解脲支原体和人型支原体共同感染PROM孕妇耐药特征及细胞因子变化

Drug-resistance and cytokine changes in pregnant women with PROM infected by Ureaplasma urealyticum and Mycoplasma hominis

目的 探讨人型支原体(Mh)和解脲支原体(Uu)合并感染胎膜早破(PROM)孕妇耐药特征及细胞因子改变。方法 选取大连市妇女儿童医疗中心产科2018年5月-2019年12月收治的胎膜早破并生殖道支原体感染孕妇84例作为研究对象,分为Uu组(n=71)和Uu+Mh组(n=13),选择同期医院收治的非感染性胎膜早破孕妇60例作为非感染组。分析耐药特征,比较三组产妇妊娠结局和血清中Toll受体2(TLR2)、Toll受体4(TLR4)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)水平。结果 Uu组红霉素、阿奇霉素、克拉霉素和交沙霉素敏感率较高,Uu+Mh组红霉素和交沙霉素敏感率较高;Uu+Mh组绒毛膜羊膜炎及新生儿感染发生率高于Uu组及非感染组(P<0.05),出生时孕周、新生儿体质量及Apgar评分低于Uu组及非感染组(P<0.05),Uu组绒毛膜羊膜炎及新生儿感染发生率高于非感染组(P<0.05),出生时孕周、新生儿体质量及Apgar评分低于非感染组(P<0.05);Uu+Mh组IL-6、IL-8、TNF-α水平高于Uu组及非感染组(P<0.05),Uu组IL-6、IL-8、TNF-α水平高于非感染组(P<0.05)。结论 胎膜早破合并生殖道支原体感染可能与IL-6、IL-8、TNF-α上调表达有关,应加强产前的生殖道病原检查,根据其耐药特征给予针对性的治疗。

OBJECTIVE To explore the drug resistance characteristics and cytokine changes in pregnant women with premature rupture of membranes(PROM) infected by Mh and Urealyticum urealyticum(Uu). METHODS A total of 84 pregnant women with premature rupture of membranes infected by mycoplasma in the genital tract admitted to the department of Obstetrics of Dalian Women and Children Medical Center from May 2018 to Dec 2019 were enrolled in the study, and divided into the Uu group(n=71) and Uu+Mh group(n=13). Another 60 pregnant women with non-infectious premature rupture of membranes admitted to the hospital during the same period were in the non-infected group. The characteristics of drug resistance were tested analyzed. The pregnancy outcome and serum levels of Toll receptor 2(TLR2), Toll receptor 2(TLR4), interleukin-6(IL-6) and interleukin-8(IL-8) among the three groups were compared. RESULTS The drug-sensitivity rates of erythromycin, azithromycin, clarithromycin and josamycin in the Uu group was higher. The drug-sensitivity rates of erythromycin, and josamycin in the Uu+Mh group were higher. The incidence of chorioamnitis and neonatal infection in the Uu+Mh group was significantly higher than that in the Uu group and non-infection group(P<0.05), while gestational age at birth, neonatal weight and Apgar score were significantly lower than that in the Uu group and non-infection group(P<0.05). The incidence of chorioamnitis and neonatal infection in the Uu group was significantly higher than that in the non-infection group(P<0.05). Gestational age, neonatal weight and Apgar score at birth were significantly lower than those in the non-infected group(P<0.05). The levels of IL-6, IL-8, and TNF-α in the Uu+Mh group were significantly higher than those in the Uu group and non-infected group(P<0.05);the levels of IL-6, IL-8 and TNF-α in the Uu group were significantly higher than those in the non-infected group(P<0.05). CONCLUSION Premature rupture of membranes with mycoplasma infection in the genital tract may be related to the up-regulated expression of IL-6, IL-8, and TNF-α. The prenatal genital tract pathogen detection should be applied and targeted treatment should be given based on drug-resistance tests.