妊娠期阴道菌群变化与胎膜早破的相关性

Correlation between Changes of Vaginal Microflora and Premature Rupture of Membranes during Pregnancy

目的通过对正常妊娠与胎膜早破孕妇的阴道微生物群落分析,阐明阴道菌群变化与胎膜早破的相关性。方法随机收集符合纳入标准的不同孕周阶段胎膜早破孕妇阴道分泌物50例为实验组,正常孕妇阴道分泌物30例为正常对照组,提取细菌DNA后用高通量测序技术,分析比较胎膜早破与正常孕妇阴道微生物群落的多样性指数及群落结构。结果各组的Alpha多样性丰富度及均匀度指数,差异无统计学意义(P>0.05),各组菌群非度量多维尺度分析(nonmetric multidimensional scaling,NMDS)Stress=0.02,差异具有统计学意义(P<0.05)。根据维恩图显示未足月胎膜早破组的物种多样性最高,为529个;未足月正常对照组组的多样性最低,为207个。结论正常孕期阴道菌群较稳定,Alpha多样性小,Beta多样性显著。妊娠期阴道微生物群落以卷曲乳杆菌为主,若孕期阴道内菌群多样性增加,惰性乳杆菌、加德纳菌、纤毛菌、普氏菌、奇异菌等异常增加,易发生细菌性阴道病、胎膜早破。

Objective To elucidate the relationship between vaginal microbiota and premature rupture of membranes by analyzing the vaginal microbiota of normal pregnancy and pregnant women of premature rupture of membranes.Methods Gestational age meeting inclusion criteria was randomly collected(gestational age<28 weeks;28 to 34 weeks;34 and 37 weeks;37 to 39 weeks;each case was 10 at 39-41 weeks),a total of 50 cases of vaginal secretions from pregnant women with premature rupture of membranes were used as the experimental group.Vaginal secretions were collected from 6 normal pregnant women at the above relative gestational age,and a total of 30 normal women were selected as the control group.The bacterial DNA of vaginal secretions was extracted by the second generation high throughput sequencing method,and the diversity index,microbial community structure and dominant species of vaginal microbiome were analyzed and compared between premature rupture of membranes and normal pregnant women.Results The P value of Wilcoxon test for Alpha diversity richness and evenness index among each group was>0.05,The Stress value of nonmetric multidimensional scaling was=0.02,less than 0.05,the difference was statistically significant.According to Venn diagram,the species diversity of preterm premature rupture of membranes was the highest(529).The diversity of normal control group before term was the lowest(207).Conclusions In normal pregnancy,vaginal microflora is stable,with small Alpha diversity and significant Beta diversity.Vaginal microbial community during pregnancy can be divided into five types,mainly L.crispatus,if the increase of L.iners,gardnella,prevotella,sneathia,ureaplasma and atopobium etc in the vagina during pregnancy,bacterial vaginosis and premature rupture of membranes are prone to occur.