早产感染孕妇阴道分泌物病原菌与血清MCP-1和TNF-α及sTNFRI水平

Serum McP-1,TNF-α,sTNFRI and pathogenic bacteria in vaginal secretions of pregnant women with infectious preterm birth

目的探讨早产感染孕妇阴道分泌物病原菌及血清单核细胞趋化蛋白-1(MCP-1)、可溶性肿瘤坏死因子受体I(sTNFRI)、肿瘤坏死因子-α(TNF-α)水平。方法选择2018年8月-2020年8月于浙江省立同德医院产科分娩的早产孕妇97例,根据胎盘病理学检查结果分为研究组(早产感染孕妇)36例,对照组(早产非感染孕妇)61例,收集研究组阴道分泌物开展病原菌鉴定及药敏性试验,分析病原菌耐药性;记录并比较两组血清炎症因子水平及免疫调节功能并分析其与早产感染发生的相关性。结果在36例早产感染孕妇中共培养分离出病原菌45株,以真菌和支原体感染为主。药敏性检测结果显示真菌对氟胞嘧啶耐药率最高,对制霉素耐药率最低;支原体对阿奇霉素耐药率最高,对司帕沙星耐药率最低;革兰阳性菌对四环素耐药率最高,对亚培胺南耐药率最低;革兰阴性菌株对氨苄西林耐药率最高,对亚培胺南最为敏感。研究组MCP-1、sTNFRI、TNF-α高于对照组(P<0.05)。研究组Th17细胞比例、Th17/Treg高于对照组(P<0.05),Treg细胞比例较对照组低(P<0.05)。结论早产孕妇感染以真菌和支原体为主要,感染后炎症反应提高、免疫力下降,临床应就患者病原菌药敏性结果合理用药以及时控制感染。

OBJECTIVE To investigate the levels of monocyte chemotactic protein-1(McP-1), soluble tumor necrosis factor receptor I(sTNFRI) and tumor necrosis factor-α(TNF-α) in serum of pregnant women with infectious preterm birth. METHODS Ninety-seven preterm pregnant women who delivered in the department of Obstetrics of Litongde Hospital, Zhejiang Province from Aug 2018 to Aug 2020 were selected. According to the placental pathological examination results, they were divided into two groups, 36 cases in research group(infected pregnant women in preterm birth) and 61 cases in control group(non-infected pregnant women in preterm birth).Collected vaginal secretions to identify pathogenic bacteria and drug susceptibility experiment to analyze drug resistance of pathogenic bacteria;the levels of serum inflammatory factors and immunomodulatory functions were Recorded and compared between the two groups, and the correlation between them and the occurrence of infectious preterm birth were analyzed. RESULTS A total of 45 strains of pathogenic bacteria were isolated from 36 pregnant women with infectious preterm birth, with fungal and mycoplasma infections predominating;the results of drug sensitivity test showed that, fungi had the highest drug resistance to fluorocytosine, the lowest rate of resistance to ponomycin. Mycoplasma had the highest drug resistance to azithromycin, the lowest rate of resistance to sparfloxacin. Gram positive bacteria had the highest drug resistance to tetracycline, the lowest rate of resistance to epenem. Gram-negative strain had the highest resistance rate to ampicillin, most sensitive to apenem. McP-1, sTNFRI and TNF-α in the study group were significantly higher than control group(P<0.05). The proportion of Th17 cells and Th17/Treg in the study group was significantly higher than control group(P<0.05), and the proportion of Treg cells was significantly lower in the control group(P<0.05). CONCLUSION Fungi and Mycoplasma are the main infection factors in preterm pregnant women. The inflammatory response is heightened and the immunity is reduced after infection. It is necessary to control the infection by using rational drug timely and the drug sensitivity of the patients.