阴道微生态指标与宫腔粘连的相关性

The association between vaginal microecological indexes and intrauterine adhesions

目的:分析阴道微生态相关指标与宫腔粘连(IUA)及其严重程度的相关性。方法:回顾性选择2018年6月-2020年12月本院妇科行宫腔镜检查者临床资料,其中IUA患者(IUA组)和宫腔正常(对照组),IUA分为轻度粘连组、中度粘连组、重度粘连组。各组妇女均宫腔镜检查前行阴道微生态检测。结果:IUA组阴道微生态菌群密集度Ⅰ、Ⅳ级,菌群多样性Ⅰ、Ⅳ级,优势菌为非乳杆菌、PH值>4.5、滴虫、细菌性阴道病、过氧化氢(H2O2)阳性率、乙酰氨基葡萄糖苷酶(NAG)阳性率、唾液酸苷酶(SNA)阳性率均高于对照组(P<0.05),真菌的检出率、白细胞酯酶(LE)阳性率、β-葡萄糖醛酸酶(GUS)阳性率两组无差异(P>0.05);菌群多样性Ⅰ、Ⅳ级,细菌性阴道病、H2O2阳性、SNA阳性是IUA的独立影响因素(P<0.05)。IUA中,重度粘连患者阴道微生态菌群多样性Ⅰ、Ⅳ级,优势菌为非乳杆菌、PH值>4.5、细菌性阴道病、H2O2阳性率、SNA阳性率均高于轻度粘连及中度粘连患者(P<0.05),轻度粘连与中度粘连上述指标无差异(P>0.05),各粘连组阴道菌群密集度、滴虫检出率、NAG阳性率未见差异(P>0.05);菌群多样性Ⅰ、Ⅳ级,细菌性阴道病、SNA阳性是重度IUA的独立影响因素(P<0.05)。结论:阴道微生态失衡与IUA的发生有关,尤其是重度IUA,应引起临床关注。

Objective:To analyze the correlation between vaginal microecological related indexes and intrauterine adhesion(IUA)and the severity of IUA.Methods:The clinical data of the women who had accepted hysteroscopy from June 2018 to June 2020 were selected retrospectively,which included women with IUA in study group and women with normal uterine cavity in control group.According to the severity of IUA,the women in the study group were further divided into group A(women with mild IUA),group B(women with moderate IUA),and group C(women with severe IUA).The vaginal microecological examinations before hysteroscopy of the women in these groups were conducted.Results:The percentages ofⅠorⅣclass of vaginal microecological bacteria concentration,ⅠorⅣclass of flora diversity,the lactobacillus not in dominant bacteria,PH>4.5,trichomoniasis,and bacterial vaginosis,and the positive rates of hydrogen peroxide(H2O2),acetyl amino glycosidase enzymes(NAG),and saliva acid glycosides enzyme(SNA)of the women in the study group were significant higher than those of the women in the control group(P<0.05).The fungicidal detected rate,and the positive rates of leucocyte esterase(LE)andβ-glucuronidase(GUS)of the women had no significant different between the two groups(P>0.05).ⅠorⅣclass of bacterial diversity,bacterial vaginosis,positive H2O2,and positive SNA were the independent influencing factors of IUA(P<0.05).The percentages ofⅠorⅣclass of bacterial diversity,the lactobacillus not in dominant bacteria,PH>4.5,and bacterial vaginosis,and the positive rates of hydrogen peroxide(H2O2),acetyl amino glycosidase enzymes(NAG),and saliva acid glycosides enzyme(SNA)of the women in group C were significant higher than those of the women in group A and group B(P<0.05),but which of the women had no significant different between group A and group B.There were no significant differences in the concentration of vaginal flora,the detection rate of trichomonas,and the positive rate of NAG of the women among group A,group B,and group C(P>0.05).ⅠorⅣclass of bacterial diversity,bacterial vaginosis,and positive SNA were the independent influencing factors of severe IUA(P<0.05).Conclusion:Vaginal microecological imbalance of the women is closely related to their occurrence of IUA,especially severe IUA,so which should be paid close attention to in clinical practice.