妊娠晚期胎膜早破孕妇阴道菌群、炎症因子改变及对妊娠结局影响

The changes of vaginal flora and inflammatory factors of women with premature rupture of fetal membranes during the third trimester pregnancy and its influence on their pregnancy outcomes

目的:探讨妊娠晚期胎膜早破(PROM)孕妇阴道菌群及炎症因子的变化规律,分析其对妊娠结局的影响。方法:选取本院产科180例妊娠晚期PROM孕妇(PROM组)和100例正常妊娠孕妇(对照组)。分娩前测定阴道分泌物菌群分布,血清超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平。对比两组阴道菌群及炎症因子水平并分析与PROM妊娠结局关系。结果:PROM组乳酸杆菌占比低于对照组,革兰阳性杆菌、革兰阴性杆菌、革兰阳性球菌占比均高于对照组,各类致病菌(溶血葡萄球菌、粪肠球菌、阴沟肠球菌、变形杆菌等)检出率高于对照组;孕妇阴道pH值(7.15±0.43)高于对照组(4.82±0.36),阴道密集度Ⅱ、Ⅲ级占比,阴道菌群多样性Ⅱ、Ⅲ级占比及阴道微生态正常者占比均低于对照组(均P<0.05);血清IL-6水平高于对照组(P<0.05),但hs-CRP、TNF-α水平两组无差异(P>0.05)。PROM组中,阴道微生态失调孕妇的早产、新生儿感染、病理性黄疸、产褥感染发生率高于阴道微生态正常孕妇(P<0.05),低出生体重儿发生率未见差异(P>0.05),妊娠结局良好孕妇血清IL-6水平低于结局不良孕妇(P<0.05),血清hs-CRP、TNF-α水平在妊娠结局比较未见差异(P>0.05)。结论:妊娠晚期阴道pH值升高、乳酸杆菌减少及机体炎症反应可能是引发PROM的主要因素,阴道菌群失调和炎症反应可能增加早产、产褥感染、胎儿窘迫、新生儿感染等不良母婴结局风险,应引起临床重视。

Objective:To investigate the changes of vaginal flora and inflammatory factors of women with premature rupture of fetal membranes(PROM)during the third trimester pregnancy,and to analyze its influence on their pregnancy outcomes.Methods:During the third trimester pregnancy,180 pregnant women with PROM were enrolled into observation group and 100 normal pregnant women were enrolled into control group.The distributions of vaginal flora of the women ante partum in the two groups were measured,and the levels of serum highly sensitive C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)of these women were also detected.The situations of vaginal flora and inflammatory factors of women were compared between the two groups,and the relationship between the levels of vaginal flora and inflammatory factors of women and their pregnancy outcomes were analyzed.Results:The proportion of lactobacilli of women in the observation group was significant lower than that of women in the control group,but the proportion of gram-positive bacilli,gram-negative bacilli,or gram-positive cocci of women in the observation group was significant higher(P<0.05).The detection rate of various pathogens(staphylococcus haemolyticus,enterococcus faecalis,enterococcus cloacae,or proteus,etc.)of women in the observation group was significant higher than that of women in the control group(P<0.05).The mean value of vaginal pH of women in the observation group was 7.15±0.43,which was significant higher than that(4.82±0.36)of women in the control group(P<0.05).The proportions of vagina density gradeⅡandⅢ,vagina flora diversity gradeⅡandⅢ,and vagina microecology of women in the observation group were significant lower of those of women in the control group(all P<0.05).The serum level of IL-6 of women in the observation group was significant higher than that of women in the control group(P<0.05),but the levels of hs-CRP and TNF-αof women had no significant diffrent between the two groups(P>0.05).In the observation group,the incidences of premature delivery,neonatal infection,neonatal pathological jaundice,and puerperal infection of women with endovaginal microecologics dysbiosis were significant higher than those of women with normal endovaginal microecologics(P<0.05),but the incidence of low birth weight infants,the level of serum IL-6 of women with normal pregnancy outcomes was significant lower than that of women with adverse pregnancy outcomes(P<0.05),and the levels of serum hs CRP and TNF-αhad no significant different(P>0.05).Conclusion:The vaginal PH increased,lactobacilli decreased,and inflammatory reaction of pregnant women during the third trimester of pregnancy may be the main factors of PROM.The imbalance of vaginal flora and inflammatory reaction may also increase the risk of adverse maternal and infant outcomes,such as premature delivery,puerperal infection,fetal distress,and neonatal infection.