早产妇女妊娠期阴道微生物群落分析

Analysis on vaginal microflora during pregnancy in women with premature labor

目的检测早产妇女妊娠期阴道微生物群落情况。方法选择2016年1月至2018年1月在我院妇产科住院的孕妇,根据妊娠结局将产妇分为早产组(186例)和足月产组(114例)。早产组中孕龄<28周的20例,28周≤孕龄<32周的62例,32周≤孕龄<37周的104例。研究患者基本资料,包括年龄、孕前体重指数(BMI)、是否吸烟、既往史、分娩时孕龄、新生儿体重、性别、Apgar评分和新生儿是否进入重症监护病房(NICU)。检测患者阴道菌群情况。结果全部的早产孕妇孕早期和孕中期阴道大肠埃希菌以及孕龄<28周产妇孕中期阴道肺炎克雷伯菌检出率明显高于足月产孕妇。全部的早产孕妇孕早期和孕中期阴道乳杆菌检出率明显低于足月产孕妇。孕龄<28周和28周≤孕龄<32周的早产孕妇新生儿出生体重和Apgar评分明显低于足月产产妇。全部的早产孕妇早产新生儿NICU入院率明显高于足月产新生儿,孕龄<28周早产新生儿死亡率明显高于足月产新生儿。阴道大肠埃希菌、肺炎克雷伯菌和乳杆菌与产妇是否早产存在相关性,其中大肠埃希菌和肺炎克雷伯菌检出率与早产成正相关,乳杆菌检出率与早产成负相关。结论阴道肺炎克雷伯菌和大肠埃希菌检出率增加与早产存在相关性,可能成为早产的预测指标。

Objective To detect the vaginal microflora during pregnancy in women with premature labor. Methods Pregnant women admitted to the Department of Obstetrics and Gynecology of our hospital from January 2016 to January 2018 were divided into preterm labor group(186 cases, including 20 patients with gestational ages of <28 weeks, 62 ones with gestational ages of ≥28 and <32 weeks, 104 ones with gestational ages of ≥32 and <37 weeks) and preterm labor group(114 cases) according to the pregnancy outcome. The basic data of patients including age, pre-pregnancy body mass index(BMI), smoking status, past history and gestational age at labor, as well as neonatals′ weight, gender, Apgar score, and whether being admitted to NICU were studied. The vaginal flora was detected. Results The prevalence of E. coli in early pregnancy and second trimester were significantly higher than that in full-term pregnant women. The detection rate of Klebsiella pneumoniae in the second trimester in women with gestational age <28 weeks was significantly higher than that in full-term pregnant women. The detection rates of Lactobacilli in early pregnancy and second trimester were significantly lower than that in full-term pregnant women. In women with gestational age of <28 weeks and the ones with gestational age of ≥28 and <32 weeks, the neonatal birth weight and Apgar score were significantly lower. The NICU admission rate of preterm neonates was significantly higher than that of full-term neonates, and the mortality of preterm neonatas with gestational age of <28 weeks was significantly higher than full-term neonates. The detection rates of E. coli and Klebsiella pneumoniae were positively correlated with premature delivery, while that of Lactobacilli was inversely proportional to premature delivery. Conclusion The increase in the detection rates of vaginal Klebsiella pneumoniae and E. coli is related to preterm delivery, which may be a predictor of preterm delivery.