胎膜早破与下生殖道病原体感染相关性分析

Correlation between lower genital infection and premature rupture of membranes

目的探讨胎膜早破与下生殖道病原体感染的相关性。方法随机选取2014年3月至2016年3月在粤北人民医院产科产检并住院分娩的胎膜早破孕妇200例资料(研究组),选取同期在产科住院分娩的胎膜未破正常孕妇200例(对照组),分别对两组的入院C-反应蛋白(CRP)、白带常规、细菌性阴道病(BV)、沙眼衣原体(CT)、细小脲原体(UP)、人型支原体(MH)、B族溶血性链球菌(GBS)检测资料进行分析。结果研究组CRP值高于对照组(t=3.221,P=0.001);研究组UP、CT、BV、MH、GBS、白色念珠菌、滴虫及混合感染的发生率均高于对照组(χ~2=49.520,4.810,5.498,12.210,9.421,4.815,4.592,41.813,均P<0.05),其中UP、MH及混合感染的发生率组间差异具有统计学意义(P<0.05),下生殖道总感染率研究组(60%)高于对照组(26%)(χ~2=47.160,P=0.000);研究组新生儿早产、新生儿肺炎、新生儿窒息及新生儿病理性黄疸的发生率均高于对照组(χ~2=17.330,33.006,9.355,4.891,均P<0.05),而低体重儿的发生率则差异无统计学意义(P>0.05);多元相关分析结果表明,UP、MH、GBS、CT及白色念珠菌与胎膜早破发生密切相关,其中UP为相关因素(P=0.000),BV和滴虫与胎膜早破的发生无相关性(P>0.05)。结论胎膜早破与下生殖道UP、MH、GBS、CT及白色念珠菌感染相关,细小脲原体感染为最主要的因素,有必要在孕前及孕期进行相关病原体筛查,针对病因采取相应防治措施,以降低胎膜早破的发生,减少母儿不良结局。

Objective To explore the correlation between lower genital infection and premature rupture of membranes （PROM）. Methods Totally 200 pregnant women with PROM who had babies in our hospital between March 2014 and March 2016 were selected as study group, while 200 normal pregnant women during the same period were selected as control group. C-reactive protein （CRP）, routine examination of leucorrhea, bacterial vaginosis （BV）, cervical secretions for Chlamydia trachomatis （CT）, Ureaplasma parvum （UP）, Mycoplasma hominis （MH） and group B Streptococcus （GBS） were analyzed in both groups. Results CRP of the study group was significantly higher than that of the control group （t = 3.221, P 〈 0.05）. The incidences of BV, infections caused by UP, CT, MH, GBS, Candida albicans, Trichomonas vaginalis, and mixed infections in the study group were significantly higher than those in the control group （χ^2 = 5.498, 49.520, 4.810, 12.210, 9.421, 4.815, 4.592 and 41.813 respectively, P 〈 0.05）. The total infection rate of the study group （60%） was higher than that of the control group （26%）, which had statistically significant difference （χ^2 = 47.16, P 〈 0.05）. The incidences of premature birth, pneumonia of newborn, neonatal asphyxia, and pathological jaundice in the newborns of the study group were significantly higher than those of the control group （χ^2 = 17.330, 33.006, 9.355 and 4.891 respectively, P 〈 0.05）, except the infants of low-birth weight （P 〉 0.05）. The correlative factors of PROM were UP, MH, GBS, CT and Candida albicans infections; among which UP was the significantly correlative factor in PROM pregnant women （P 〈 0.05）. Conclusions There are close correlations between the premature rupture of membranes and lower reproductive tract infections. The causes of PROM are closely related to UP, MH, GBS, CT and Caudida albicans infections; UP infection is the most important factor. It is necessary to screen the pathogens in pregestational and pregnant stages and take the corresponding prevention and treatment measures so as to lower the occurrence of PROM and reduce the adverse effects of PROM on pregnant women and perinatal infants.