孕妇围生期B族链球菌的分布特征及其相关因素分析

Distribution characteristics and related factors of perinatal group B streptococcus in pregnant women

目的分析本地区孕妇围生期B族链球菌的分布特征及定值率相关影响因素。方法收集2018-2020年医院妇产科1245例接受GBS筛查的围生期孕妇,采集其阴道-直肠分泌标本。采用荧光定量PCR筛查GBS阳性孕妇,乳胶凝集法对GBS菌株进行血清分型。采用K-B纸片扩散法对GBS菌株进行药敏分析。结果1245例围生期孕妇,阳性病例113例,定植率9.08%。通过乳胶凝集法共检测到6种血清型,分别为Ia型23例,Ib型29例,Ⅲ型45例,Ⅴ型2例,Ⅵ型3例,Ⅸ型4例,7例NT。氨苄西林、青霉素、头孢曲松、万古霉素100%敏感,克林霉素、红霉素的耐药率2018-2020年均大于60%。GBS定植率与年龄、经产史、流产史、BMI、文化程度、经济情况、妊娠高血压差异不具有统计学意义(P>0.05)。孕周(>37)、甲状腺功能异常、妊娠糖尿病、阴道与宫颈炎症是GBS定植率的危险因素(P<0.05),孕前检查为保护性因素(P<0.05)。GBS感染者与非感染者妊娠结局对比显示,产后出血,产褥感染差异无统计学意义(P>0.05),胎膜早破、早产、宫内感染、胎儿宫内窘迫、新生儿感染,差异具统计学意义(P<0.05)。结论本研究中GBS血清分型主要以Ⅲ型为主。孕周(>37)、甲状腺功能异常、妊娠糖尿病、阴道与宫颈炎症是GBS定植率的危险因素,孕前检查为保护性因素。GBS阳性孕妇容易出现宫内感染、胎膜早破、早产、胎儿宫内窘迫及新生儿感染等不良妊娠结局。

Objective To analyze the distribution characteristics of perinatal group B streptococci and the related influencing factors of fixed value rate.Methods 1245 perinatal pregnant women who underwent GBS screening in the Department of Obstetrics and Gynecology of Hospital from 2018 to 2020 were collected,and their vaginal rectal secretion samples were collected.GBS positive pregnant women were screened by fluorescence quantitative PCR,and GBS strains were serotyped by latex agglutination.The drug sensitivity of GBS strain was analyzed by K-B disk diffusion method.Results Among 1245 perinatal pregnant women,113 were positive,and the colonization rate was 9.08%.Six serotypes were detected by latex agglutination method,including 23 cases of type Ia,29 cases of type Ib,45 cases of type III,2 cases of type V,3 cases of type VI,4 cases of type IX and 7 cases of NT.Ampicillin,penicillin,ceftriaxone and vancomycin were 100%sensitive,and the resistance rate of clindamycin and erythromycin was more than 60%from 2018 to 2020.There was no significant difference between GBS colonization rate and age,menstrual history,abortion history,BMI,educational level,economic situation and pregnancy induced hypertension(P>0.05).Gestational weeks(>37),abnormal thyroid function,gestational diabetes mellitus,vagina and cervicitis were the risk factors for GBS colonization rate(P<0.05),but there was significant difference in premature rupture of membranes,premature delivery,intrauterine infection,intrauterine fetal distress and neonatal infection(P 37),abnormal thyroid function,gestational diabetes mellitus,vagina and cervicitis were the risk factors for GBS colonization rate,and pre pregnancy examination was the protective factor.GBS positive pregnant women are prone to adverse pregnancy outcomes such as intrauterine infection,premature rupture of membranes,premature delivery,intrauterine fetal distress and neonatal infection.