妊娠期糖尿病孕妇产后阴道微生态状况分析

Analysis of the postpartum vaginal microecology of pregnant women with gestational diabetes mellitus

目的探讨妊娠期糖尿病孕妇产后阴道微生态的状况,为孕妇产后恢复阴道微生态提供重要实验依据。方法回顾性分析2018年1-12月在武汉市江汉区妇幼保健院进行体检的128例妊娠期糖尿病孕妇(实验组)与120例健康孕妇(对照组)产后阴道微生态状况,比较两组间阴道微生态形态学(阴道优势菌、阴道菌群密集度、阴道菌群多样性、阴道清洁度、Donders评分、其他病原微生物及Nugent评分等)与功能学(阴道pH值、过氧化氢、凝固酶、β-葡萄糖醛酸苷酶、唾液酸苷酶、白细胞酯酶)的差异变化。结果实验组产后阴道优势菌以革兰阳性球菌(48.44%)和革兰阴性杆菌(34.38%)为主,对照组以革兰阳性杆菌(88.33%)为主,两组间比较差异有统计学意义(P<0.05)。实验组菌群密集度较低,以Ⅰ级和Ⅱ级为主,而对照组密集度则以Ⅲ级和Ⅳ级为主,差异有统计学意义(P<0.05),且两组间菌群构成及多样性也明显不同,差异有统计学意义(P<0.05)。与对照组相比,实验组阴道清洁度较差,白细胞数目明显增多,阴道病原菌感染率为91.41%,以细菌性阴道病及混合感染患者居多,其中有症状者为84.38%,显著高于对照组,差异有统计学意义(P<0.05)。实验组阴道pH值较对照组显著升高,实验组过氧化氢、凝固酶、β-葡萄糖醛酸苷酶、唾液酸苷酶和白细胞酯酶阳性率显著高于对照组,差异有统计学意义(P<0.05)。结论妊娠期糖尿病孕妇产后阴道菌群较健康孕妇有明显异常,阴道微生态失衡,需恢复正常阴道微生态,减少阴道病原菌感染的发生。

Objective To investigate the status of postpartum vaginal microecology in pregnant women with gestational diabetes mellitus,and to provide important experimental basis for postpartum restoration of vaginal microecology in patients.Methods Retrospective analysis was performed on the postpartum vaginal microecological status of 128 pregnant women with gestational diabetes(experimental group)and 120 healthy pregnant women(control group)who underwent physical examination in Wuhan jianghan district maternal and child health hospital from January to December 2018.Compared the vaginal microecological morphology difference of the two groups(vagina advantage bacterium intensity,vaginal flora,vaginal flora diversity,vaginal cleanness,Donders score,other pathogenic microorganism,Nugent scores,etc.)and function(vaginal pH value,hydrogen peroxide,coagulase,β-glucuronidase,sialidase and leucocyte esterase).Results In the experimental group,gram-positive cocci(48.44%)and gram-negative bacilli(34.38%)were the dominant bacteria,while in the control group,gram-positive bacilli(88.33%)were the dominant bacteria,the difference between the two groups was statistically significant(P<0.05).The intensity of the experimental group flora levels is lower,give priority toⅠandⅡlevel,whereas the control bacteria concentration was higher,performance for gradeⅢandⅣlevel,the proportion of relatively and flora composition and diversity between the two groups also significantly different,the difference was statistically significant(P<0.05).Compared with the control group,the vaginal cleanliness of the experimental group was poor,the number of white blood cells increased significantly,the infection rate of vaginal pathogens was 91.41%,bacterial vaginosis and mixed infection were the majority of patients,and the symptoms were 84.38%,significantly higher than control group,the difference was statistically significant(P<0.05).The pH value of vagina in the experimental group was significantly higher than that in the control group,and the positive rates of hydrogen peroxide,coagulase,β-glucuronidase,sialidase and leucocyte esterase in the experimental group were significantly higher than those in the control group,with statistically significant differences(P<0.05).Conclusion The vaginal microecology in pregnant women with gestational diabetes is obviously abnormal compared with that in normal pregnant women.Therefore,adjustment should be made to restore normal vaginal microecology and reduce the incidence of vaginal pathogen infection.