GBS阳性孕妇阴道微生态与妊娠不良事件的相关性

Correlation between vaginal microecology and adverse pregnancy events of pregnant women with GBS positive

目的研究B族链球菌(GBS)阳性孕妇阴道微生态与不良妊娠事件间的相关性。方法前瞻性选取2017年6月至2019年6月间于恩施州土家族苗族自治州中心医院行常规孕检并分娩的880例孕妇纳为研究对象,分别在孕早期(孕8~12周)及孕晚期(孕37周)使用胶体金免疫层析法行GBS检测。使用五联阴道试剂盒检测阴道微生态,同时记录孕妇围产结局,分析GBS阳性、孕妇阴道微生态与妊娠结局间的相关性。结果880例孕妇孕早期GBS鉴定结果显示,GBS阳性者共101例,GBS阴性者共779例。随访发现,孕早期GBS阳性组早产及流产发生率为15.84%、5.94%,均显著高于GBS阴性组(4.61%、1.67%),差异有统计学意义(P<0.05)。排除早产及流产的71例孕妇,剩余809例产妇获得孕37周GBS鉴定结果,其中GBS阳性112例,阴性697例,随访发现,孕晚期GBS阳性组胎膜早破及新生儿感染占比为27.68%、4.46%,均显著高于阴性组(6.20%、0.29%),差异有统计学意义(P<0.05);孕早期及晚期GBS阳性者与阴性者阴道pH差异无统计学意义(P>0.05),但两组乳酸杆菌量、白细胞分度,细菌性阴道病、滴虫、念珠菌等病原菌定植情况均差异有统计学意义(P<0.05)。结论孕早期及孕晚期阴道GBS感染者,其阴道微生态失衡及致病菌定植状况均更严重,推测GBS感染与阴道微生态失衡通过相互作用,增加围产期不良结局风险。

Objective To investigate the correlation between vaginal microecology and adverse pregnancy events of pregnant women with group B streptococcus(GBS)positive.Methods A total of 880 pregnant women in Women's and Children's Hospital,Enshi Tujia and Miao Autonomous Prefecture Central Hospital from June 2017 to June 2019 were enrolled.Serotyping of GBS was detected by colloidal gold immunochromatography in the first trimester(8-12 gestational weeks)and the third trimester(37 gestational weeks).The vaginal microecology was detected with the vaginitis multi-test kit.At the same time,the pregnancy outcome was recorded,and the correlation between GBS positive,vaginal microecology and adverse pregnancy outcome was analyzed.Results The GBS test results of 880 pregnant women in the first trimesters showed that 101 cases were GBS positive and 779 cases were GBS negative.The incidence of preterm birth and abortion among women in first trimester was 15.84%,5.94%in GBS positive group,which was significantly higher than that in GBS negative group(4.61%,1.67%),the difference was statistically significant(P<0.05).After excluding the 71 cases of premature delivery and abortion,GBS test results of the remaining 809 pregnant women in third trimester included 112 cases GBS positive and 697 cases GBS negative.The incidence of premature rupture of membranes and neonatal infection among women in third trimester was 27.68%,4.46%in GBS positive group,which was significantly higher than in GBS negative group(6.20%,0.29%),the difference was statistically significant(P<0.05).Vaginal pH in first and third trimesters had no significant difference between GBS positive and negative groups(P>0.05),while significant difference was found in amount of lactobacillus,leucopoenia degree,colonization of BV,Trichomonas,Candida and other pathogenic bacteria between groups(P<0.05).Conclusion Vaginal microecological imbalance and pathogenic bacteria colonization are more serious in patients with GBS positive in early and late pregnancy,furthermore,there is a risk the interaction between GBS infection and vaginal microecological imbalance may increase the risk of adverse pregnancy outcomes.