围产期胎膜早破与生殖道病原菌感染的分析

Analysis of Perinatal Premature Rupture of Membranes and Reproductive Tract Pathogen Infection

目的 分析围产期发生胎膜早破与生殖道病原菌感染的关系。方法 依照病例定义选择2011年6月-2012年5月陕西省人民医院产科的正常孕妇112例和胎膜早破的孕妇108例,采集孕妇的阴道分泌物和宫颈分泌物用定量PCR检测解脲支原体（ureaplasma urealyticum,UU）、沙眼衣原体（chlamydia trachomatis,CT）、B族链球菌（group B streptococcus,GBS）、白色念珠菌（candida albicans,C.albicans）、淋病奈瑟菌（neisseria gonorrhoeae,NG）、单疱病毒Ⅰ（herps simple virusⅠ,HSV-Ⅰ）和单疱病毒Ⅱ（herps simple virusⅡ,HSV-Ⅱ）共7种病原菌,对研究数据用卡方检验和Fisher判别分析病原菌感染与胎膜早破的关系。结果 7种病原菌中UU,GBS和CT的感染在正常孕产妇组和胎膜早破孕产妇组之间的差异有统计学意义（χ^2=3.644-6.093,P〈0.05）,而C.albicans,NG,HSV-Ⅰ,HSV-Ⅱ的感染在二组间差异无统计学意义（χ^2=0.000-0.046,P〉 0.05）。同时阴道分泌物病原菌定量检测：UU≥105 copy/ml,CT≥103 copy/ml和GBS≥103 copy/ml的含量在正常孕产妇和胎膜早破孕产妇之间的差异有统计学意义（χ^2=0.278-7.015,P〈0.05）。采用Fisher判别分析病原菌的分类正确性,对UU按照〈103 copy/ml,103-104 copy/ml,≥105 copy/ml分为三段; GBS按照〈103 copy/ml和≥103 copy/ml分为两段; CT按照〈103 copy/ml和≥103 copy/ml分为两段作散点图,投影显示UU,GBS和CT感染分类区分明显,说明病原菌感染的数量与胎膜早破的发生是密切相关的,为临床提供了判断感染的依据。结论 围产期发生胎膜早破与生殖道病原菌感染的数量有关,临床应结合病原菌的感染数量来评估其与胎膜早破发生的相关性。

Objective To analysis of the perinatal premature rupture of membranes occurred relations with genital tract pathogen infection. Methods According to the case definition,selected 112 cases of normalpregnant women and 108 cases of pregnant women with premature rupture of membranes in Shaanxi Provincial People＇s Hospital from June 2011 to May 2012. Collected vaginal and cervical secretions of the pregnant women,and detected 7 kinds of pathogen Ureaplasma Mycoplasma, Chlamydia trachomatis , group B Streptococcus bacteria, Candida albicans , Neisseria gonorrhea, Herps simple virus Ⅰ and Herps simple virus Ⅱ totally with quantitative PCR method. To the research data,discriminated and analyzed the relation- ship between pathogen infection and premature rupure of membranes. Results Seven kinds of pathogenic bacteria in UU, GBS and CT infection in the normal maternal premature rupture of membranes and maternal group the difference was statis-tically significant between （χ^2= 3. 644-6.093 ,P〈0.05）, while C. albicans. NG, HSV-Ⅰ , HSV-Ⅱ no statistical difference between two groups （χ^2=0. 000 - 0.046, P〉0.05 ）. And vaginal pathogen quantitative detection： UU≥10^5 copy/ml, CT≥10^3 copy/ml,GBS≥10^3 copy/ml in premature rupture of membranes and maternal between the difference was statistically significant （χ^2= 0. 278 - 7.015, P〈0.05）. By the Fisher discriminant analysis pathogen classification accuracy, the UU according to UU〈10^3 copy/ml, 10^3 - 10^4 copy/ml, ≥10^5 copy/ml was divided into three sections ; GBS according to 〈10^3 copy/ml and ≥10^3 copy/ml was divided into two sections;CT according to 〈10^3 copy/ml and ≥10^3 copy/ml was divided into two segments to make a scatter diagram,projection display UU, GBS and CT classification to distinguish between apparent infection, the number of pathogen infection and is closely related to the occurrence of premature rupture of membranes, for clinical provides the basis of infection. Conclusion Perinatal premature rupture of membranes occurred related to the number of genital tract pathogen infection, clinical should be combined with pathogen infection number to assess their correlation with premature rupture of membranes.