孕晚期B族链球菌带菌者母儿结局及高危因素分析

Analysis of perinatal outcomes and highrisk factors of group B streptococcus carrying pregnant women

目的了解孕晚期孕妇B族链球菌(GBS)的带菌情况及应用抗生素预防性治疗后的母儿结局,并分析GBS带菌的高危因素。方法回顾性收集2014年1月至2014年12月在北京妇产医院分娩体验门诊就诊的孕妇4959例,于孕35~37周采集阴道下1/3及肛门括约肌上2~3cm处直肠标本(共1份),采用PCR法进行GBS检测,其中278例检测出B族链球菌阳性者为研究组,随机抽取同期产检332例检测GBS阴性者为对照组。GBS阳性者临产后或胎膜早破时给予抗生素预防感染,分析其妊娠结局及GBS带菌的高危因素。结果 GBS阳性者278例,带菌率为5.61%。GBS阳性组年龄显著高于GBS阴性组(t=2.941,P<0.05),两组文化程度有显著性差异(X^2=8.108,P<0.05),而两组经产妇所占比例无显著性差异(X^2=2.593,P>0.05)。新生儿中无GBS感染导致肺炎、败血症、脑膜炎等发生,1例可疑GBS感染,1例新生儿脓疱疹。GBS阳性组新生儿窒息发生率显著高于GBS阴性组(X^2=4.809,P<0.05),两组胎膜早破、胎儿窘迫、产时发热比较均无显著性差异(X^2值分别为1.180、0.009、2.187,均P>0.05),两组新生儿体重、产后出血比较均无显著性差异(t值分别为0.497、0.529,均P>0.05)。年龄、阴道炎是GBS定植的危险因素(OR值分别为1.071、2.955,均P<0.05),而糖尿病不是GBS定植的高危因素(OR=1.108,P>0.05)。结论 GBS阳性孕妇临产后使用抗生素规范治疗可改善母儿结局,建议对GBS高危人群进行筛查。

Objective To investigate group B streptococcus （ GBS ） carrying of pregnant women in the third trimester and pregnancy outcomes after using antibiotics and to analyze the highrisk factors of GBS carrier .Methods Totally 4 959 outpatients participating in delivery experience from January to December in 2014 were retrospectively analyzed .Specimen was taken from each patient ’ s vagina and rectum （ one sample ） at 35-37 weeks of gestation and all specimens were detected by PCR .There were 278 cases of GBS positive in study group, and 332 cases of GBS negative were randomly selected in control group .Antibiotics were given to prevent infection for GBS positive cases when laboring or membranes ruptured .Pregnancy outcomes and risk factors of GBS carrier were analyzed .Results There were 278 cases of GBS positive , and the positive rate was 5.61%.GBS positive group had a significantly older age than GBS negative group （ t=2.941,P〈0.05）, and there was significant difference in level of education between two groups （χ2 =8.108,P〈0.05）.There was no significant difference in proportion of multipara （χ2 =2.593, P〉0.05）.There was no neonatal pneumonia , septicemia, meningitis caused by GBS infection , but there was one case of suspected neonatal GBS infection and one case of neonatal pustular rash .The incidence of neonatal asphyxia was significantly higher in GBS positive group than in GBS negative group （χ2 =4.809,P 〈0.05）.There was no significant difference between two groups in the incidence of premature rupture of membranes , fetal distress and intrapartum fever （χ2 value was 1.180, 0.009 and 2.187, respectively, all P〉0.05）, and no significant difference was found in newborn body weight and postpartum hemorrhage between two groups （t value was 0.497 and 0.529, respectively, both P〉0.05）.The high risk factors of GBS were age and vaginitis （OR value was 1.071 and 2.955, respectively, both P〈0.05）, while diabetes mellitus was not risk factor （OR=1.108,P〉0.05）.Conclusion Standard antibiotics treatment for GBS positive women in labor can improve maternal and neonatal outcomes , and screening is recommended for high risk population of GBS .