胎膜早破孕妇,其中PPROM167例,PROM135例;胎膜早破孕妇阴道菌群以G+大杆菌为主,同时合并解脲支原体(ureaplasma urealyticum,UU)感染和其他细菌感染较多。PPROM组阴道分泌物优势菌为非G+大杆菌,UU阳性率及其他菌阳性率均明显高于PROM组(P<0.05)。阴道优势菌变化对菌群改变无明显影响(P>0.05),阴道菌群变化对新生儿出生时脐动脉血气pH无明显影响(P>0.05)。阴道优势菌为非G+大杆菌组及菌群抑制时,新生儿出生后24 h经皮胆红素测定值升高;阴道优势菌为非G+大杆菌同时伴有UU及其他病原菌阳性,可引起新生儿出生后24 h经皮胆红素测定值升高;阴道微生态菌群抑制伴有UU阳性,可引起新生儿出生后24 h经皮胆红素测定值升高(P<0.05)。结论:阴道菌群为非G+大杆菌同时合并UU及其他菌感染是PPROM的高危因素。阴道优势菌改变对其他菌群变化无明显影响,但阴道微生态优势菌改变、支原体及其他病原菌感染可引起新生儿黄疸。

Objective:To investigate the distribution and variation of bacterial flora in the vaginal microenvironment of pregnant women with premature rupture of membranes(PROM) through a retrospective analysis,and to provide a reference for the prevention and treatment of PROM caused by infection. Methods:The pregnant women with PROM who were admitted to our hospital from January 2016 to October 2017 were enrolled,with other related complications excluded. The bacterial flora in vaginal microenvironment during rupture of membranes and pregnancy outcome were analyzed. Results:A total of 302 patients were enrolled and divided into PROM group(n=135) and preterm premature rupture of membranes(PPROM) group(n=167). The vaginal flora of pregnant women with PROM was dominated by G^+ bacillus,usually with ureaplasma urealyticum(UU) infection and other bacterial infection. The dominant bacteria in the vaginal discharge of PPROM group were non-G^+ bacillus,and showed significantly higher positive rates of UU and other bacteria than the PROM group(P<0.05). The change in dominant vaginal bacteria had no significant effect on vaginal flora(P >0.05),and the change in vaginal flora had no significant effect on umbilical artery blood pH of neonates at birth(P >0.05). When the dominant vaginal bacteria were non-G^+ bacillus and the flora was inhabited,the transcutaneous bilirubin measurement of neonates aged 24 h was increased. When the dominant vaginal bacteria were non-G^+ bacillus with positive UU and other pathogenic bacteria,the transcutaneous bilirubin measurement of neonates aged 24 h could be increased. When the bacterial flora in vaginal microecology was inhibited with positive UU,the transcutaneous bilirubin measurement of neonates aged 24 h could be increased(P <0.05). Conclusion:Vaginal flora composed of non-G^+ bacillus and infection with UU and other bacteria is the high-risk factor for PPROM. The change in dominant vaginal bacteria cannot cause imbalance of other flora. However,the change in dominant bacteria of vaginal microecology and infection with mycoplasma and other pathogenic bacteria can lead to neonatal jaundice.