复发性流产患者阴道菌群变化及其与凋亡蛋白Bcl-2和Bax的相关性

Changes of vaginal microflora and its correlation with apoptosis proteins Bcl-2 and Bax in patients with recurrent spontaneous abortion

目的 研究复发性流产(RSA)患者阴道菌群变化及其与凋亡蛋白Bcl-2及Bax的相关性。方法 将我院2016年1月至2019年1月收治的75例RSA患者纳入RSA组,并将同期于医院计划生育门诊自愿接受早孕吸宫流产的100例早孕妇女纳入早孕人流组。比较两组阴道菌群差异,IL-17、TNF-α水平及绒毛组织凋亡蛋白Bcl-2及Bax阳性表达量,分析血清IL-17及TNF-α与绒毛组织凋亡蛋白阳性表达间的相关性。结果 RSA组异常菌群检出率显著高于早孕人流组(P<0.05)。RSA组占比最高的三种异常优势菌分别为粪肠球菌、大肠埃希菌和白假丝酵母菌,早孕人流组分别为解脲脲原体、白假丝酵母菌和无乳链球菌。RSA组血清IL-17水平显著低于早孕人流组,TNF-α水平显著高于早孕人流组(P<0.05)。RSA组绒毛组织Bcl-2阳性细胞数及Bcl-2/Bax水平均显著低于早孕人流组(P<0.05),RSA组绒毛组织中Bax阳性细胞数显著高于早孕人流组(P<0.05)。相关性分析显示,RSA组IL-17与绒毛组织Bcl-2阳性表达呈正相关,与绒毛组织Bax阳性表达呈负相关,TNF-α与患者绒毛组织Bcl-2阳性表达水平呈负相关,与绒毛组织Bax阳性表达成正相关。结论 RSA患者阴道异常菌群检出率高,其优势菌分布情况与早孕人流患者也存在差异,阴道异常菌群可能通过影响免疫细胞因子水平,导致绒毛组织凋亡蛋白Bcl-2及Bax表达异常造成流产,但其具体机制尚不明确。

Objective To observe the changes of vaginal microflora and its correlation with apoptosis proteins Bcl-2 and Bax in patients with recurrent spontaneous abortion(RSA). Methods Seventy-five RSA patients(RSA group) and 100 early pregnancy women with uterine aspiration [early pregnancy abortion(EPA) group] admitted to the hospital from January 2016 to January 2019 were included. The vaginal microflora, levels of IL-17 and TNF-α, as well as the positive expression levels of Bcl-2 and Bax in villus were compared between groups. The correlation between serum IL-17 and TNF-α and the expression of apoptosis proteins in villus was analyzed. Results The detection rate of abnormal microflora in RSA group was significantly higher than that in EPA group(P<0.05). The three dominant abnormal bacteria with higher proportion were Enterococcus faecalis, Escherichia coli and Candida albicans in the RSA group, and Ureaplasma urealyticum, Candida albicans and Streptococcus agalactiae in EPA group. The serum IL-17 level in the RSA group was significantly lower, and the TNF-α level was significantly higher than in the EPA group, respectively(P<0.05). The number of Bcl-2 positive cells and the level of Bcl-2/Bax in the villi of RSA group were significantly lower, and that of Bax positive cells was significantly higher than in EPA group, respectively(P<0.05). Correlation analysis showed that positive expression of Bcl-2 in villus was positively correlated with IL-17 and negatively correlated with TNF-α;meanwhile, the positive expression of Bax in villus was negatively correlated with IL-17, and positively correlated with TNF-α. Conclusion The detection rate of abnormal vaginal bacteria in RSA patients is high, and the distribution of dominant bacteria is also different from that in early pregnancy abortion patients. Abnormal vaginal bacteria may affect the levels of immune cytokines, leading to abnormal expression of apoptosis protein Bcl-2 and Bax in villus tissue, thus causing abortion, but the specificmechanism still remains unclear.