孕妇UU、CT、GBS感染与胎膜早破的关系及对妊娠结局的影响

Relationship between UU, CT, GBS Infection and Premature Rupture of Membranes in Pregnant Women and Its Effect on Pregnancy Outcome

目的探究孕妇解脲支原体(UU)、沙眼衣原体(CT)、B族链球菌(GBS)感染与胎膜早破(PROM)的关系及对妊娠结局的影响。方法选取2018年1月1日-2019年8月31日某院胎膜早破(PROM)孕妇44例作为PROM组,另选取同期无PROM孕妇82例作为无PROM组。均于33周~36周,且未发生PROM前,采集生殖道分泌物标本检测UU、CT、GBS感染情况,比较两组一般资料、UU、CT、GBS感染率及感染患者病原菌数量,Logistic多元回归方程分析UU、CT、GBS感染与PROM的关系,接收者操作特征(ROC)曲线及ROC下面积(AUC)分析UU、CT、GBS病原菌数量对PROM的预测价值,比较分析UU、CT、GBS感染对PROM产妇结局、新生儿结局的影响。结果 PROM组UU、CT、GBS感染率高于无PROM组(P<0.01);UU、CT、GBS感染是PROM发生的重要影响因素(P<0.05);PROM组UU、CT、GBS感染患者病原菌数量高于无PROM组感染患者(P<0.05);预测PROM的AUC:CT>GBS>UU,病原菌数量截断值分别为6.63×10~3、12.30×10~3、10.92×10~3 copy/mL(P<0.05);UU、CT、GBS感染者剖宫产发生率高于未感染者,差异有统计学意义(P<0.05),产后出血、产褥感染发生率高于未感染者,但差异无统计学意义(P>0.05);UU、CT、GBS感染者早产、胎儿宫内窘迫、新生儿宫内感染发生率高于未感染者,但差异无统计学意义(P>0.05)。结论孕妇UU、CT、GBS感染是PROM发生的重要影响因素,并能增加不良妊娠结局的风险,对病原菌进行定量可预测PROM的发生风险,为临床针对性干预提供重要的参考信息。

Objectives To investigate the relationship between ureaplasma urealyticum(UU), chlamydia trachomatis(CT), and group B streptococcus(GBS) infections and premature rupture of membranes(PROM) in pregnant women and their effects on pregnancy outcome.Methods A total of 44 pregnant women with PROM in our hospital from January 1 st,2018 to August 31 st, 2019 were selected as the PROM group, and 82 pregnant women without PROM during the same period were selected as the PROM-free group. All were from 33 to 36 weeks, and before the occurrence of PROM, samples of reproductive tract secretions were collected to detect UU, CT, and GBS infection. Compare the general data, UU, CT, GBS infection rates and the number of pathogenic bacteria in infected patients between the two groups. Logistic multiple regression equation analysis of the relationship between UU, CT, GBS infection and PROM, receiver operating characteristic(ROC) curve and area under ROC(AUC) analysis of the predictive value of UU, CT, GBS pathogenic bacteria on PROM, the effects of UU, CT and GBS infection on maternal outcomes and neonatal outcomes of PROM were compared and analyzed.Results The UU, CT, and GBS infection rates in the PROM group were higher than those in the PROM-free group(P<0.01);UU, CT and GBS infection were the important factors of PROM(P<0.05);the number of pathogenic bacteria in patients with UU, CT, GBS infection in PROM group was higher than that in patients without PROM infection(P<0.05);prediction of AUC of PROM: CT>GBS>UU, the cut-off values of pathogenic bacteria were 6.63×10~3,12.30×10~3,10.92×10~3 copy/mL(P<0.05);the incidence of cesarean section among UU, CT, and GBS infected patients was higher than that of uninfected patients, and the difference was statistically significant(P<0.05), the incidence of postpartum hemorrhage was higher than that of uninfected patients, but the difference was not statistically significant(P>0.05);the incidence of preterm birth, intrauterine distress, and neonatal asphyxia was higher in UU, CT, and GBS-infected patients than in uninfected patients, but the difference was not statistically significant(P>0.05).Conclusions UU, CT and GBS infections in pregnant women were important influencing factors of PROM, and could increase the risk of adverse pregnancy outcome, quantitative analysis of pathogenic bacteria could predict the risk of PROM, and provide important reference information for clinical targeted intervention.