孕妇早产与妊娠期阴道微生态环境变化的关系研究

Study on the relationship between preterm delivery and the changes of vaginal microecological environment during pregnancy

目的分析孕妇早产与妊娠期阴道微生态环境变化的关系。方法选取2016年10月至2018年11月于西安交通大学第一附属医院产检的186例孕妇为研究对象,将孕周≥37周有分娩指征的108例孕妇纳入足月组,将孕周为28周至36周+6的有早产迹象需行保胎治疗延长孕周的78例孕妇纳入早产组。采集两组孕妇阴道和宫颈分泌物,比较其阴道微生态环境变化。观察两组孕妇阴道菌群密集度和多样性,检测其阴道病原菌中的菌丝、孢子、解脲支原体、沙眼衣原体等,计算相应病原菌的阳性率,比较两组孕妇阴道pH、过氧化氢、白细胞酯酶、唾液酸苷酶等功能酶类指标的检出情况。通过Nugent评分和需氧菌性阴道炎(aerobic vaginitis,AV)评分分析孕妇早产与妊娠期阴道微生态环境变化的关系。结果两组孕妇阴道菌群密集度和菌群多样性比较差异均有统计学意义(均P<0.05)。早产组孕妇菌丝和孢子阳性率均显著高于足月组(均P<0.05),pH显著低于足月组(P<0.05)。早产组检出唾液酸苷酶孕妇占比和细菌性阴道病(bacterial vaginosis,BV)发生率均显著高于足月组(均P<0.05),AV严重程度显著大于足月组(P<0.05)。结论孕妇早产与阴道微生态失调有关,特别是与BV和AV有关。评价微生态环境变化能更好地指导临床治疗,改善母婴结局。

Objective To investigate the relationship between premature delivery and the changes of vaginal microecological environment during pregnancy.Method One hundred and eighty-six pregnant women who underwent antenatal examination in thethe First Affiliated Hospital of Xi'an Jiaotong University from October 2016 to November 2018 were selected as subjects,108 pregnant women with gestational age≥37 weeks with indications of delivery were included in term labor group,and 78 pregnant women with signs of premature delivery from 28 weeks to 36 weeks+6 were included in premature delivery group.Vaginal and cervical secretions were collected from the two groups of pregnant women,and the changes of vaginal microecological environment were compared.The density and diversity of vaginal flora in the two groups were observed,and the mycelia,spores,Ureaplasma urealyticum and Chlamydia trachomatis in the vaginal pathogens were detected,the positive rate of the corresponding pathogenic bacteria was calculated,and the detection of vaginal pH,hydrogen peroxide,leukocyte esterase,sialidase and other functional enzymes in the two groups were compared.The relationship between premature delivery and the changes of vaginal microenvironment during pregnancy was analyzed by Nugent score and aerobic vaginitis(AV)score.Result There were significant differences in vaginal flora density and diversity between the two groups(all P<0.05).The positive rates of mycelium and spores in premature delivery group were significantly higher than those in term labor group(P<0.05),pH was significantly lower than that in term labor group.The proportion of pregnant women with sialidase and the incidence of bacterial vaginosis(BV)in premature delivery group were significantly higher than those in term labor group(all P<0.05),the severity of AV was significantly higher than that in term labor group(P<0.05).Conclusion Premature delivery is associated with vaginal microecological disorders,especially with BV and AV.The evaluation of the changes of microecological environment can better guide the clinical treatment and improve the maternal and infant outcome.