妊娠前、后女性阴道菌群分布情况分析

Comparison of the vaginal microecosystem between antenatal and postpartum women

目的探讨育龄女性妊娠前、后阴道菌群分布情况及其相关的影响因素。方法选择2010年1月至2013年12月在广西妇产医院妇科门诊行孕前体检的2 179例育龄女性纳入妊娠前组（n=2 179）。选择同期于本院体检的1 683例分娩后女性纳入妊娠后组（n=1 683）。采用精密pH试纸对两组女性进行阴道pH值测定,并对其阴道菌群的密集度、多样性、优势菌等方面进行微生态检测,同时对血液及阴道分泌物相关指标进行检测。本研究遵循的程序符合广西妇产医院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象本人的知情同意,并与之签署临床研究知情同意书。两组患者年龄等一般情况比较,差异无统计学意义（P〉0.05）。结果妊娠后组经Nugent评分结果确诊为细菌性阴道病（BV）患者例数（519例,30.84%）显著高于妊娠前组（259例,11.89%）,两组比较,差异有统计学意义（χ^2=212.01,P〈0.01）。妊娠后组女性阴道乳酸杆菌强度较妊娠前组女性明显减弱,菌群多样性明显低于妊娠前组女性,两组比较,差异均有统计学意义（χ^2=105.3,689.2;P〈0.01）。妊娠前组女性阴道平均pH值为（4.1±0.8）,低于妊娠后组的（5.0±0.2）,两组比较,差异有统计学意义（t=43.0,P〈0.05）,妊娠后组女性的雌二醇水平显著低于妊娠前组,而阴道分泌物唾液酸苷酶、过氧化氢（H2O2）和白细胞酯酶阳性率（分别为43.7%,28.0%和91.0%）均高于妊娠前组（7.9%,6.7%和11.2%）,两组比较,差异均有统计学意义（t=258.2,χ^2=320.5,678.2,2 433.1;P〈0.05）。结论妊娠后女性雌激素水平较妊娠前显著降低,阴道乳酸杆菌数量减少、pH值升高、微生态变化较大,可导致BV发生。

Objective To investigate the influence of pregnancy on pH value and lactobacilli distribution in vagina.Methods From January 2010 to December 2013,a total of 2 179 women of childbearing age who took physically pregnant examinations in Obstetrics and Gynecology Hospital of Guangxi Zhuang Autonomous Region were included in the study as antenatal group（n=2 179）.Meanwhile,another 1 683 postpartum women were selected in the study as postpartum group（n=1 683）.The vaginal pH value were detected.The vaginal microecosystem and the related indexes were also detected and compared between two groups.There were no significant differences in general conditions between two groups（P〉0.05）.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Obstetrics and Gynecology Hospital of Guangxi Zhuang Autonomous Region.Informed consent was obtained from each participants.Results There were 519 women（30.84%）were diagnosed as bacterial vaginosis（BV）by Nugent scores in postpartum group,which were 259women（11.89%）in antenatal group,and the difference was significant（χ^2= 212.01,P〈0.01）.Compared to antenatal group,the ratio of lactobacilli detection was significantly lower than that of postpartum group（P〈0.01）.Furthermore,the vaginal pH value in postpartum group（5.0±0.2）was higher than that of antenatal group（4.1±0.84）,and the difference was significant（t=43.0,P〈0.05）.The level of estradiol in postpartum was lower than that of antenatal group,and the positive rate of hydrogen peroxide（H2O2）,neuraminidase and leucocyte esterase in postpartum group（43.7%,28.0% and 91.0%,respectively）were significantly higher than those of antenatal group（7.9%,6.1% and 11.2%）,all the differences were significant（t=258.2,χ^2=320.5,678.2,2 433.1;P〈0.05）.Conclusions In postpartum women,the amount of lactobacillus in vagina and the estrogen level in blood were greatly reduced,the vaginal pH value is obviously increased and the vaginal microecosystem is dramatically changed,which could lead to the occurrence of BV.