不孕不育患者宫颈解脲支原体感染情况分析及耐药监测

Analysis of Ureaplasma urealyticum infections and drug resistance in the infertile patients

目的分析解脲支原体在不孕不育女性患者宫颈中感染情况及其药敏谱,为临床防治解脲支原体感染提供参考依据。方法选取2015年1—12月期间于丽水市中心医院就诊的不孕不育女性200例作为观察组,200名健康妊娠女性作为对照组,对所选取对象先行解脲支原体微生物液体培养初筛法,其中阳性者进行实时荧光定量PCR确诊实验,并用MIC法检测阳性者对9种抗生素的药敏情况。同时回顾性分析2010年1月—2015年12月期间丽水市中心医院8 571例女性患者资料,调查分析解脲支原体总体感染特征。结果 200例不孕不育组解脲支原体感染率(62.50%)明显高于可孕育组(41.50%),差异有统计学意义(P<0.05)。药敏实验显示解脲支原体对多西环素、米诺环素和克拉霉素高度敏感,敏感率分别为97.60%、96.80%、93.60%;其次为交沙霉素和阿奇霉素,敏感率分别为81.60%、74.40%;而氧氟沙星和罗红霉素的耐药性强,耐药率分别为20.00%、10.40%。8 571例患者中解脲支原体检测阳性患者为4 091例,感染率为47.73%,2010—2015年解脲支原体检测阳性率呈逐年上升趋势;不同年龄段解脲支原体感染分布显示,20~29、30~39、40~49岁感染率分别为47.48%、50.07%、49.84%,高于其他年龄段,差异有统计学意义(P<0.05)。结论本地区近年来解脲支原体感染有明显上升趋势,感染女性主要集中在可生育年龄段,这些无症状的感染会影响女性受孕并参与不良妊娠结局,因此对于不孕不育的女性患者,应尽早进行解脲支原体感染的检查,并根据药敏试验合理选用抗生素进行治疗。

Objective To investigate the distribution of Ureaplasma urealyticum and drug resistance in the infertile women so as to provide references for early diagnosis and treatments. Methods A total 200 cases infertile women who treated in the hospital from January to December 2015 were assigned as the observation group, meanwhile, 200 healthy pregnant women were chosen as the control group. Ureaplasma urealyticum infections of two groups of women were detected by real time fluorescence PCR（FQ-PCR） and nine kinds of antibiotics sensitivity test. The clinical data of 8 571 women who ex- amination in the hospital from January,2010 to December,2015 were retrospectively analyzed, then the total distribution of Ureaplasma urealyticum infections were investigated. Results Infertile group of 200 cases Ureaplasma urealyticum infec- ted higher than healthy group obviously（62.50% vs. 41.50% ）. The differences were significant（ P 〈 0.05 ）. Drug sus- ceptibility test show Ureaplasma urealytieum high sensitivity to doxycycline, minocycline and elarithromycin were 97.60% ,96.80% ,and 93.60% ,respectively;sensitivity to azithromycin and josamycin were 81.60% and 74.40% , re- spectively. The drug resistance rates high of oxygen danofloxacin and roxithromycin were 20.00% and 10.40%. In 8 571 clinical samples,4 091 proved to be positive in Ureap]asma urealyticum testing and the general infection rate was 47.73%. Ureaplasma urealyticum positive rate showed increasing trend from 2010 to 2015. The results showed that rela- tively high infection rates were among 20 -29,30 -39,40 -49 than others. The differences were significant（ P 〈 0.05 ）. Conclusion In recent years Ureaplasma urealyticum infection has increased significantly in our hospital,infected women were mainly concentrated in the fertile age groups, these asymptomatie infections might affect pregnant women and in- volved in adverse pregnancy outcomes, so Ureaplasma urealyticum should check as soon as possible among infertility women, and using antibiotics based on susceptibility testing rationally.